Empowering Customers: The AvMed Way
Created in 1969 as a prepaid health care system for pilots in the Miami aviation industry, AvMed Health Plans is Florida's largest, not-for-profit health plan serving employers in the major metropolitan areas of Florida. AvMed has offices in Miami, Fort Lauderdale, Palm Beach, Orlando, Tampa, Gainesville and Jacksonville and offers health care coverage on a fully-insured and self-funded basis for employer groups in Florida. Additionally, AvMed offers health care products to Medicare beneficiaries in South Florida.
In an effort to empower its members to take an active role in managing their health and improve customer service, AvMed began automating services to its customers in 1997 through the use of kiosks. These kiosks were designed to allow users to locate physicians using a touch-screen computer system. The company took its self-service another step forward in 1998 when it launched AvMed.org. And today, with over 200,000 providers and customers, AvMed has replaced its dual tone multi-frequency (DTMF) system with speech technology to enable yet another level of self-service for its members and providers.
For 12 years, AvMed used an automated self-service application based on a DTMF touchtone technology called TALX. Its members and medical providers learned to navigate the system fairly efficiently, but AvMed was frustrated with the DTMF system because it was a proprietary solution that required AvMed to call and schedule appointments, some times several weeks in advance, in order for the vendor's professional services team to perform menu changes or content additions. Compounding the need to update their telephone system, AvMed's DTMF solution vendor had announced that their product had reached the end of its lifecycle. This meant the vendor would no longer provide support or service for the product or AvMed's application. In order to continue to receive service, AvMed would need to buy another product from the vendor and begin implementation again from scratch. At wits end, AvMed felt pressured to find something new to replace its DTMF solution.
Manny Miranda, Senior Systems Manager at AvMed
AvMed heard about speech being adopted by several major health insurance providers. To maintain its competitive edge of providing superior customer service, AvMed spent six-months researching speech technology, informally, using colleagues and friends in other companies with similar offerings as their main resources. According to Manny Miranda, senior systems manager at AvMed, "We knew we had to go with speech because it provides a better caller experience and most key players in health care insurance are transitioning or have already transitioned to speech."
AvMed's primary goal for speech was to provide a better caller experience to its members and health service providers, such as doctors, hospitals and specialists. Its secondary goal for the implementation was to have full control over the application so that they could update and extend the application using their own IT resources as often as they liked. To achieve these goals, AvMed replaced its 12-year-old DTMF system with the TuVox Healthcare Application Suite, which automated all of the preceding system's services including access for members and medical providers to information regarding authorizations, referrals and member eligibility.
Before fully deploying the application suite, AvMed performed three phases of testing. The first phase involved the execution of test scripts to verify each sub-application and ensure that all design functionality worked in conjunction with the design specification. During this testing phase, AvMed made some slight modifications to the design in order to accommodate an upgrade to its database as well as optimize its customer experience. The second phase of testing focused on the quality of the application; specifically, tests were run on the quality of the prompts and the flow of the application. Using information gathered in these tests, minor improvements were made to some of the help topics to assist customers in certain applications based on no input or no match topics. The final phase allowed a third party to call into the application and have those calls recorded. At the end of the calls, a survey was conducted to review the experiences. In addition, a similar approach was used internally to allow the customer service agents to make usability recommendations in the applications. The results of both tests enabled AvMed to improve the call flow which would lead to increased task completions for each call. With testing complete and the applications fine-tuned, AvMed moved forward with the deployment of its speech application.
The speech application is integrated with AvMed's consolidated database containing the latest information on providers, claims and members. It is also the database accessed by AvMed's live agents and what AvMed customers access through its Web site. The use of the database across access modalities enables users to receive consistent feedback regardless of the channel that he/she selects.
The speech system targets two audiences: health care service providers (such as doctors, nurses and facilities) and health insurance members who are employees of small to large size companies for whom AvMed provides health insurance in Florida. The system automates calls from AvMed's providers who are seeking to:
Authenticate user access
Check member eligibility and co-pay
Request new treatment authorization or confirm authorization requests for treatment
Request authorization to refer a patient to a specialist doctor
For its health insurance members, the application automates calls for members who want to:
Enroll in the program and select primary doctor
Check the status of a claim
Authenticate user access
Check deductible balances
Verify member eligibility and co-pay for doctor visits or drugs
The speech application suite also includes a sub-application that sends live agents a transcript of the entire transaction between the caller and the system so that callers are transferred to a live agent who already knows who the customer is, why he/she is calling and where the caller exited the system. Live agents can then assist the caller in completing his/her task or re-route the caller to the appropriate place in the speech application to complete the task on his/her own.
No longer limited by a proprietary application, two IT staff members maintain and update the speech application. The internal staff at AvMed have also developed a new speech application called "Audio Health Library" using the TuVox Life Cycle Management suite of tools. The library is a knowledge base of health information topics previously available only through a CD subscription. The speech-enabled application provides instructions or medical information on what to do in various situations, for example if a bee stings your child. AvMed has set this application up so that it can also be leveraged via its Web site.
Including the Audio Health Library, AvMed has been able to repurpose more than 40 percent of the routine tasks available via the Web site with the speech application. The company's goal is to leverage even more content from its Web site than it currently does using speech. AvMed is working on leveraging existing Web content to deploy a sub-application that will allow members to order a new ID card using the speech system. The caller should be able to call in and speak a code that will initiate the process of mailing a card to the member.
Since deploying speech in May 2005, AvMed has seen automation rates that run from 42 percent on certain call types to 65 percent on request authorizations. AvMed uses the reporting analytics provided with their solution to monitor the system, examine the types of calls received, determine other potential areas for automation, and tune the application for calls that are already automated. The self-service applications are available 24 hours a day, seven days a week and intercept 45,000 calls per month. On average, the speech applications automated roughly 45 percent of all calls.
More importantly, AvMed's providers have been able to complete their calls 25-30 percent faster by speaking the information that previously had to be entered via touchtone. The menus trees have been trimmed back to five or six choices per customer type with access from the main menu with one choice to get directly to the customer content. To measure user satisfaction, AvMed sends representatives out in the field to ask for health service provider input on the ease and speed of use among its providers. Feedback from these one-on-one surveys has shown that providers really like the system and are able to complete the calls much faster than before.
AvMed plans to continue to look for new areas of opportunity for automating services using speech. With a great deal of investment in its Web content, AvMed's goal is to extend the speech application to provide all the capabilities available via its Web site. The company currently has more information available on the Web site than in the speech application, such as claims, medical, benefits and payment options. The ability to order replacement cards is an example of an extension that the company is currently looking to automate.
When asked if there was anything that he would have done differently, Manny Miranda responded, "I wish we would have done it at least one to two years sooner. Had we started sooner, we would have more applications live today."