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AI-Powered Virtual Care Platform for Health Insurance Member Consultations & Care Navigation

Plavno developed an embedded virtual care platform for a US health insurance product, enabling secure member consultations, care navigation, and connected communication workflows directly inside the platform.

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Overview

Key Metrics & Impact

This case reflects Plavno’s role as a specialized module development partner inside a broader healthcare insurance ecosystem. The client’s core platform already existed, but it needed a native communication layer for virtual member consultations, care coordination, and navigation support. Plavno delivered a secure in-platform communication solution that enabled members, care coordinators, and healthcare professionals to connect directly inside the insurance product without relying on disconnected third-party meeting tools.

  • Better continuity across member consultations, support, and care navigation workflows

  • Reduced reliance on external communication platforms

  • Stronger member experience inside the health insurance product

  • Improved control over virtual care and support workflows

  • Higher product value through embedded communication capabilities

Solutions
Challenges
Use Cases
Key Metrics & Impact
01

Problem

Many health insurance and member services platforms support eligibility, benefits, care coordination, and case management, but still depend on external tools for virtual communication.

Common challenges included:


  • Fragmented member experience across separate platforms

  • Context switching between payer workflows and third-party video tools

  • Weaker control over consultation and support experiences

  • Difficulty embedding communication into core member workflows

  • Limited product ownership over virtual care functionality


The client needed a secure, payer-native virtual care layer that could support member consultations and care navigation without forcing users outside the platform.

Problem
02

Challenge

The platform needed to:



There were also important constraints:


  • The communication experience had to feel native to the insurance platform

  • The module needed to work inside an existing product ecosystem

  • Sessions had to align with care navigation and support processes, not generic meeting logic

  • The system had to improve member engagement while preserving workflow continuity

Challenge

Solution

Embedded Virtual Care Ecosystem – AI-Powered Platform for Payer-First Member Journeys

A fully native, role-based communication layer that unifies video consultations, care navigation, member support, and payer workflow integration within a single health insurance ecosystem—designed for extensibility and future AI-driven engagement capabilities.

Product Highlights

User Flows

Experience & Scalability

    • Suitable for US health insurance and payer platforms

    • Supports secure embedded communication without product fragmentation

    • Improves continuity across consultation, support, and care navigation workflows

    • Works across care coordinators, support teams, and member engagement scenarios

    • Scalable for broader virtual care and payer-side service expansion

Architecture Overview

Deep Dive: Project Architecture

  • Communication Layer:The platform handles embedded audio and video communication for healthcare insurance and member-support workflows.

  • Session Management Layer: Consultation and navigation sessions are managed inside payer workflows rather than through external meeting logic.

  • Workflow Integration Layer: Eligibility, support, case handling, and care coordination remain connected to the communication layer.

  • Role & Access Layer: The platform respects insurance-product roles including members, care coordinators, and provider-facing users.

  • Extension Layer: The communication architecture can support future AI-assisted member support, triage, and engagement features.

  • Product Integration Layer: The solution works inside the broader payer platform without replacing the core system.

Deep Dive: Project Architecture

Value

Quality & Fidelity

Delivering better member experience, cleaner care navigation flows, and stronger platform ownership

Better Member Continuity

Better Member Continuity

Members stay inside the same platform throughout the interaction journey.

Member experience
Embedded communication
Platform UX
MVP
MVP
Stronger Product Ownership

Stronger Product Ownership

The client controls the consultation experience instead of depending fully on third-party tools.

Product ownership
Virtual care platform
Payer product
MVP
MVP
Better Workflow Integration

Better Workflow Integration

Communication is connected to eligibility, support, and navigation workflows.

Workflow integration
Care navigation
Member support
MVP
MVP
More Scalable Virtual Care

More Scalable Virtual Care

The platform becomes more capable as a digital member engagement and care coordination solution.

Virtual care
Scalability
Product enhancement
MVP
MVP

Benchmarks

Scale & Reliability

Built for embedded payer workflows, repeated member interactions, and scalable virtual care support

Native Platform Fit

Native Platform Fit

The solution works inside the insurance platform instead of outside it.

Embedded communication
Platform fit
Product continuity
Stable Support Flows

Stable Support Flows

The communication layer supports repeatable member consultation and care navigation scenarios.

Consultation workflows
Session reliability
Payer ops
Reusable Communication Architecture

Reusable Communication Architecture

The platform can support additional engagement features over time.

