Empire Medicare Services Achieves Their Best Performance Level with Speech-Enabled System

Empire Medicare Services is one of the largest Medicare contractors in the United States, providing services under contracting arrangements with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. 

As a CMS contractor, Empire is required to keep up with agency-established telephone service performance standards - a monthly all-trunk busy (ATB) rate of no more than five percent on the interactive voice response (IVR) system and 20 percent on the customer service representative (CSR) line when responding to telephone inquiries from customers. CMS also requires contractors to respond to telephone and written inquiries in a prompt and accurate manner.  

In addition, the Health Insurance Portability and Accountability Act (HIPAA) privacy regulations call for authentication of each caller before releasing confidential information. This includes alphanumeric information such as provider number, patient Medicare number, the patient's date of birth, gender and name. 

When processing tens of millions of claims a year, it's easy to see that this is no small task.

Going Back in Time…
Historically, Empire Medicare Services relied on a touchtone IVR system to handle calls from providers (such as doctor's offices), billing agencies and hospitals. The touchtone system provided a front-end interface to callers through which they could access claim status and other information. Despite the ease of use that Empire's IVR system provided, most callers opted to be transferred to a live agent in Empire's call center, even with excessive wait times. But with an annual 30 percent growth rate in call volume, Empire Medicare recognized that their call center needed a more effective way to automate a majority of the calls and increase their end-user adoption rate.

Over time, it was readily apparent to Empire Medicare Services that traditional IVR applications could not handle the increasing complexity of the alphanumeric account numbers and information that providers needed to input to obtain the information they required from Empire.

The Challenge
While it was known that Empire's touchtone IVR handled approximately 39 percent of incoming calls, there was no way to determine how many transactions were completed successfully in the IVR.  Based on existing call center volume, it was obvious to Empire that a majority of the calls were eventually transferred to call center agents due to a variety of reasons. Upon further study it was determined that 45 percent of the calls to live agents were for simple and routine questions, such as patient eligibility information while an additional 40 percent were for claim status information.

Based on that information, it quickly became apparent that automating patient eligibility and claim status with a speech-enabled IVR system had the ability to dramatically lower costs and significantly improve service.

"As our caller base and volume continued to grow, we recognized the need to invest in new technologies to improve our customer service in a cost-effective manner," said Gloria McCarthy, executive vice president and chief operation officer at Empire Medicare Services.

Empire Receives a Powerful Voice
Empire Medicare Services' foresight had led them to implement a computer telephony integration (CTI) solution in 2004 as a building block to address their customer's future requirements.   So it was an easy decision for the management team to work with the same solution and vendor to address its integration requirements including speech enabling its IVR.

Empire designed and deployed a state-of-the-art, speech-enabled IVR solution that allows complete voice self-service functionality. Callers can obtain information such as patient eligibility, claim status, deductible information, procedure code pricing, check payment information, commonly requested phone numbers, addresses, Web sites and seminar information.

The Real Test
In September 2004, Empire requested that the new integration be operational by its busiest call day of the year - the Monday after the long Thanksgiving holiday. So, Empire committed to an aggressive, four-month implementation schedule.  To ensure a smooth implementation, the deployment was carefully planned using a prototype which included a sampling of doctor's offices and hospitals to simulate the environment in which the system would operate.

Technically Speaking
To meet its commitment to Empire, MicroAutomation selected a platform based on VoiceXML open application development standards. Four IVR high-availability server systems consisting of Vocalocity Voice Gateways and Intel Dialogic voice cards were configured to host the speech-enabled IVR applications. Each server was configured as a Web server with ScanSoft Open Speech Recognizer (OSR), emulation software and MicroAutomation's mainframe host server application. 

The host server application allowed scripts to be developed quickly to retrieve customer information from Empire Medicare's host mainframe systems, using simple screen scraping technology.

Finally, MicroAutomation configured a database server system running Microsoft SQL Server as a repository for transaction information. Detailed transaction summary reports were created to track and report every transaction handled by the IVR systems, allowing Empire to more efficiently focus on what matters most, serving the provider community.

Stunning Results
Empire Medicare Services has been able to handle a 30 percent growth in call volume without adding call center personnel. In addition, Empire achieved the best service level it has ever had on their busiest day of the year - the Monday after Thanksgiving.

The portability of the solution has allowed Empire Medicare Services to easily deploy the solution to two of its other call centers in a very short time period.  Today, the speech-enabled, IVR system efficiently handles over 79 percent of all incoming calls for the three call centers, or approximately 14,000 calls per day. Because of the overwhelming success of the solution, Empire Medicare Services plans to continue its expansion by adding capacity and continuing to introduce new speech-enabled applications as necessary to accommodate the needs of both CMS and its provider community.

Felicia Kelley is a communications specialist for MicroAutomation.  Her healthcare background includes working with organizations such as the American Red Cross and Inova Health Systems. Kelley can be reached at fkelley@microaut.com .

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