Getting seniors enrolled into the right Medicare plan is typically an inefficient process that many older patients find confusing and frustrating, spending hours on the phone with human call center agents.
Startup Fair Square Medicare is using advancements with generative AI to build AI-based voice agents to screen seniors for insurance coverage and improve and streamline the customer experience. After testing the tools internally, the company is now offering this technology as an enterprise product for large insurance distributors and carriers.
Fair Square Medicare launched in 2020 as a tech-forward Medicare brokerage to help older adults find health insurance plans to best fit their healthcare needs. Founder and CEO Daniel Petkevich was motivated to launch the company when he saw firsthand how his own parents navigated the complex maze of available Medicare coverage and enrollment.
The company has evolved into a generative AI lab building what Petkevich calls the next generation of software solutions for Medicare companies.
We see a world where your insurance agent is AI and that is what we're building." —Daniel Petkevich
In the past four years, Fair Square Medicare has grown its services to tens of thousands of customers and operates in all 50 states, Petkevich said. The company has a net promoter score (NPS) of 95, while the average NPS for insurance brokers in the U.S. was 34 in 2021. Fair Square Medicare also says it retains more than 90% of its customers.
"But, the ultimate goal was not to build a brokerage. We're trying to figure out, how can we use technology to scale that incredible customer experience that exists at Fair Square Medicare to everyone, to every senior," Petkevich said in an interview. "It was a challenge at first because a lot of these sales are telephonic. On the phone call, you have a human and so what determines whether that human agent enrolls you in the right plan is kind of a function of the human and their incentives, and less of a function of any software that they're looking at."
He added, "We actually think all this is about to change with the advent of generative AI. We see a world where your insurance agent is AI and that is what we're building."
Petkevich points out that he sees AI voice agents as beneficial for call center agents, not local field agents.
Fair Square Medicare built out this technology internally using Vox, a generative AI platform built on GPT-4. Fair Square’s Vox platform provides software solutions engineered to build customer loyalty, streamline operations, boost sales and provide critical insights that inform plan designs, according to the company.
The company developed AI tools to both interact with customers and learn from each encounter to help screen seniors for coverage, provide insights and assist with coaching for human sales teams, Petkevich said.
Fair Square Medicare engineered a suite of generative AI voice agents that can handle nearly every part of the plan enrollment process. It started with Sophia, a voice-generating AI screening agent that qualifies potential customers looking for Medicare coverage before they speak to a sales agent.
The benefits of using Sophia is that calls are answered promptly and the AI voice agent can ask key questions, comprehend the answers and help determine coverage eligibility, according to the company. Sophia can help determine eligibility and gather the insights needed to ensure seniors ultimately access the benefit plan best suited for them, Petkevich said. And, human sales agents aren’t wasting time handling non-qualified leads.
"We have been using the AI screener internally at Fair Square; so we're half tech company, half brokerage, and the brokerage is basically an incubator for our technology products. We've been using the AI screener with great success here," he said.
The AI voice agent matched human team sales conversion rates during working hours, converting about 12% calls to enrollment in a Medicare plan. "That's the bar for the AI screener, can you do as well as the human screener," Petkevich said.
But, where Sophia really shines, he noted, is in after-hours calls. The AI voice agent has proven to deliver 4x conversions for calls that came in after hours—all at a fraction of the cost of using large call-center teams, he noted.
Customers on the call are informed that they are speaking with an AI voice agent, according to the company.
Sophia is just the first AI voice agent to launch, Petkevich noted, and the company is building multiple others in the coming months, including generative AI agents for enrollment script reading; conducting health risk assessments; and activating ancillary benefits for enrollees.
Every day in the U.S., 10,000 people turn 65, according to data from AARP. The number of older adults will more than double over the next several decades to top 88 million people and represent over 20 percent of the population by 2050.
A majority of seniors seeking Medicare coverage struggle with understanding their coverage options. In fact, a previous study found that nearly 70% of Medicare enrollees don’t review or compare their coverage options annually with the overwhelming amount of information. The issue is compounded for older beneficiaries and those in poor health.
That opens up enormous opportunities for Medicare plans and brokers to provide a better customer experience, according to Petkevich.
Fair Square Medicare is offering an AI-enabled tech platform today. But, he sees the potential for generative AI to reshape how seniors enroll in Medicare and a broader opportunity to completely overhaul the customer experience.
"You can imagine an AI member experience agent that is really exciting. You call to use your patient transportation benefit, and instead of waiting five minutes on hold to be transferred to someone, an AI agent with the right API endpoints can do it in three minutes," he said. "We think there's this interesting opportunity for whichever carrier who embraces this first to create a differentiated experience and to enroll significantly more members based on that reputation," Petkevich noted.
The company also developed two additional gen AI-based tools for Medicare companies. One is a generative AI transcription and auditing application that tracks every customer call, whether AI or human. Leveraging retrieval-augmented generation (RAG) and large language models (LLMs), the application comes with a searchable interface to query data and gather intelligence on any topic,
"That application can answer questions like, what kind of leads am I getting? Why are people calling member experience? What the top issues for frustrated callers? What benefits are people asking about? What are issue-resolution rates? What benefits drive the most sales? All these different questions that help you increase close rates, increase retention and design a more desirable plan for next year," Petkevich said.
The company also used generative AI to develop a coaching program that identifies issues that occur on customer calls and suggests education to human agents. "Using insight to coach the humans to perform better," Petkevich said.
The application can analyze metrics like conversion and objection rates and then give human teams real-time feedback on poor objection handling.
There is a perception that older seniors do not embrace technology and are cautious about the use of AI. But, Petkevich sees enormous opportunities for AI technology to revolutionize customer service for a demographic of consumers who typically prefer phone calls to other forms of communication.
"I think that voice AI will turn out to be 'the' senior interface," he said. "With our customers and the folks I know over 65, calling is the natural way of interacting with a business. There's all this data out there saying seniors are using phones more and tablets more, and that's true, they are using those platforms more. But there's a difference between using the platform and being fully comfortable with the platform. They're comfortable with the phone."
He added, "The problem with the phone is that it is really expensive to find good people to answer. And, that's our opportunity. Imagine every time you call your carrier with a question about healthcare, there's a really competent AI to answer 90% of the questions, and then maybe 10% are really complicated and you need to get a human on the phone. That allows anyone staffing a call center to provide a significantly better experience at reduced cost."
A 2020 Y-combinator (YC) graduate, Fair Square Medicare is backed by Define Ventures, Slow Ventures, Amplo and YC. The company has raised $20 million to date, including a $15 million series A round in 2022.