The CX Rx: How Healthcare Contact Centers Serve More Patients With Replicant

By Replicant
July 19, 2023

Healthcare is the most important service a customer will use in their lifetime. For providers, that means it’s crucial their customer experience is streamlined to assist callers during their biggest time of need.

But that’s become much easier said than done. On top of the challenges facing every CX team, healthcare contact centers have their own unique set of obstacles:

Cyclical busy seasons. From January to March, new patient onboarding and appointment requests swell following open enrollment periods, while the later months experience increased demand around flu season.
Unpredictable call spikes. On top of foreseeable busy seasons, healthcare contact centers can be faced with a barrage of calls at a moment’s notice during events like public health emergencies or supply chain shortages.
Clinical imperatives. Many healthcare calls are costly, requiring clinically trained experts to handle them. But high demand can force experts to field non-clinical calls and cause answer rates for clinical calls decrease.
Non-traditional business hours. Healthcare contact centers often operate on non-traditional schedules, like 5×12, causing after-hours and weekend calls to go unanswered.
Strict SLAs. Partnered health plans can come with stringent SLA requirements that state a maximum wait time before a call must be answered, putting added pressure on contact center business models.

To tackle these challenges, healthcare services and technology are prioritizing “operational changes that will improve efficiency, including through the use of technology and automation across services” through 2026.

Many providers have already started, leveraging Contact Center Automation to bolster their patient experience. From hospital systems to dentists, fitness programs, telehealth companies and provider networks, healthcare contact centers can meet more SLAs and lower costs with AI-powered customer service.

Resolve More Patient Requests With Zero Wait Times

Reducing costs and meeting more SLAs shouldn’t come at the cost of the patient experience. Replicant’s Thinking Machine is designed to fully resolve – not deflect – patient requests, so clinicians and agents can spend more time on the tasks that matter most.

Replicant helps millions of patients access care faster with natural, automated voice conversations that increase CSAT compared to IVRs and legacy chatbots. Common flows automated by the Thinking Machine include:

Intelligent Routing Accurately get patients where they need to go without forcing them to sit through long IVR menus.

Route existing patients to the correct queue and get new patients into intake and onboarding faster
Accurately route health plans to the correct queue to ensure SLAs are met
Immediately escalate urgent or emotional requests to appropriate clinical team

HIPAA Authentication

Authenticate existing patients with an API call to access account details
Securely collect details and patient information like zip codes, date of birth and member IDs
Leverage SMS-based Flex Forms to accurately collect patient information

Appointment Scheduling

Create, update and manage appointments
Send outbound appointment reminders
Provide members with appointment options over the phone or via SMS-based form
Determine appointment eligibility and route complex appointment types to appropriate team

Intake

Collect patient information via voice or secure form
Pre-qualify new patients before transfers
Reduce repetitive work during agent handoffs

Account Management

Update patient information
Resolve document requests end-to-end

Outbound

Send appointment reminders
Schedule prescription reminders and instructions

Case Study: How a Leading Healthcare Provider Achieved a 4.7/5 CSAT With Replicant

Customer Overview: Before partnering with Replicant, a healthcare provider that offers members a healthy aging and exercise program was interested in modernizing their IVR. They wanted to eliminate wait times and free up agents to spend more time with members. But, as their VP of Customer Service said, “conversational AI hadn’t gotten to the point where I felt like it was a good member experience until we saw Replicant.”

The Partnership: Replicant partnered with this provider to identify four initial use cases that would lower costs and improve the member experience. The selected call drivers – Member Authentication, Provide Fitness ID, Determining Eligibility, and Find a Gym Location – were high in volume, prone to seasonal spikes, and repetitive, making them ideal automation candidates. Replicant designed a Thinking Machine around three goals: 1) deliver natural conversations 2) fully resolve member requests and 3) provide seamless handoffs to agents when escalations are needed.

“Our first true test was that first week of January and the Replicant Thinking Machine performed really well. Having the pre-verification step off our agents’ plates gives them the ability to focus on what the member actually needs versus just checking the initial boxes.” – VP of Customer Service, Leading Healthcare Provider

The Outcome: Replicant launched at the start of the calendar year, when Fitness ID requests are at their peak. Now, members can resolve these requests naturally without having to navigate a rigid IVR or wait on hold. This streamlined the member experience and significantly reduced the time agents spent on simple requests. Meanwhile, agents who received escalations no longer had to collect initial member information, which saved valuable time in their workflows. With Replicant taking calls, the provider relies less on temporary FTEs, making member experiences more consistent and workforce management more efficient.

4.7/5 Member Satisfaction
3 Min. Avg. Time Saved in Escalations
Up to 25% Total Call Volume Automated
50 FTEs Saved During Peak Season
Scale Symbol Elastic Scalability During Spikes

“Our partnership with Replicant has been very successful in meeting our expectations and evolving the call flows with each use case. We’re learning a lot every day by listening to recordings and A/B testing.” – VP of Customer Service, Leading Healthcare Provider