Call centers + AI technology: A game changer

Game-changing technology is coming to state agency contact centers. You may already have it in your home or built into your phone.

Virtual assistants like Alexa and Siri have changed the way we get things done. From ordering groceries to adjusting the thermostat to answering common questions, we can accomplish a growing number of tasks with a simple voice command.

Now imagine technology designed with health care in mind. We’ve built it with person-specific knowledge and to answer program-specific questions or direct to the person best equipped to do so.

Optum uses intelligent virtual assistant (IVA) technology. It has the power to provide better service to members and providers, boost agency efficiency and improve call center employee retention.

The power of IVA

Contact center evolution has been a slow process. Initially, phone trees helped guide callers to the correct department. Interactive voice response (IVR) made the process slightly more user-friendly.

But neither technology has the power to directly answer free-form questions. And consistently getting the caller to the right person can be hit or miss. Optum uses AI-driven IVA technology that is a contact center game changer. It understands and can respond to free-form questions. It can even detect when a caller is upset and adapt. It also knows which call center employee is best equipped to take over when more help is needed.

It can even help that employee get to the real business of helping people faster. Optum IVA can establish the caller's identity, confirming it using two-factor authentication, then connect to relevant data about the caller. The moment the call center employee gets on the line, they know who's calling. They can pull up details on active benefits, information needed for finding providers and more. It’s information critical to guiding the help they provide.

And it’s continuously improving. Optum closely monitors how the IVA performs, looking for opportunities to make it even more efficient and effective.

Employee retention

State agency contact center work can be as common as helping with a replacement Medicaid card. Or it can be as urgent as getting a prescription approved before the pharmacy closes.

Contact center workers passionate about helping others and effectively solving problems are extremely valuable. That’s a critical component of delivering care. Keeping them can be a challenge.

In a McKinsey & Company survey, 26% of those working in health care insurance call centers said they were dissatisfied.* The only industry faring worse was telecom and technology at 30%. Pay, job security and promotion opportunities topped the list of issues driving dissatisfaction.

Yet the nature and mission of the work and stress also ranked high. Knocking down barriers to achieving the mission is critical to improving job satisfaction and reducing stress.

IVA reduces misdirected calls and proactively tackles some of the more mundane tasks. That puts the contact center employee in a position to do what provides the most job satisfaction — helping callers.

Member benefits

Optum designs its contact center solutions to improve service to members. This includes specific components that will help agencies overcome health care inequities.

• Tools can proactively reach out to Medicaid members who do not have internet access and provide Medicaid or health care messaging and facilitate better health care outcomes.
• Currently, Medicaid programs mainly rely on inbound communication from members. SMS and outbound dialing with attached conversational IVAs provide opportunities to call or text populations who may otherwise not self-advocate and become underserved.
• Intelligent AI tools allow for 24/7 answers to frequently asked questions, statuses and scheduling of appointments when members do not have internet in the home.

Provider benefits

Optum contact center solutions focus on improving the customer experience to promote efficient and effective interactions.

• AI supports IVA interactions, as well as contact center agents, by providing information in the form of data and insights about the contact. For example, when a provider calls, the AI can automatically check the status of provider enrollment, submitted claims, submitted PA and more. This helps predict contact reason(s) and proactively provide resolution information.
• Our continuous learning model and contact analysis ensure further improvements to the customer experience and enhanced interactions.

State agency benefits

The Optum contact center platform, including the IVA, is cloud-driven. That means it’s very accessible, scalable and has high uptimes. And unlike most, if not all, other cloud platforms available, the Optum platform is MARS-E compliant. This provides an advanced level of security recommended by the Centers for Medicare and Medicaid Services.

We design them to work as a suite of tools or as individual, stand-alone solutions. Among the benefits for agencies:

• Reduce costs through improved contact center efficiency
• Fewer misdirected calls and increased ability to resolve issues efficiently
• Reduce employee turnover
• Ability to scale up operations to meet unexpected demand
• Consolidate multiple contact centers into a single solution
• Conversational IVAs can create one phone number for members and providers instead of multiple numbers
• Higher customer satisfaction scores from both members and providers who are not getting stuck or misdirected by traditional IVRs

Better contact center operations lead to better outcomes for members, providers, state agencies and taxpayers. Members get the answers and interventions they need to live healthier lives. Providers are empowered to make better decisions on behalf of their patients.

State agencies can put employees in a position to do what they do best — help people. And taxpayers benefit from a more efficient delivery of critical services.

Let’s continue the conversation about your state’s unique situation and how Optum can be a resource for you. Contact us by visiting optum.com/stategov.