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Front-office accelerators

Bridging journey gaps through the digital front-door

In terms of optimized healthcare experience delivery, the digital front door has been less an entry point and more an essential touchpoint of the complete healthcare member journey that connects experience and care. While health insurance has been flagged for low customer satisfaction in the past, that’s all changing with new digital levers that bridge journey gaps.

These transformation levers are leaning on customized healthcare domain and journey-specific contextual information to drive significant boosts in member / provider engagement, satisfaction, and brand loyalty. The key focus is to empower members / providers to self-serve based on their channel or medium of choice for a faster response.

One core disrupter has been the digital front office leveraging a knowledge base of unified truth across member, provider, and claims data. When framing and enveloping a seamless experience across every step of the customer journey, three accelerators are increasingly critical: voice contact flow, web context channel, and the ultra agent.

1. Voice contact flow:

Evolving tools can address different fluency levels by leaning on a robust knowledge base boost. When supported by intelligent AI-powered IVR, automated speech recognition (ASR) and natural language processing (NLP) can more efficiently address member and provider queries. This HIPAA-compliant integration leverages business and algorithmic edits for suggestion of next-best actions for decision making. With automation built on top of business rules and contextual inferences from interactions, IVR integration is optimized with experience, cognitive learning, and an evolving knowledge base.

One case example would be prior authorization approvals in real time — for example, a digital nurse providing required approvals via voice for the procedure type in question. The auto-approval process is reinforced via feedback from an approval propensity model which draws from the unified truth. Based on the voice-driven contact flow, if the auto-approval process is incomplete or needs more evidence, it will be routed to an ultra agent for closure.

2. Web context channel:

A web-based contact channel works much like a digital voice assistant except that the conversational AI here is comprised of via textual inputs delivered via a web / mobile / progressive application portal. A member or provider will interact with input forms or an NLP-based contextual chat to complete a questionnaire. As a mix of a deterministic and probabilistic model, interactions are sourced from the unified truth, or knowledge base, that has been continually learning and growing over time.

In addition to prior authorization, digital agents via voice and text can also address queries across member eligibility, explanation of benefits and claim status. There is also high applicability in the DME space, where supply chain-related queries pertaining to order status, inquiry, payments, and dispatch can be entirely digital-agent driven.

3. Ultra agent:

With introduction of these solutions and the foundation of a machine learning (ML)-powered knowledge base — involvement of the agent will be more exception based. When an ultra agent is introduced for escalation, tech-agent ingenuity better addresses any complexities. The ultra agent is super powered and armed with more accurate and timely information with a unified desktop for next-best actions supported by comprehensive case history, interaction disposition, AI-powered suggestions, and the unified knowledge truth. All of this comes in the form of digital tools that help with timely assimilation of the required information and optimized interaction with member experience focus.

Working in tandem across interaction channels, these three accelerators are delivering:

  • Contact volume reductions of 15-20%
  • Call handle time reductions of 15-20%
  • Reduced provider and member abrasion
  • Enhanced provider and member satisfaction with NPS®, CSAT, and Star ratings boosts
  • Aggregate cost savings of up to 30-35%, including administrative costs

A well-traveled journey starts with a good map and guideposts. Ultimately, these digital-first front-office accelerators help meet member / provider demand for a concierge, frictionless, and fast experience. For healthcare organizations, a digital-first strategy leverages these accelerators to drive to positive impact across care experience, costs, and outcomes.

Reetha Menon
By Reetha Menon,
Practice Lead – Digital Transformation,
HGS Healthcare

Reetha heads HGS Healthcare’s intelligent automation and new-age digital solutions practice. Reetha is responsible for digital transformation centres of excellence (CoEs) for healthcare clients with a focus on end customer experience (CX) and cost optimization delivery strategy.

Abhishek Danturti Sharma
By Abhishek Danturti Sharma,
Lead Innovation – Digital,
HGS Healthcare

Abhishek leads HGS Healthcare’s cognitive and AI initiatives in a consulting and solution delivery capacity. Abhishek is responsible for and executes the digital product and innovation agenda across the healthcare organization. Abhishek is an alumnus of the University of Maryland, College Park and BITS-Pilani, India.

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