Finding the right doctor, understanding where to go for care, and making sense of benefits shouldn't be hard. Yet for most employees and health plan members, healthcare navigation is confusing, slow, and disconnected from their daily lives. Even with digital tools and support lines, many still end up in the wrong place — or nowhere at all.

‍

Generative AI is changing this. Not as a replacement for clinical insights, but as a guide to meet people where they are, offer timely support, and avoid low-quality care decisions. It is reshaping healthcare navigation by stepping in where outdated tools fall short, bringing clarity, speed, and smarter choices to moments that matter most.

‍

The Portal Problem: Why Traditional Tools Have Plateaued

Letters. Portals. Emails. App reminders. Most member portals operate using a "pull" system that expects people to know what they're looking for, when they need it, and where to find it — a significant burden in an already confusing system. These platforms are:

• Passive and reactive: Waiting behind login screens for members to initiate contact

• Single-channel and fragmented: Operating in silos without cross-platform memory or continuity

• Information-heavy, guidance-light: Providing data without actionable context or next steps

The evidence? Fewer than 10% of members use traditional portals or tools, even after significant investment on behalf of health plans and employers. This disconnect has measurable consequences that impact both healthcare outcomes and overall spend:

• Missed preventive care: Critical screenings fall through the cracks, leading to high-cost interventions later

• Poor provider choices: Decisions based on convenience, not quality metrics

• Unnecessary high-acuity care: Members end up in ERs for avoidable conditions that could be managed in lower-cost settings

• Wasted investment: Millions spent on underutilized point solutions that fail to drive behavior change

• Competitive disadvantage: Plans that fall behind risk losing members to those that lead

To lower costs and improve outcomes, the smartest investment isn’t in more point solutions, it’s in better ways to guide members to high-quality care.

Generative AI: The Missing Link in Healthcare Navigation

Outside healthcare, consumers are transitioning away from traditional search to intelligent agents like ChatGPT for quick, personalized, and conversational answers. And it’s working: AI-driven personalization has been shown to increase customer satisfaction by 10–20% and reduce service costs by up to 30%.

Generative AI is particularly powerful because of it’s potential to address the core limitation of "pull" systems: the assumption that members know what they need and when to seek it. Generative AI assistants don't wait for members to ask for help — they engage in real-time during the moments that matter most, across familiar channels with intelligent, personalized guidance.

This goes far beyond answering "Who's in my network?" Instead, it helps members navigate harder questions like:

• "Should I go to urgent care or use telehealth for these symptoms?"

• "Which mental health option in my plan fits my needs right now?"

• "Who's the best doctor for my specific condition?"

They’re not simple bots, they combine multiple data streams — benefits structure, provider quality scores, and individual preferences — to deliver personalized recommendations that feel tailored and trustworthy. This level of personalization is what drives the behavior change that health plans and employers need for sustainable improvements.  

The EVA Effect: Intelligent Navigation in Action

Generative AI tools like Embold’s Virtual Assistant (EVA) are  transforming how people navigate healthcare by offering personalized guidance at the exact moment decisions are being made.  

Unlike traditional tools, EVA offers real-time, omnichannel support across multiple touchpoints — text messages, email, benefits portals, and workplace tools like Microsoft Teams. EVA is neutral, evidence-based, and grounded in clinical quality. That's because the technology was developed with a physician-led foundation that prioritized outcomes over transactions.  

After integrating Embold's Virtual Assistant, one national employer saw immediate results, including:

• Higher engagement compared to traditional portals

• Lower costs when members choose high-performing providers

• Significant increases in preventive screenings and decrease in ER visits

• Boost in NPS as members feel more supported and confident in navigating care

Moving Beyond The Portal: A Bold Plan Forward

Generative AI is ushering in a new era in healthcare navigation — more intelligent, adaptive, and member-centered. While traditional digital engagement has plateaued and costs continue to rise, this shift from passive search to dynamic guidance represents one of the most important advances in member experience and cost containment. In fact, patients with higher engagement levels incur 8% lower healthcare costs in the first year and 21% lower costs in the subsequent six months.

These tools are finally delivering on the long-promised goal of personalization at scale, meeting members in the moment they need support and guiding smarter care decisions. Embold Health’s e-book, Beyond the Portal, showcases how transformation is reshaping member engagement and creating measurable impact. This level of personalization is what drives the behavior change that health plans and employers need to see sustainable improvements in both outcomes and costs.

‍

The technology is proven, the results are measurable, and the opportunity for health plans and employers is immediate.