AI-driven Health Plan Customer Care Transformation with Hitachi Solutions and Microsoft

AdvisoryAICustomer & User ExperienceCustomer Relationship Management (CRM)Dynamics 365Power Platform

When outdated and disparate frontline tools started to prolong service calls and negatively affect call center productivity, this health plan decided to modernize their customer care operations with Microsoft Dynamics 365. To help with their digital transformation, the healthcare organization turned to Microsoft partner Hitachi Solutions. Together, we were able to design and implement a new AI-driven system that provided the centralization, simplification, and visibility they needed to enhance member/provider satisfaction, improve operational efficiency, and gain substantial labor and cost savings along the way.


In the world of healthcare, quick and efficient call resolution is critical. Members and patients often have urgent and sensitive healthcare-related inquiries that demand immediate attention. Getting timely resolutions contributes to their overall care and trust in their provider. Operationally, swift issue resolution minimizes the strain on resources, optimizing productivity and controlling costs.

So, when this large health plan provider’s call center began experiencing higher-than-average handle time (AHT), they knew they had to do something. They determined that their antiquated frontline tools, disjointed processes, and lack of system integration were the cause of the increased handling times.
Healthcare customer service representatives (CSRs) had to navigate several disparate systems to get member/provider information. This was difficult and time-consuming and led to the longer call times. As a result, customer satisfaction scores dropped and cost-per-contact costs and employee turnover increased.

Faced with these significant challenges, the company sought a simplified, modern solution that would unify their data, streamline their processes, and provide a holistic view of the customer. Embarking on this comprehensive digital journey, they turned to Hitachi Solutions to help strategize, implement, and manage.


After collaborating with the customer on their vision and goals, Hitachi Solutions was able to develop a phased, multiyear strategic roadmap that would guide them to a robust infrastructure that supported centralized data aggregation, automated workflow processes, and seamless systems integration.

We determined Microsoft Dynamics 365, Microsoft Copilot, Microsoft Power Platform, and Hitachi Solutions Engage for Health Plans were the right building blocks to create the new AI-driven member care solution. The primary goal was to reduce service time, personalize interactions, and create a smooth and efficient customer service experience for members/providers and CSRs alike.

Now the member has a coordinated and tailored engagement fueled by internal transparency and consolidated data, a unified view of all interactions, integration across all digital products, and valuable data-driven knowledge and insights. And the new system is easy for CSRs to learn and use.

Together, we were able to transform the customer from an outdated and disparate solution with a complex and less-than-optimal service model to a modern customer care solution with a streamlined and efficient service experience.


The new Microsoft Dynamics 365-powered solution has enabled a true omnichannel experience with a 360-degree view of members and providers, personalized journeys with automated outreach, and integrated benefits libraries and knowledge databases that simplify and speed engagements.

The project has yielded significant improvements for the company, with a notable reduction in customer satisfaction benchmarks, increased CSR productivity and efficiency, and substantial labor savings. Benefits include:

A strategic approach to how healthcare organizations service members can result in tangible benefits, improved member and employee experiences, and significant cost savings. It serves as an innovative example for organizations seeking to modernize their operations and enhance their member service operations in a rapidly evolving and competitive healthcare landscape.


As mentioned, we created a multi-year strategic roadmap for this project. With the successful completion of the first stage, the customer is now shifting focus to the next phases, which include predictive analytics, AI virtual assistants, and optimizing marketing campaigns to better target their members/providers.

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