Extensibility
Communication stack
Future-ready platform
Scalable Payer Capability

Scalable Payer Capability

The system supports broader virtual care expansion across the insurance product.

Health insurance scale
Member engagement
Product growth

Data Protection

Security & Compliance

Secure communication workflows for embedded member consultations inside a healthcare insurance platform

Controlled Communication Environment

Controlled Communication Environment

Sessions take place inside governed payer workflows.

Better Platform-Level Oversight

Better Platform-Level Oversight

The client has stronger visibility into communication flows than with disconnected tools.

Secure Member Experience

Secure Member Experience

The platform is designed for member-facing communication within a healthcare insurance context.

Innovative Experience

Industries & Use Cases

Virtual care platforms for health insurance products, member consultations, and care navigation

Health Insurance Platforms

Health Insurance Platforms

Add native consultation and care navigation functionality to an existing payer product.

Care Navigation Programs

Care Navigation Programs

Reduce fragmentation across support, consultation, and follow-up flows.

Member Support Platforms

Member Support Platforms

Support member communication inside a unified insurance workflow.

Virtual Member Engagement Initiatives

Virtual Member Engagement Initiatives

Strengthen payer-side product capabilities with embedded communication solutions.

Delivery Crew

Project Team

High-performing developers for growing companies

Eugene Katovich

Eugene Katovich

Sales Manager

Need an AI-powered virtual care platform for member consultations and care navigation?

Plavno builds embedded healthcare communication solutions that help payer platforms deliver native member support, consultations, and care navigation without relying on disconnected third-party tools.

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Competitive Ability

Key Performance Flow

Demonstrating how Plavno transforms fragmented payer communication into a native virtual care and care navigation experience

From member support workflow to virtual consultation and follow-up — everything happens through one embedded virtual care layer inside the insurance platform.

01

Enter Through the Member Workflow

The member reaches a consultation or navigation flow through existing platform logic.

02

Launch the In-Platform Session

The embedded virtual care platform starts the interaction without redirecting users to external tools.

03

Enable Secure Member Communication

The system supports live member-to-care-team communication inside a controlled environment.

04

Continue the Support Journey

After the session, the platform remains the central place for next steps, follow-up, and care coordination.

Delivery & Automation

Delivery & Automation

    • Session launch flows

    • Care navigation continuity

    • Member support integration

    • Reduced tool switching

Throughput & Scale

Throughput & Scale

    • Payer platform readiness

    • Reusable communication architecture

    • Product ecosystem fit

    • Scalable member support capability

Communication Quality Stack

Communication Quality Stack

    • Embedded virtual sessions

    • Native platform experience

    • Role-aware access

    • Member workflow continuity

Results

Measurable outcomes delivered by an AI-powered virtual care platform for payer environments

Better Member Experience

Better Member Experience

Members do not need to leave the platform for support or consultation sessions.

Stronger Workflow Continuity

Stronger Workflow Continuity

Eligibility, communication, and care navigation flows stay more connected.

Stronger Product Value

Stronger Product Value

The insurance platform becomes more complete as a digital member support environment.

Extensible Architecture for Future AI Capabilities

Extensible Architecture for Future AI Capabilities

The platform is built to support future AI-powered engagement features without additional redevelopment.

Lower Dependence on External Tools

Lower Dependence on External Tools

The client gains more control over virtual care capabilities.

Tools We Used

Technology stack

Communication Layer

Communication Layer

Real-time audio/video
Session control
Embedded communication
Platform Connectivity

Platform Connectivity

Payer platform integration
User roles
Internal workflows
Workflow Integration

Workflow Integration

Care navigation sync
Support flows
Role-aware access
Infrastructure

Infrastructure

Cloud deployment
Monitoring
Scalable communication architecture
Backend

Backend

Node.js
Python
API orchestration

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Frequently Asked Questions

Quick Answers

Find answers to your common concerns

Did Plavno build the full insurance platform?

No. Plavno delivered the embedded communication solution inside the client’s broader healthcare insurance ecosystem.

Is this just a third-party meeting integration?

No. The goal was to create a native in-platform virtual care experience.

Can it work with existing navigation workflows?

Yes. The platform is integrated into broader payer workflows.

Is it reusable for future communication scenarios?

Yes. The architecture supports further member-support and engagement extensions.

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