Case Study:
Elevating Member Experience and Extending Care with Generative AI Healthcare Agents
Medical Mutual
at a Glance
1934
3000 +
1,200,000 +
About Medical Mutual
At Medical Mutual, our commitment to exceptional customer service is at the heart of everything we do. Our top priority is helping members stay healthy, supported, and engaged throughout their care journey. We focus on meaningful and consistent engagement by connecting members with the resources they need such as onboarding calls, health check-ins, medication reminders, and care gap interventions.
To support this priority, Medical Mutual launched its own generative AI healthcare agent, Stephanie, in collaboration with Hippocratic AI. Stephanie expands member outreach with personalized, empathetic, and safety-focused conversations. Stephanie is not meant to replace human interaction, instead she enhances member engagement through proactive wellness conversations and extends the capacity of our clinical team without compromising care quality.
The Growing Challenge of Chronic Disease Management
Managing chronic illness remains one of the most persistent and costly public health challenges in the United States. Nearly 129 million people in the US live with at least one major chronic disease such as diabetes, obesity, or hypertension¹. With so many people living with one or more chronic conditions, the need for structured, supportive programs has never been more critical. Studies show that chronic disease management programs significantly improve outcomes and reduce utilization. For example, diabetes-focused initiatives yield notable gains in HEDIS performance, such as a 12.8% increase in HbA1c testing, 14.2% in eye screening, and 29.2% in kidney screenings.² These improvements correlate with preventative cost savings up to $5,532 per member annually.²’³
Additionally, utilization patterns shift favorably with reductions in inpatient admissions, emergency department visits, and hospital length of stay.⁴’⁵
Yet, despite the high prevalence of chronic disease, many individuals face systemic barriers often preventing them from remaining active in their care. Recent research links engagement to clinical improvement. A 2021 study in JMIR Diabetes found that individuals with higher digital participation saw up to a 43% improvement in glucose levels.⁶ This direct connection between outreach and outcomes highlights a key challenge: how to reach more members, more often, in meaningful ways that drive adherence to clinical guidelines and improve quality measures.
Medical Mutual recognized these gaps and launched its Chronic Condition Management Program focused on helping members with diabetes stay informed, supported, and connected by offering access to diabetes education, medication assistance, medical supplies, and ongoing check-ins. However, sustaining frequent, high-touch outreach across a growing and dynamic member population required a scalable and innovative solution.
Scaling Member Support to Transform Chronic Care Outcomes with AI
Proactive, member-centered engagement remains central to Medical Mutual’s approach. To reach more members without sacrificing personalized care, Stephanie connects at key moments, offering tailored support and guidance across a variety of touchpoints, including:
- Member onboarding calls
- Medication adherence follow-ups
- Health check-ins
- Care gap interventions
- Annual wellness visit scheduling
For example, during quarterly wellness check-in calls, Stephanie asks how the member has been feeling, whether they’ve experienced any new symptoms, and if medication routines have changed, then provides member education, and checks if they need support with access or adherence. Stephanie also checks in on members’
confidence in managing their health and satisfaction with Medical Mutual’s support. She connects members with Medical Mutual staff for any complex follow ups or escalations. In addition, the initiative includes outreach via SMS and marketing support to ensure the seamless introduction to Stephanie as an extended member of the care team.
By offloading these routine yet essential interactions, Stephanie allows clinical staff to concentrate on complex, high-impact care that supports both operational efficiency and stronger member relationships.
Driving Real World Outcomes
Extending Care, Increasing Capacity
With Stephanie leading routine care conversations, Medical Mutual expanded human care team capacity by over 360%, enabling more frequent member check-ins and maintaining consistent engagement across a broader population. This expanded reach enables teams to personally touch more lives without compromising the quality of care.
Strong Member Satisfaction and Trust
Members responded positively to AI-led outreach. The average satisfaction score for calls with Stephanie reached 9 out of 10, comparable to the same score for human-led calls. Importantly, 93% of members rated their experience 7 or higher, underscoring growing comfort in Hippocratic AI’s healthcare agent.
