Introduction: SCAN Health Plan
SCAN Health Plan, a nonprofit Medicare Advantage carrier with over 277,000 members, has revolutionized its call center operations through the strategic integration of artificial intelligence (AI). This initiative addresses key challenges such as employee burnout, operational inefficiencies, and member satisfaction. By partnering with Cresta, an AI-powered tool, SCAN has set a benchmark for leveraging technology to improve healthcare service delivery.
The Challenges in Call Center Operations
Managing High Call Volumes
With millions of annual calls from seniors, SCAN’s call centers face immense pressure. Member service advocates (MSAs) juggle multiple responsibilities, including real-time assistance, call documentation, and resolving member queries.
The Need for Consistency
Before adopting AI, MSAs struggled to consistently address member needs due to varying workloads and time constraints. Random sampling of calls often missed critical insights, leading to gaps in service improvement.
The Genesis of SCAN’s AI Initiative
Understanding the Need
In 2023, SCAN identified call center operations as a prime candidate for AI transformation. Recognizing the limitations of traditional workflows, the leadership aimed to enhance efficiency while maintaining a personal touch with members.
The Role of Cresta in Transformation
After an extensive vendor selection process, SCAN partnered with Cresta, an AI tool offering:
- Real-time transcription and automated note-taking.
- Guided workflows for resolving complex member inquiries.
- Contextual suggestions to streamline issue resolution.
Corinne Stroum, SCAN’s head of emerging technologies, emphasized the importance of keeping AI as an aid rather than a barrier between MSAs and members.
Phased Rollout of AI Technology
Pilot Testing and Feedback
SCAN began with a one-week soft launch involving a small group of employees. The organization gathered feedback and fine-tuned the system to ensure seamless integration.
Full Deployment and Results
By September 2023:
- Adoption Rate: 96% of MSAs used Cresta.
- Call Assistance: AI supported 78.5% of calls.
- Member Satisfaction: Achieved an 89% satisfaction rate and a Net Promoter Score of 82.
- Efficiency Gains: A 1.6-point improvement in single-call resolution was observed between April and August.
Impact on Member Experience and Employee Efficiency
Enhanced Member Interactions
AI-powered workflows have transformed how MSAs interact with members. The technology provides instant insights, enabling agents to offer accurate and timely solutions. Members frequently express delight at the seamless service.
Employee Adaptation and Benefits
Initially, after-call work times increased as MSAs adapted to the new workflows. However, with practice, they became more efficient, leading to normalized work times and reduced stress.
Expanding AI Beyond the Call Center
Scaling Across Departments
In August 2023, SCAN extended Cresta’s capabilities to its sales teams. Future plans include rolling out the tool across other departments, aiming for a comprehensive AI-driven operational model.
Integrating Advanced Features
SCAN is exploring new features such as automated generation of talking points for frequently asked questions. These additions aim to further personalize member interactions.
Lessons for Healthcare Organizations
Leveraging Untapped Data Sources
Ms. Stroum highlights the importance of analyzing unstructured data, such as call transcripts, to identify improvement opportunities. This data-driven approach can enhance decision-making and service quality.
Building Digital Literacy
Fostering AI literacy among employees is crucial for successful adoption. Training programs and ongoing support can help staff embrace new technologies confidently.
Conclusion
SCAN Health Plan’s AI-powered call center revamp exemplifies how technology can address critical operational challenges while enhancing the member experience. Through Cresta, SCAN has achieved significant improvements in efficiency, satisfaction, and employee morale. By scaling AI across departments and encouraging other healthcare organizations to adopt similar strategies, SCAN continues to lead the way in innovation and service excellence.
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FAQs
1. What challenges did SCAN’s call centers face before AI implementation?
A. SCAN’s call centers struggled with high call volumes, inconsistent service delivery, and employee burnout due to manual workflows.
2. How does Cresta improve call center operations?
A. Cresta provides real-time transcription, automated note-taking, and guided workflows, enabling MSAs to resolve member issues more efficiently.
3. What results has SCAN achieved with AI?
A. SCAN observed a 1.6-point improvement in single-call resolution, an 89% satisfaction rate, and an 82 Net Promoter Score after adopting Cresta.
4. How is SCAN scaling AI across departments?
A. SCAN is expanding Cresta’s use to sales teams and exploring new features such as automated talking points to enhance member interactions.
5. Why should healthcare organizations consider AI for operations?
AI can improve efficiency, personalize member experiences, and unlock insights from untapped data sources, leading to better outcomes for patients and organizations.
