Improve Member Outcomes with an Intelligent Healthcare Call Center

An under-recognized, but crucial part of American healthcare is the payor call center experience. Call centers handle critical tasks for payors, members and providers: appointment scheduling and reminders, enrollment, authorizations, financial assistance and premium collection. Despite their importance, these call centers are frequently sources of frustration for all involved.

To better serve members, close the technology gap and reduce agent attrition, payors need to deploy an innovative Intelligent Call Center that blends automation and human collaboration.

What Is an Intelligent Call Center?

An Intelligent Call Center is a digital member community built on the Salesforce platform that uses the power of IBM Watson, a 360 degree view of the member and dynamic knowledge bases to enable agents and members to complete their transactions faster and with greater accuracy. 

An Intelligent Call Center doesn’t replace agents. On the contrary, an Intelligent Call Center frees up your agents to focus on larger priorities and driving higher engagement levels. It proactively analyzes data and can give a notification when members are overdue on filling a prescription or visiting their primary care provider. These alerts can trigger follow up steps by agents that ultimately improve patient outcomes and lower the overall cost of care.

An Intelligent Call Center does enable you to provide users with human-like interactions with chatbots. When implemented correctly, the combination of IBM Watson and Salesforce Analytics allows an Intelligent Call Center’s chatbot to:

  1. Provide only accurate and hyper-relevant information
  2. Accurately interpret a member’s intent and maintain the context of any dialog
  3. Ensure interactions are indistinguishable from those with live agents

This thoughtful use of artificial intelligence (AI) and automation of manual processes improves the efficiency and accuracy of member engagements, leading to call deflection and cost savings.

Intelligent Call Centers for Members (Patients)

A human-centered approach is critical to holistically supporting your members. An Intelligent Call Center uses personalization to ensure that members are treated as individuals, not group numbers. Tactics such as effective, personalized onboarding let each member select the aspects of their care that are most important to them and puts the resources they seek right at their fingertips. In turn, payors can reference these preferences and use the inputs to inform future agent or chatbot discussions. 

Chatbots can easily address (and unearth) frequently asked questions, show provider locations and copay information, and summarize plans. These chats will also suggest next best actions, such as filling prescriptions or scheduling follow-up appointments. With Watson as the virtual assistant, your system will accurately interpret requests, resulting in members feeling as if they are talking to, and being supported by, a real person.

Intelligent Call Centers for Providers

It’s no secret that payors’ and providers’ systems do not easily talk to one another. This disconnect leads healthcare providers to rely on fax machines and other outdated technologies for authorizations and related tasks. An Intelligent Call Center helps connect payors and providers by working on top of existing softwares and systems, enabling modern data sharing and collaboration.

When you embrace this solution to enhance your provider experience, you decrease cost to serve and improve the overall experience for these users with fast call responses. Verifications and certification processes are completed using community and AI-powered features. Automation and personalization enable providers to quickly and efficiently access relevant resources for specific patients, streamlining user journeys and saving time and money.

It’s no secret that payors’ and providers’ systems do not easily talk to one another. This disconnect leads healthcare providers to rely on fax machines and other outdated technologies for authorizations and related tasks. An Intelligent Call Center helps connect payors and providers by working on top of existing softwares and systems, enabling modern data sharing and collaboration.

When you embrace an Intelligent Call Center to enhance your provider experience, you decrease cost to serve and improve the overall experience for these users with fast call responses. Verifications and certification processes are completed using community and AI-powered features. Automation and personalization enable providers to quickly and efficiently access relevant resources for specific patients, streamlining user journeys and saving time and money.

Intelligent Call Centers for Agents & Coordinators

An Intelligent Call Center is much more than chatbots and FAQs. Your agents get access to knowledge bases and workflow automations that support their live interactions with members and providers. An Intelligent Call Center also provides advanced metrics, such as capturing agent performance (analytics and recordings), tracking bottlenecks, and summarizing overall performance.

When issues are escalated, an Intelligent Call Center helps streamline those user journeys as well. The handoff from the chatbot to an agent is seamless. The entire automated conversation is visible to the agent, as are relevant resources and recommended next steps. This keeps members engaged in a positive way that prioritizes accuracy, efficiency and compliance with healthcare regulations.

Summary of Business Value from Intelligent Call Centers

An Intelligent Call Center from Salesforce and IBM, implemented by 7Summits, enables human and human-like interactions with stakeholders. Blending automation with collaboration in a thoughtfully designed digital experience increases customer satisfaction and new customer acquisition. Cost savings go up thanks to call deflection, which simultaneously satisfies agents and increases retention. 

An Intelligent Call Center provides more relevant responses, more meaningful insights and more accurate metrics to serve and support patient care across the care continuum. 

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