Smarter Triage and Improved Team Impact
Stephanie successfully resolved 93.3% of member calls without the need for human intervention, demonstrating exceptional efficiency and reliability. When escalations were necessary, they were targeted and appropriate: 6.7% of calls escalated to human teams, largely among members who expressed low health confidence. These individuals were significantly more likely to need medication support (26.9%) compared to high-confidence members (1.9%, p < 0.001), allowing Medical Mutual to direct high-touch resources to those most in need. By identifying the right moments to involve pharmacists, care coordinators, and clinicians, Stephanie ensures staff can work at the top of their license. This not only improves efficiency, but also contributes to higher employee satisfaction. Perhaps most importantly, members valued the experience. As one shared in a post-call survey after rating the interaction a 10/10.
These results demonstrate that members not only accepted AI-led outreach, but they also truly valued it. Hippocratic AI’s healthcare agents, built with empathy and clinical awareness, delivers a high-quality, scalable member experience, enabling Medical Mutual to offer a new model of connected proactive support that meets members where they are.
360%+
6.7%
enabling high-touch, targeted support for those who need it most.
93%
of members rated their experience 7 or higher
9/10
Average satisfaction for calls with Stephanie, comparable to the same score for human-led calls
Rethinking Care Engagement with Generative AI
By combining Medical Mutual’s member-first approach with Hippocratic AI’s Polaris safety constellation architecture, which is a multilayered safety framework that includes clinical validation, real-time monitoring, and intelligent escalation, the program delivers care that is both clinically sound and resonates with members. This ensures every interaction is safe, effective, and tailored to individual needs. Ultimately, it builds trust and improves health outcomes for those we serve. This program reflects a broader shift in healthcare. According to a Q1 2024 McKinsey survey, 89% of healthcare leaders say they are using or testing generative AI tools⁷.
The key to success lies in how these tools are designed and thoughtfully deployed. By combining proactive, conversational outreach with clinical intelligence, Medical Mutual and Hippocratic AI are improving the member experience and their health outcomes.
Moving Forward – Advancing Member Experience and Outcomes through AI
AI can do more than scale operations, it drives better member experiences, improves health outcomes, closes care gaps, and builds confidence for people managing complex health needs. Stephanie helps members stay enrolled in a program that makes them feel more supported, more capable, and more connected to their care.
What began as a targeted outreach initiative for chronic conditions has evolved into a foundational tool for scalable, high-touch member engagement. Medical Mutual is expanding the program to address more chronic conditions and new outreach opportunities. This includes helping members close six common care gaps and educating those on high-cost medications about lower-cost alternatives. Looking ahead, Stephanie will help onboard new members so they better understand their plan and available benefits, ensuring that even more members receive timely, empathetic, and proactive care wherever they are in their health journey.
1. Chronic Disease Prevalence in the US: Sociodemographic and Geographic Variations by Zip Code Tabulation Area. Accessed July 30, 2025. https://www.cdc.gov/pcd/issues/2024/23_0267.htm#:~:text
=throughout%20the%20US.-,Introduction,at%20least%205%20(5).
2. Sidorov J, Shull R, Tomcavage J, Girolami S, Lawton N, Harris R. Does diabetes disease management save money and improve outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria. Diabetes Care. 2002;25(4):684-689.
3. Rosenzweig JL, Taitel MS, Norman GK, Moore TJ, Turenne W, Tang P. Diabetes disease management in Medicare Advantage reduces hospitalizations and costs. Am J Manag Care. 2010;16(7):e157-e162.
4. Wagner EH, Grothaus LC, Sandhu N, et al. Chronic care clinics for diabetes in primary care: a system-wide randomized trial. Diabetes Care. 2001;24(4):695-700.
5. Berg GD, Wadhwa S. Diabetes disease management in a community-based setting. Manag Care. 2002;11(6):42, 45-50.
6. Fundoiano-Hershcovitz Y, Hirsch A, Dar S, Feniger E, Goldstein P. Role of digital engagement in diabetes care beyond measurement: Retrospective cohort study. JMIR Diabetes. 2021;6(1):e24030.
7. Lamb J. Generative AI in healthcare: Adoption trends and what’s next. July 30, 2024. Accessed July 16, 2025. https://www.mckinsey.com/industries/healthcare/our-insights/generative-ai-in-healthcare-adoption-trends-and-whats-next
Learn More at HippocraticAI.com