Payer Call Centers are Pricey. Digital Technology Delivers Premium Engagement for Less.

Whoever said talk is cheap wasn’t thinking about healthcare. In reality, it’s expensive. Depending on the number of lives covered by a plan, costs can run well into the millions. No matter how you try to optimize call center operations, the fact remains they’re not only pricey to operate, but often they’re not the most efficient response to member and provider concerns.

Fact is, today’s consumers are used to digital access to actionable data. So it shouldn’t come as a surprise that they now expect their healthcare information to be just as digitally available and dynamic. Moreover, providers are navigating an increasingly complex healthcare environment that requires more information and adherence to stricter guidelines. And they, too, expect and need readily accessible data.

Leveraging Digital Technology

The good news is that digital technology can deliver a win for you, your members, and your providers. The very same tech driving today’s thirst for information can be leveraged—if appropriately done—to automate meaningful information exchanges that significantly slash costs. In fact, a digital strategy and solution can cut call center costs by more than 50% while increasing the satisfaction of plan stakeholders. How? By answering simple inquiries via virtual health assistants and allowing your representatives to be more proactive and focused on the more complicated and unique member and provider concerns. Automating even the simplest inquiries can make a significant difference. With little set-up, virtual health assistants can easily be trained to handle information like:

  • Active coverage
  • Benefits for a specific service, like physical therapy
  • Accessing ID cards and requesting copies
  • Claim status
  • Identifying an in-network covered provider or facility
  • Accessing the cost of a service
  • Authorization status

An AI-driven Omnichannel Engagement Platform

Central to this solution is a comprehensive digital presence that extends beyond member and provider portals to become a sophisticated and seamless engagement platform—an omnichannel communication command center that delivers virtual health assistants built on conversational artificial intelligence, natural language processing, and machine learning—to interact with members and providers via their preferred channels. Whether it be inbound or outbound communication, virtual health assistants are capable of delivering messages, answering routine inquiries and providing information at a fraction of the cost of call center representatives. And unlike a limited function chatbot, as the system learns appropriate responses through AI and ML, more complex information can be automated through virtual health assistants.

A 21st Century Solution

Your members and providers are already used to interacting with virtual assistants. They are doing it in their cars, homes, and at work through smart speakers, smart watches, their phones, and apps. It’s the nature of the way all, or most of us, interact with the world around us. These applications run specific automated tasks when prompted, often with a friendly interface with human characteristics, like the automated calls you receive from your pharmacy or the chat engines that answer basic questions about your online purchases. These are all more commonly being powered by AI assistants, instead of relying on live agents to answer every question.

Pleasing constituents is another win-win and prevents users from gravitating too quickly to the phone for answers from live operators. The key in healthcare, however, goes beyond just focusing on facilitating user satisfaction and meeting their needs with meaningful dialogue and solutions, it also means ensuring compliance with multiple requirements that include HIPAA regulations, and delivering a SOC II audited and HITRUST secure solutions.

Healthx is leading the way in implementing AI for healthcare payer engagement. Our Healthx OXPsm is the first AI-powered omnichannel platform for payers. Using virtual health assistants, OXP orchestrates consumer, payer, and provider interactions and information access seamlessly across all communication channels.


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