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Avatars Promise a Solution for the Challenges Facing Health Care Contact Centers

Note from the editor: This is the first of a series of three articles that comes as a result of Dr. Thomas Morrow's research for two key articles on the use of Intelligent Virtual Agents in healthcare.

The pressure on health-care related contact centers has never been greater, but with the challenges presented by the Affordable Care Act, the creation of exchanges, increasing Medicaid enrollment and the dramatic change in the landscape of medical insurance comes an enormous opportunity for innovation.

This year millions of people, many of whom have not had insurance in the recent past, will be thrust into Health Insurance Exchanges, an environment that is not only unfamiliar but in many cases downright unfriendly and uninviting.

Millions of people with pre-existing conditions who have been waiting for access to affordable medical care will be suddenly looking for answers – most simple, some complex.  Health plans, hospitals and the state and federal exchanges have been preparing in a manner not matched since the Y2K push.  Building and renting the brick and mortar call centers, creating policies and procedures, data systems and processes and, finally, hiring tens of thousands of agents to answer the needs and demands brought to them from previously disenfranchised members will challenge even the most experienced contact center managers.

To add to the difficulty of preparation, there is no way to predict with certainty the number or complexity of the upcoming calls, the number of agents needed, the exact number of work stations, the type of training required … the list of uncertainty goes on and on.  So, most call centers will over-staff and know that a high turnover rate will take care of the overage while simultaneously necessitating constant new-hire training of agents over the coming years.

There is, however, a much more logical, efficient, and expedient answer: hire an avatar!

What is an avatar?  An avatar, more accurately called an Intelligent Virtual Agent (IVA), is basically an interface made possible through human emulation.  If your agents can provide an answer or a solution, an avatar can too.  IVAs use advanced artificial intelligence and natural language recognition to emulate some of your best agents.  Sure, there are things a computer-agent cannot answer, but with continuous training, these agents can be “taught” to handle about 80% of your current call volume – and at a fraction of the cost.

An Intelligent Virtual Agent will never become bored, raise their voice, become insulted, wonder when his or her next raise will occur, take a break, require retraining on basics, quit, or go on leave. In fact, a Virtual Agent doesn’t even go home at quitting time!  Plus, an avatar can easily “hot-transfer” a more complex call to what will now become a very specialized focused group of “super-experts” at your contact center. 

An Intelligent Agent is not the same as an IVR, FAQ or a chat bot.

IVR systems drive phone-user action through the course of a one-way, pre-determined dialog.  Telephone keypad touch-tones and basic speech recognition are used to interpret the caller's response to voice prompts and lead them to a few predetermined endpoints.  The traditional web-based chat bot simply scans for keywords within text input and pulls a reply with the most matching keywords or the most similar wording pattern from a textual database, much like a search engine.

Even the most sophisticated of the IVR, ChatBot and FAQ systems provides little to no contextual awareness or understanding of what an individual is trying to accomplish because these systems are designed with rigid parameters that are meant to get a user to one of a few predetermined end goals.  These limitations cause user frustration and are a leading cause of escalation to call center employees.

The Intelligent Virtual Agent is able to accept any type of input; be it talking, text or tapping on the screen of a smartphone or tablet. It actually understands the exact meaning of a message and uses this information to provide an exact solution for the user.  The IVA system can also “learn” over time so that it becomes more adept at responding to user needs.  The experience delivered to the user is extremely robust.

IVA systems are already widely used in numerous industries, including most major airlines, numerous financial institutions, the U.S. Army, and one of the largest national health plans.  Their ability to understand is unparalleled; nearly 99.9% of interactions are “understood” by the Intelligent Virtual Agent.  And, if given access to the proper databases, they can answer the vast majority of user needs, deflecting 80% of contacts from your live agents.
Clinical Applications of Intelligent Virtual Agents

But, there are also other significant possibilities for the use of Intelligent Virtual Agents specifically in the healthcare industry.  These agents can be used as Virtual Health Assistants for your patients/members.  They can be used as a smart phone application to encourage and improve adherence to medication and lifestyle changes for those with chronic diseases.  They can also be used to remind people of needed immunizations and age appropriate periodic health screening to promote early detection of disease.  Their use in healthcare has been documented in numerous clinical trials and has been demonstrated to improve readmission rates to hospitals and improve adherence to medication.  Even weight loss has been demonstrated to be more enduring with the use of these agents.

Never in the history of our medical-care system, has the need for innovation been more compelling.  The use of Intelligent Virtual Agents in health care is not only needed, but inevitable.

Dr. Morrow has nearly 30 years experience in managed care and other health care related industries. He has been the founding medical director of 4 HMOs, an NCQA surveyor, the clinical lead for a national disease management company and has authored nearly 200 articles. He is a full time employee of a major biotechnology company.

The views and opinions of Dr. Morrow are his alone and do not necessarily reflect those of his employer. He serves as an unpaid chair of the Advisor Board for Next It, one of the leading companies leading the use of Virtual Intelligent Agents in the US.