Healthcare

Agentic AI in healthcare refers to autonomous, goal-directed AI agents that execute complex workflows, such as prior authorizations, claims adjudication, and care coordination, with minimal human intervention. Brillio applies this model through modular agent libraries and an AI-first software development lifecycle (SDLC), with more than 100 use cases already live across payers, PBMs, and pharmacies. The ADAM platform underpins this approach by combining GenAI copilots, prebuilt agents, and full-lifecycle governance to fast-track healthcare enterprises into production-grade AI deployment at scale.

For healthcare payers, PBMs, and pharmacies, agentic AI delivers measurable gains across operational speed, member experience, and financial integrity, eliminating the manual bottlenecks that slow claims, utilization management, and provider network operations. Brillio’s prebuilt agents and industry playbooks enable 3x faster delivery compared to conventional AI build approaches, allowing organizations to realize value without lengthy custom development cycles. Cross-functional squads with deep expertise in payer, PBM, and pharmacy ecosystems, covering claims, STARs, and Rx workflows, ensure that deployed agents align precisely with domain-specific requirements from day one.

Brillio’s Claims, Payments, and Integrity accelerators deploy agentic workflows that handle fast, accurate claims adjudication, risk adjustment, and fraud detection, reducing errors and protecting financial integrity across the revenue cycle. These agents operate within a PHI-safe architecture and are governed through ADAM, ensuring auditability and compliance at every step of the adjudication process. By embedding AI directly into existing enterprise platforms like Snowflake and Databricks, Brillio minimizes integration friction while maximizing the accuracy and throughput of payment integrity operations.

Healthcare organizations working with Brillio have achieved a 96% reduction in turnaround time for consent management, an 86% reduction in member navigation time, and an 80% member call containment rate, demonstrating the real operational impact of production-grade agentic AI. Additional outcomes include a 30% reduction in unnecessary ER visits and a 72% increase in customer engagement through AI, reflecting improvements across both clinical and digital experience dimensions. These results span payer, PBM, and pharmacy contexts, making them a credible benchmark for enterprises evaluating the business case for AI transformation.

Brillio’s healthcare AI accelerators span six core operational domains: Digital Front Door transformation, Benefit and Plan Operations, Clinical and Care Enablement, Claims and Payment Integrity, Member and Provider Support Operations, and Provider Network Management. Within these domains, specific use cases include member onboarding, formulary management, prior authorization, care coordination, utilization management, medication therapy management (MTM), grievance handling, and provider contracting automation. With more than 100 use cases already live, Brillio offers one of the broadest and most validated libraries of agentic AI applications available to healthcare enterprises today.

ADAM, Brillio’s Agentic Data and Application Management platform, provides the foundational infrastructure for deploying AI in healthcare environments where data privacy and regulatory compliance are non-negotiable. It incorporates PHI-safe architecture, complete auditability, and full-lifecycle agent governance, ensuring that every agent deployed across payer or pharmacy workflows operates within defined compliance boundaries. This trust-centered design allows healthcare organizations to scale agentic AI confidently, knowing that observability and accountability are built into the platform rather than retrofitted after deployment.

Brillio embeds AI across a broad stack of enterprise platforms widely used in healthcare, including Salesforce, Snowflake, Epic, Adobe, ServiceNow, and Databricks, enabling seamless reuse of existing infrastructure rather than requiring wholesale replacement. This platform-agnostic integration approach means that payers, PBMs, and pharmacies can activate agentic capabilities within the systems their teams already operate, accelerating adoption and reducing change management burden. The depth of these integrations reflects Brillio’s position as a multi-platform partner with AI embedded across both clinical and operational technology layers.

Brillio delivers 3x faster time to value through a combination of prebuilt agents, reusable ADAM platform assets, and industry-specific playbooks that eliminate the exploratory groundwork most enterprises face when building AI capabilities from scratch. AI-native squads trained in GenAI, prompt engineering, agent design, and healthcare workflows are embedded directly into delivery, ensuring that technical execution is paired with deep domain context across claims, utilization management, and member operations. This accelerator-led model means healthcare organizations can move from evaluation to production-grade deployment significantly faster than through conventional consulting or custom development engagements.