A New Kind of House Call

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I am nothing if not an unrepentant hypochondriac. At any given time, I am likely to have between seven and 10 medical professionals on call: a primary care physician, a gastroenterologist, an acupuncturist, a therapist, a dentist, a backup primary care physician, a psychiatrist, and several pharmacists.

And like any good hypochondriac, I am always on the phone, scheduling, rescheduling, and confirming office visits. But it wasn’t until this past month—when I started seeing yet another doctor—that I experienced the convenience that is every nervous patient’s dream: automated outbound messaging in the healthcare space.

What happened was this: My cell phone rang, and I was greeted by a pleasant—if not exactly sentient—woman who, in a gentle voice, reminded me about my upcoming medical appointment. Of course, I hadn’t forgotten about the appointment. On the contrary, I was looking forward to it. But it was convenient to be reminded, all thanks to the magic of speech technology. 

In the healthcare vertical, this kind of messaging—the use of outbound interactive voice response (IVR)—is becoming more common among doctors, dentists, pharmacies, and even veterinarians, all of whom are adopting the technology and services in some fashion. 

According to Donna Fluss, president of DMG Consulting, outbound represents the fastest growing piece of the IVR market because of the value it provides. And while Fluss insists that blind dialing is dead, she says relationship dialing and multichannel relationship dialing, like the kind my new doctor uses, are both alive and well.

Within the healthcare vertical, Fluss describes the use of outbound IVR as “very, very prevalent,” with the technology being used by a variety of different medical institutions, including mom-and-pop organizations.

“Doctors’ offices, large and small, are using these tools,” she says. “It’s kind of one of the standard things you do nowadays.” 

Among the many types of proactive customer care applications, Fluss cites some of the most effective—in terms of profitability and customer experience—as prescription refill reminders, early-stage collections, and appointment reminders. 

“Customers don’t find those useful. They find them extremely useful,” she says, noting that in some cases patients can confirm or even change appointment dates and times without ever speaking to a live agent. “That’s pretty good service.”

Daniel Hong, senior analyst at Datamonitor, also cites appointment reminders and prescription refill applications as prevalent uses of outbound IVR in the healthcare space—noting that one-third of every dollar spent on healthcare is currently spent on administrative, rather than clinical, functions. He also points to member enrollment and patient registration services as other smart uses of the technology. 

“In healthcare, outbound IVR is a promising technology,” Hong says. “There’s a lot of opportunity to reduce costs and automate tasks.”

Hong stresses the potential for outbound IVR to be used effectively in preventative care and wellness management. In a Datamonitor white paper titled “Understanding the Benefits of Outbound IVR Solutions in Healthcare,” Hong asserts that healthcare is moving toward more holistic care for the patient during a longer time frame, and outbound IVR is a tool that will support that trend. 

“Today, outbound IVR is being used to deliver appointment reminders and scheduling, which focus on immediate conditions and generic preventative measures,” Hong writes. “Tomorrow, outbound IVR applications, which focus on a patient’s potential future needs in preventative care and wellness management, will become an integral part of healthcare providers’ and payers’ toolkits.”

However, Hong is relatively cautious in his estimation of the market, suggesting that in healthcare the use of outbound communications won’t hit “critical mass” any time soon. 

“I think it’s ramping up; the interest is there,” he says, noting that outbound IVR should be used as part of a multichannel approach that includes tools like text messaging. “I think it’s going to take a while before we see mass adoption, but we will see pretty strong growth in healthcare year after year.”

Touting the benefits of outbound messaging, Fluss points to paybacks like cost savings, revenue generation, improved communications, and—perhaps most important for the healthcare vertical—good customer experience and an improved quality of care.

“These are interactive calls. You can do just a call, but increasingly the tools being used for outbound IVR are two-way communication,” she says. “And depending on what you are trying to do, the tool will reach you on your channel of choice.”

Believe the Hype

Among the many companies providing outbound IVR to the healthcare vertical, Fluss and Hong cite vendors like West Interactive, Silverlink, Voxify, SoundBite, and Varolii as some of the best. 

