Payors face more regulation and weaker profit margins than ever before, which has led to consolidation and industry exit. Nonetheless, as the population continues to age, healthcare needs will likely continue to grow – leading to higher benefit expenses. In 2016, benefit expenses accounted for 75% of health insurers’ costs; now more than ever, payors need to find creative ways to cut costs in other areas of the business.
For payors, voice automation can actually offer a great cost-cutting mechanism and improve the patient experience. Older populations, often characterized as “wanting to speak with live people,” have actually embraced voice self-service – assuming it works effectively. Further, an advanced system can perform backend processes that sometimes require waiting on hold or navigating menu-based IVRs for other companies. Automating these processes gives payors a chance to reallocate resources, like agents, into higher priority patient situations.
Some industry-specific call types are:
“Insurance processes requiring pre-authorizations and wait times for approvals prior to medical treatment.”
Payors often require pre-authorization for treatment of certain ailments or conditions. Typically providers call in requesting pre-authorization of specific conditions, treatments, or prescriptions. Processing these requests requires a unique ability to understand the conditions and respond accordingly. Automation streamlines this process by integrating with case management systems, assigning case numbers, and allowing payors to access them efficiently. Furthermore, patients can quickly and easily call in to confirm pre-authorization status, utilizing the case numbers previously assigned.
Checking on a claim can be a painstaking process. It requires the patient to be authenticated and his/her account to be scanned for details. It is a low value, high volume operation for the call center, that is extremely important to the patient. Advanced automation can provide a summary of the patient’s claim, having reviewed the patient file, and offer more specific details when prompted. This takes the call off the headset of the agent while emulating exactly what the agent would do to provide an excellent experience for a patient who is awaiting a claim.
The Affordable Care Act (ACA) has largely changed the face of healthcare in the US. More people than ever are enrolled in healthcare coverage plans, which has increased demand for primary care providers (PCP) substantially. Not to mention insurance processes have become increasingly burdensome and required for more patients, and therefore hold times have grown across the board. With heavy regulations and strict HIPAA requirements, it is important that patient information is handled extremely carefully.
Automation can serve as a consistent and cost-effective option for PCPs and hospitals alike. Advanced self-service solutions can personalize patient care, recognize and assist with complex requests, and perform the tedious outbound dialing that many providers still use receptionists or agents for.
Appointment Setting & Rescheduling
“Providers are unable to maximize patient load due to missed appointments by patients.”
Voice self-service can get callers through the entire appointment-setting process, with the final result being a confirmed appointment. From the initial inbound scheduling call, to outbound confirmation calls prior to the date of the appointment, automation is valuable because of its availability (24/7/365), unlike normal business hours. Additionally, automating these processes frees up human resources from performing them while simultaneously reducing no-shows and patient effort.
“Providing lab results to patients while maintaining HIPAA compliance and saving money.”
Advanced self-service solutions should integrate with databases and access results in real-time so that when patients call (or receive an outbound call from a provider or lab), the results of recent lab work are readily available. This service frees up live agents to respond to more crucial and complex inquiries, which saves money, but is only worthwhile if it is certified as HIPAA compliant. For patients who have additional questions, the automated service has a direct line to a human agent.