Hygia for Payers
Understand the member beyond the claim.
Claims tell a health plan what happened. They rarely explain why. Hygia maintains an ongoing relationship with members and surfaces the understanding, intent and barriers behind the data.
Health plans already invest heavily in outreach, care management and member communication. Hygia is not another campaign. It is one persistent relationship through which many member objectives can be addressed.
The challenge
The member exists between the data points.
A missed screening appears in a record. An unfilled prescription appears in a claim. A referral remains incomplete. A member does not respond to outreach. Those events tell a plan that something did or did not happen. They do not tell the plan why.
The answer may be confusion, cost, transportation, fear, competing priorities, a misunderstanding of the care plan, a change in symptoms or something no existing system has captured.
Member engagement has traditionally required substantial human infrastructure — call centers, care-management teams, outreach personnel, service representatives and specialised programmes — and even then, most contact is episodic.
What Hygia does
Scale the relationship, not the call center.
Hygia provides a persistent communication layer across the member population. Routine engagement can occur through the digital relationship, follow-up can continue without a manual call every time, and members can receive support between formal outreach events.
Hygia does not eliminate human functions. It changes where human resources need to be deployed. When escalation is necessary, the plan receives relevant context so the human interaction begins further along.
The result is a model in which a plan can expand the breadth and frequency of member communication without increasing headcount in direct proportion to member volume.
Use cases
One relationship. Multiple use cases.
These are not disconnected programmes. They can occur through one persistent relationship.
- Care-gap closure
- Preventive care
- Medication adherence
- Chronic-care engagement
- Post-discharge follow-up
- Benefit and healthcare navigation
- Appointment and referral follow-through
- Member education
- Social and practical barrier identification
- Caregiver engagement
- Human escalation and care coordination
- Member experience
Medicare Advantage
A relationship model built for the realities of Medicare Advantage.
Medicare Advantage populations often sit at the intersection of many of healthcare's hardest challenges. Members may have multiple chronic conditions, medications, specialists and care plans. Family caregivers may play an important role. Benefits can be difficult to navigate. Preventive services and care gaps matter. Transitions between settings create additional complexity.
At the same time, plans are expected to engage members effectively while operating within real staffing and cost constraints.
Hygia provides a way to maintain continuity with members at scale while preserving the ability to involve people when human attention is needed. Instead of building another campaign for each individual objective, Hygia builds the relationship through which many of those objectives can be addressed.
The value
What changes.
Greater reach
Maintain an ongoing relationship with more members than a human-only outreach model can reasonably support.
Lower marginal cost of engagement
Increase the frequency and continuity of member communication without requiring staffing to grow at the same rate.
Better understanding
Learn not only what happened, but why a member did or did not act.
More efficient human intervention
Escalate the members and situations that require human attention, with relevant context already available.
Continuous visibility
Gain a window into what is happening between claims, appointments and other traditional data points.
Stronger member experience
Give members a familiar, consistent point of contact rather than a series of disconnected campaigns.
The same five steps
Connect → Engage → Understand → Act → Learn.
Every audience meets the same relationship cycle from a different side of it.
- 1Connect
Hygia connects the patient to the organizations and people supporting their healthcare journey.
- 2Engage
Gia maintains an ongoing, natural conversation rather than relying solely on episodic outreach.
- 3Understand
Over time, those interactions can reveal what the person understands, intends to do, is worried about and what may be preventing them from moving forward.
- 4Act
Hygia can help translate that understanding into the appropriate next step, whether that means helping the patient, supporting follow-through, creating a task or bringing the right person into the loop.
- 5Learn
Each interaction adds context to the relationship, allowing future engagement to become more relevant and informed.
Across the entire cycle
Memory and persistent context — the relationship does not restart at each interaction.
Health plans do not need another tool that sends more messages.
They need a way to maintain a meaningful relationship with members at scale — one that surfaces what traditional data cannot reveal and escalates the situations where human attention matters.