According to Jennie Hanson, senior vice president of notifications at West Interactive, much of the excitement—or what some industry analysts have called hype—around medical outbound notification is due to several transformations occurring within the healthcare industry. Hanson cites two of these transformations as the movement from doctor to patient control and the movement from reactive, symptomatic diagnosis to proactive, asymptomatic wellness healthcare. 

“Both of these drive more active involvement of the patient,” she wrote in an email to Speech Technology. “And, as such, we see patients wanting more information and communication from their doctors. Outbound notifications—of appointments, lab calls, and chronic disease medication reminders—allow for enhanced patient information and informed decision-making.”

Additionally, Hanson asserts that if there is indeed hype surrounding outbound, then the technology must be judged as living up to the expectations. “We see this every day from our customers wanting more expanded applications,” she writes, “and from prospective customers expressing interest in integrating notifications into their communications contact strategy.” 

West includes among its customers eight of the top 10 healthcare organizations, 16 of the top 20 hospitals, and 17 of the top 24 pediatric facilities. It offers solutions that range from welcome calls to collections to appointment reminders to automated lab results.

Hanson points to improved provider-patient communication, reduced operating expenses, increased profits, and the delivery of more personalized, relevant information to patients as some of the results West can provide a healthcare organization. She cites numerous success stories, including doctors’ offices that reduced no-show rates by 25 percent and a California hospital that reduced its no-show rate by 67 percent during four years for an increased annual revenue of $6.6 million. 

Also rejecting the term “hype” is Chuck Eberl, vice president of marketing at Silverlink, a company that focuses exclusively on the healthcare vertical, working with health plans, pharmacy benefits management companies, and disease management companies. He says a profusion of outbound applications exists in the healthcare space. 

“In this age where [healthcare providers] are trying to reach out, connect, and engage with healthcare consumers and drive their behaviors…people have realized there’s a lot of great application here,” Eberl says. “[It’s effective] because everybody’s got a phone; in many ways, it’s a technology that cuts through the noise out there; and, more importantly, it’s a way to engage people who are not engaged in their health.”

Engaging Information

Eberl says although plenty of information about health can be found on the Web, the challenge is to engage people who don’t know they have a problem and help them behave in a way that is healthier, to assist them to make healthcare decisions that are more cost-effective, and to provide them with the knowledge they need to make the right healthcare decisions.

“People do get excited, because there are lots of things that you can do with outbound communication and the healthcare consumer,” Eberl says.

Susan Frankle, Silverlink’s director of corporate communications, agrees, noting that, according to The Journal of Occupational and Environmental Medicine, 70 percent of all healthcare costs are related to preventable conditions.

“If we can take that cost out of the equation, we solve the lion’s share of this healthcare crisis that we’re in today as a country,” she says. “So being able to move consumers in measurable ways to get them to adopt a healthier behavior or a more cost-effective behavior or just make better health decisions [could reduce] 70 percent of the cost. Hundreds of billions of dollars in costs are at play.”

Eberl and Frankle both say outbound communications can be used to drive customer health, economic, and administrative behavior, such as getting a diabetic involved in a disease management program, getting a patient to migrate from a brand name to a generic drug, or getting that person to fill out needed paperwork.

And while Eberl says these uses of the technology can benefit both consumers and healthcare providers economically, he stresses the real and important benefits pertain to patient health. “If we can use technology to have people get their screenings and get better care, then we’re in much better shape than we’ve been,” he says, noting that outbound communications provides patients with personalized, relevant, and timely information.

Silverlink—which has provided automated outbound calling for years and recently added multichannel capabilities—offers a wide variety of outbound services. 

According to Frankle, on the pharmacy side, Silverlink uses outbound to process refill transactions and help convert people from brand name to generic drugs and from retail to mail-order service. On the patient health side, Silverlink operates preventative health programs that encourage people to take advantage of cancer screenings and flu shots, and works with disease and lifestyle management initiatives, like smoking cessation and medication adherence. Additionally, in consumer healthcare and operations, Silverlink offers outbound communications to aid with customer loyalty, retention, and administrative tasks. 

