AI-Powered Contract Analysis and Utilization Management for Member 360

A not‑for‑profit, community‑based healthcare provider, serving Medi‑Cal, Medicare, and other public health coverage programs with a focus on accessible care, population health outcomes, and community well‑being.

Client Objectives

Establish a unified experience layer providing a complete 360° view of members and providers to fast-track issue resolution
Automate contract management process, which currently lacks a centralized intake and review mechanism.

Solution Implemented

Built an AI-Next–powered Member 360 Dashboard, providing a unified 360° view of member eligibility, providers, claims, UM documents, and activity history
Developed an AI-driven Contract Template Analysis solution that accelerates regulatory impact assessment, enhances compliance, and improves contract review accuracy
Deployed a client-hosted AI-Next platform powered by GPT-5.1, enabling secure and scalable enterprise AI capabilities

Business Outcomes & Impact

< 0 months

Time to Value

Delivered strong time-to-value for two high-impact AI use cases: Member 360 and Contract Analysis

~0%

Faster clinical decision-making

Reduces authorization turnaround with a unified member view

~0%

Faster Compliance (GPT 5.1)

Speeds up regulatory impact assessment and automates clause-level contract analysis for contract template reviews

~0%

Data access, improving care quality

Enables accurate, guideline-driven decisions with complete member data visibility

Unified experiences for Utilization Management

Unified 360°member view, providing access to eligibility, providers, claims, UM documents, and activity history in a single interface.