How the Call Center Can Be a Driver for Value-Based Care

By Patty Hayward, General Manager of Healthcare and Life Sciences, Talkdesk
LinkedIn: Patty Hayward
LinkedIn: Talkdesk

Healthcare call centers are embracing artificial intelligence (AI) and automation as tools for both improving the patient/plan member experience and streamlining processes to increase efficiency and reduce costs.

Provider and payer organizations can greatly benefit from delivering a superior customer experience; if they can do so while cutting costs, that’s even better. But AI and automation also allow providers and payers to evolve the call center beyond the traditional “ask/answer” cost center to a value center by identifying and leveraging opportunities to increase revenue.

Contact centers play critical roles in patient acquisition and retention, and they will always need to deliver a human touch in some conversations. That’s why the most successful healthcare organizations will use these technologies not to replace contact center agents, but to free them up to engage in higher-value interactions with patients and plan members that yield greater revenue over the long-term.

Taking full advantage of AI and automation is especially important as more providers and payers operate under value-based care (VBC) contracts that incentivize proactive care, better clinical outcomes, and more efficient resource allocation. To achieve these goals, healthcare organizations must proactively ensure patients and plan members are doing the basic but essential things needed to optimize their health.

Increase outreach, improve outcomes

This includes getting flu shots, regular lab work, mammograms, and other tests and procedures that lead to better long-term health and outcomes. For high-risk patients, such as those with chronic conditions, proactive care may be the difference between a higher quality of life and worsening clinical conditions that are both costly and potentially life-threatening. AI and automation can be used to conduct outreach to patients/members reminding them that they need to get certain tests done, make an appointment for an annual physical, or come back for a follow-up procedure.

But reaching and engaging patients with outbound communication methods is only a part of the equation – and it can be very difficult and inefficient (even with AI) to connect with the high-risk and disengaged populations that providers most need to impact. Since VBC contracts create strong financial incentives, many providers are exploring automated outreach, but learning organizations are also considering inbound communication.

In a traditional “cost center” model for healthcare contact centers, the main operational goal tends to be handling a patient’s inbound call or chat as quickly and efficiently as possible. It’s a good goal, and for many patients, exactly aligned with what they want and need.

But if a high-risk patient with a gap in their care, such as a blood sugar test, is calling to refill a prescription or pay a copay, the best result for the patient and the organization is to go beyond their immediate need for calling. A contact center truly driving value would be able to use that “golden moment” to also encourage the patient to schedule their test, rather than just handle the refill or payment as fast as possible. Taking advantage of every patient and member interaction to drive the best possible actions is increasingly essential for VBC-contracted providers and payers, who have shared goals to maximize population health and preventive care. But it requires rethinking contact center workflows, technologies, and metrics. An agent helping schedule the blood test in the example above will have higher average handle time than an agent or bot that ignores the gap in care and simply handles the patient’s stated need.

But chronically short-staffed healthcare contact centers already struggle to keep up with call volume, leading to frustration for agents – who, after all, want to help patients and plan members – and people seeking assistance, many of whom are trying to cope with serious health issues. Contact center agents still provide the critical human link that patients and plan members need and appreciate in many workflows.

Keeping the human touch

While most modern consumers strongly prefer self-service options for simple transactions and requests – such as canceling appointments or refilling prescriptions – and are comfortable interacting with chatbots and virtual agents, there will always be times a patient or plan member should talk with another human being.

Many provider organizations, for example, don’t offer self-service for new patient scheduling. In those cases, ensuring agents are free to help on-board new patients or plan members is critical to business and revenue growth.

Or let’s say someone new to an area is looking for a primary care provider (PCP) or needs a specialist. If that person calls a provider and is left waiting on hold for four or five minutes because everybody in the contact center who could help is rescheduling appointments or refilling prescriptions, that caller may give up in frustration and reach out to the provider down the road. And potential long-term revenue for the provider is lost. This makes providing effective and easy automation for the more transactional use cases critically important, so that those agents are ready to help add value to the organization and consumers, instead of confirming appointments or providing directions to a clinic location.

But how do healthcare organizations train and upskill contact center workers so they can do more to help patients and plan members? Fortunately, AI can work with contact center agents to deliver a superior experience for callers.

By providing agents with the right information when they need it and offering them next-best actions in real-time, AI helps healthcare organizations meet the performance metrics that enable them to generate more revenue under value-based contracts, elevating the contact center from a cost-reduction operation to a driver of value.

AI can help agents efficiently assist callers by pulling together patient information from disparate sources (such as texts, call logs, claims systems, and electronic health records) and presenting the data in an easily consumable fashion. Generative AI tools can analyze patient/member language and tone and then advise agents on what to say and how to say it. This is especially helpful for new agents who lack experience dealing with patients or members with high-complexity needs, or who are very frustrated. Further, AI can review call transcripts to assess agent performance and provide actionable feedback for improvement.


When healthcare organizations deploy AI and automation simply to increase efficiency and cut costs, they leave a lot of value on the table. Providers and payers can leverage the full benefits of AI and automation by using these technologies to upskill and assist contact center agents as they interact with patients or members. By providing the time and tools to enable agents to engage in higher-value activities such as assisting patients or members in ways that ensure a superior customer experience, providers and payers can increase revenue while improving outcomes and reducing costs.