Eberl points to a host of healthcare entities and programs that have benefited from Silverlink’s technology. He cites a Lipitor adherence program that worked with Silverlink to increase adherence rates by 82 percent, and a mammography cancer screening program that tripled its screening rates with the company’s help.

Another vendor working with outbound messaging in the healthcare vertical is Eliza, which has been active in the space for about nine years.

On the technology side, in addition to offering an integrated platform, Eliza owns its own speech recognition engine, which has been tuned specifically for the healthcare vertical, according to Alexandra Drane, its founder and president.

“What you end up with is a very different cost structure where you have no licensing fees, no delays between prompts, and better end-to-end control,” she says. “There is a whole aspect of Eliza that is enabled by our technology.”

In addition to the company’s technical expertise, Drane stresses the importance Eliza places on the art of outbound communications. She says that within the healthcare space exists a misconception that outbound messaging consists of simply calling people and telling them to do things. “We’ve learned over the years that that’s just not the case,” Drane says. “People need to be beguiled. They need to be marketed to.… Part of what Eliza has worked on, over time, is how do we put together the data, the analytical know-how, and expertise so that we can—with case studies, with backing—go to our partners and help encourage them to interact with people in a very, very, very different way.” 

And Drane is able to point to some impressive results. By using Eliza’s outbound messaging, a health plan increased the number of hypertensive patients “in control” of their blood pressure by 56 percent compared with mail-based outreach, while another health plan reached out to newly diagnosed patients with education and support and increased the number of requests for written materials about its therapy by a factor of 27.  

Additionally, when an independent research company retained by a national health plan compared Eliza’s outbound messaging with live callers, 73 percent of members reached said the Eliza call made them feel better about their health plans, compared with 64 percent who said they felt that way following the call from a live person.

A Critical Eye

But despite the bevy of vendors and a clear track record of success for outbound communications in healthcare, the technology still has its critics, with people pointing to privacy issues and the Health Insurance Portability and Accountability Act (HIPAA) as challenges to its efficacy. 

While Silverlink’s Eberl admits that HIPAA can pose challenges, he sees different obstacles to success in the healthcare space. “With things [related to] HIPAA, you either have the technology to handle it or you don’t,” Eberl says, pointing to access to core data and closing the loop on data and results as more significant challenges.

“What are you really trying to accomplish, and do you have the data?” he says. “It’s not just about using technology for technology’s sake. It’s about driving a specific behavior, and can you really link the program and the execution of the program to business results or to the health impact you’re trying to drive.” 

Looking toward the future of outbound communications in healthcare, Eberl says the key is the use and proper integration of multiple channels. “That’s the platform that we’ve been building,” he says. “We’ve had this very complex and sophisticated system that can offer very cool dialogues to a particular patient or member, but now we’ve got to sync that up with the other technologies.”

By pulling together those multichannel pieces, a healthcare organization can not only reach out to a consumer, but it can also determine the correct message sequence for gathering information or driving specific behaviors.

Frankle agrees, stressing the importance of advanced analytics in outbound healthcare messaging. 

“Healthcare’s just waking up to this trend and set of methodologies,” she says. “If you can apply analytics—and by that we mean take a population, microsegment it, and then personalize your communications to those individual segments—you can be much more effective in your outreach.”

One-size-fits-all messaging is dead, Eberl maintains. “That does not work,” he says. “You need to have very personalized kinds of communications.” 

Drane offers a different caution. She anticipates the future for outbound communications in healthcare will remain strong, but expresses concern about the market’s changing nature. She notes that many vendors previously disinterested in the healthcare space are now suddenly interested in it. And because of this new interest, she fears that vendors with little experience in the healthcare vertical will attempt to move into it—possibly upsetting consumers and causing problems if and when their solutions don’t translate well to the market.

“The challenge is that speaking with people about their health is so different than speaking with people about banking or travel,” Drane explains. “These are really serious, deeply personal, often upsetting issues.”

Drane sees no end in the need for and opportunity to provide better, more tailored, accessible, and relevant information to people about their health. “We’re just going to have to be very careful that we don’t burn out this market, because if [companies aren’t] respectful of it…people will stop picking up the phone,” she says.

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