an automated appointment scheduling solution · the appointment meets the needs of both parties....
Post on 08-Jul-2020
8 Views
Preview:
TRANSCRIPT
AN AUTOMATED APPOINTMENT SCHEDULING SOLUTION
USE CASE
© EXL Service, Inc. All rights reserved.
EXLSERVICE.COM
USE CASE
AN AUTOMATED APPOINTMENT SCHEDULING SOLUTION
Client Need
A regional health benefit manager was asked to establish and maintain
a provider network, a claims processing and payment facilitation
process, a medical administrative management service, and customer
support services for its members across 13 states. One of its challenges
was to design, develop and maintain an automated solution that would
facilitate the scheduling of appointments via the members’ cell phones
with no impact to access to community care during this transition.
EXL Healthcare Data Services Solution Approach/Methodology
EXL Healthcare Data Services started with a thorough SWOT analysis of
the health benefit manager’s current appointment system and extensive
interviews with key decision makers and beneficiaries. Based on the
input collected, the Data Services team was able to design a solution
that would accommodate members’ desires to make appointments
with healthcare providers using their cell phones.
The solution includes:
• Master Schedule Engine: uses member information to
recommend providers for each referral, determined by the best
possible match of a provider’s availability, specialty and member’s
requirements. The master schedule is using deep learning and
artificial intelligence algorithms to bring together the provider
requirements, as well as the member’s needs. The engine
automatically creates a virtual schedule as the profiles change
in real time. It creates a neural central semantic network in the
background, generating a real-time cluster to develop a virtual
schedule of availability. This virtual schedule is then presented to
the member and to the provider, enabling them to confirm that
the appointment meets the needs of both parties.
• Member Facing Application: streamlines the appointment
scheduling process and minimizes wait times. This mobile app
provides an interactive and responsive method to schedule
appointments, receive notifications, chat in real-time, and set up
appointment reminders.
• Provider Portal: enriches the provider’s experience to manage
appointments. Appointment requests are forwarded to providers
in an email. Providers can decline, accept or reschedule an
appointment through the online portal. Any changes made to the
appointment will trigger alerts in the mobile application so that
the members are informed of all changes.
2EXLSERVICE.COM © EXL Service, Inc. All rights reserved.
AN AUTOMATED APPOINTMENT SCHEDULING SOLUTION
EXLSERVICE.COM
EXL (NASDAQ: EXLS) is a leading operations management and analytics company that helps our clients build and grow sustainablebusinesses. By orchestrating our domain expertise, data, analytics and digital technology, we look deeper to design and manageagile, customer-centric operating models to improve global operations, drive profitability, enhance customer satisfaction,increase data-driven insights, and manage risk and compliance. Headquartered in New York, EXL has more than 32,800professionals in locations throughout the United States, the UK, Europe, India, the Philippines, Colombia, Australia andSouth Africa. EXL serves multiple industries including insurance, healthcare, banking and financial services, utilities, travel,transportation and logistics, media and retail, among others.
For more information, visit www.exlservice.com
Share ShareTweet
To find out more about how EXL uses Digital Intelligence to help healthcare companies, visit us at https://www.exlservice.com/healthcare and schedule a call or meeting.
Including the Master Schedule Engine, the solution is based on the following “layers”:
• Member Profiles: based on data sourced from a member
organization and the health benefit manager, as well as data
captured during an active call. Profiles are accessible via the app
web interface, and are also linked to the call center system.
• Provider Profiles: sourced from the health benefit manager,
includes the latest contact information and schedule availability
stored in the application repository for easy access by the
schedule engine and the call-center agents.
• User Interface (UI): allows the agents to quickly find information
about the caller and provide real-time answers.
• Database: an Operational Data Store (ODS) contains all data
elements needed for the system to work, including provider,
veteran and schedule information.
• Analytics: data marts and reporting are available, used by
business analysts to monitor system performance, provider
capacities, and patient experience.
Expected Outcomes
The ultimate goal of this system was putting the member in control of
his or her care. The system was also designed to optimize a member’s
user experience and satisfaction, including the reduction of DNAs (Did
Not Answer) and less back-and-forth communication over the phone. In
addition to these and other objectives and associated benefits, the EXL
Healthcare-designed solution is expected to provide the following:
• Optimized scheduling via a rules-based engine
• A secure communication platform for scheduling and managing appointments
• An interactive method to manage appointments
• Increased scheduling efficiency by more than 400%
• Reduced cost due to automation
• Removed manual staff risk
• Flexibility in including new providers and services
• Highly satisfied consumers and stakeholders
3EXLSERVICE.COM © EXL Service, Inc. All rights reserved.
top related