Turning the call center into a driver of value-based care 

Delivering a superior customer experience is essential for healthcare organizations in today’s hypercompetitive environment. Patients and members want frictionless and personalized experiences – and if they don’t get it from your organization, they will look elsewhere.

Providers and payers are responding by embracing artificial intelligence (AI) and automation as contact center tools to both improve the patient or health plan member experience and streamline processes to increase efficiency and reduce costs. This is in keeping with broader trends in the healthcare industry to offer more digital options and automation to make tasks like scheduling appointments and finding care faster while containing organizational costs.

But AI and automation can do far more for healthcare organizations than make existing processes more efficient: These technologies enable providers and payers to identify and leverage opportunities to increase revenue, thus evolving customer support operations beyond the traditional “ask/answer” cost center to a value center.  

Contact centers are critical to patient acquisition and retention. While AI and automation can make historically understaffed contact centers far more efficient, a human touch will always be required for some customer interactions. Additionally, most healthcare organizations are already struggling with hiring, training, and retaining service center staff, and look to AI to help alleviate burnout and strained capacity.

For this reason, successful healthcare organizations will use these technologies not to replace contact center agents, but to liberate their time from tedious, repetitive tasks. This will allow agents to engage in higher-value interactions with patients and plan members that generate greater revenue over the long-term. Patients won’t need to wait on hold to speak with an agent about a complex issue, because staff will no longer have to spend time handling simple transactions like canceling appointments or logging patient payments.

Improving outcomes by increasing outreach

As more providers and payers operate under value-based care (VBC) contracts that incentivize proactive care, better clinical outcomes, and more efficient resource allocation, it is strategically important for them to take full advantage of AI and automation. 

These technologies enable healthcare organizations to proactively ensure patients and plan members are taking the basic but necessary actions to optimize their health, such as getting flu and Covid shots, having regular lab work done, and undergoing other tests and procedures. For high-risk patients (such as those with chronic illnesses), proactive care can prevent worsening clinical conditions that are potentially life-threatening and costly to treat and manage. 

Since VBC contracts create strong financial incentives, many providers are exploring automated outreach. Reaching and engaging patients with outbound communication methods, however, is only part of the customer support equation – providers and payers also must consider inbound communication.  

In a traditional “cost center” model for healthcare contact centers, the goal is to handle inbound calls or chats as quickly and efficiently as possible. This is a reasonable and understandable goal that aligns with what many patients want and need. 

Now let’s imagine a high-risk patient with a gap in care (such as a cholesterol test) is calling to refill a prescription or catch up on a copay. The best result for the patient and the organization in that scenario would be to go beyond the individual’s immediate need. A contact center truly driving value would use that “golden moment” to also encourage the patient to schedule their test, rather than just handle the refill or payment as fast as possible.   

Taking advantage of every patient and member interaction to drive the best possible actions requires rethinking contact center workflows, technologies, and metrics. An agent helping schedule the cholesterol test in the example above will spend more time on the task than an agent or bot that ignores the gap in care and simply handles the caller’s stated need. So, measuring the agents’ effectiveness based only on how fast they handle the call or chat won’t capture the value they add.

Remember, chronically short-staffed healthcare contact centers already struggle to keep up with call volume. This is incredibly frustrating for agents (who, after all, want to help their clients) as well as patients or plan members seeking assistance, many of whom are trying to cope with serious health issues. Reorienting metrics to encourage and track value-adding agent activities can create better outcomes for patients, the organization, and these agents. 

The value of a human touch 

There’s no question that most modern consumers strongly prefer self-service options for simple tasks such as canceling appointments or refilling prescriptions. And while most people today are comfortable interacting with chatbots and virtual agents, there will always be times a patient or plan member will want or need to talk with another human being.  

Suppose a person new to a neighborhood is seeking a primary care provider (PCP) or specialist. If that individual calls a provider and is put on hold for several minutes because agents are busy re-scheduling appointments or refilling prescriptions for other callers, the caller on hold may give up in frustration and contact another nearby provider. As a result, the provider loses potential long-term revenue. 

Providing effective and easy automation for more transactional use cases enables agents to focus on higher-value activities, rather than spending their time confirming appointments or providing directions to a clinic location – activities that AI and automation are more than capable of handling. 

Collaboration and training

But how can healthcare organizations train and upskill contact center agents to provide next-level help to patients and plan members? Fortunately, AI can collaborate with agents to deliver a superior experience for callers. 

By providing agents with the right information when they need it and offering them next-best actions in real-time, AI allows healthcare organizations to meet the performance metrics that generate more revenue under value-based contracts, elevating the contact center from a cost-reduction operation to a driver of value.  

Generative AI trained for healthcare contact center use cases can pull together patient information from disparate sources (such as texts, call logs, claims systems, and electronic health records) and present the data to agents in an easily consumable fashion. Gen AI tools can analyze patient/member language and tone and then advise agents on how to respond. This is especially helpful for new agents who lack experience dealing with patients or members who have complex needs or are very frustrated. Finally, AI can review call transcripts to assess agent performance and provide actionable feedback for improvement.   

Conclusion 

Healthcare organizations deploying AI and automation merely to increase efficiency and cut costs leave value on the table. Providers and payers can enjoy the full benefits of AI and automation by using these technologies to upskill and assist contact center agents as they interact with patients or members. Enabling agents to assist patients or members in ways that ensure a superior customer experience allows providers and payers to increase revenue while improving outcomes and reducing costs.