SCAN Health Plan has integrated artificial intelligence technology across its call centers to address challenges around employee burnout, efficiency, and improving the member experience.
SCAN, a nonprofit Medicare Advantage carrier with more than 277,000 members across five states, receives millions of calls from seniors every year.
The company's call center employees, or member service advocates, often juggle multiple tasks, including managing call notes, researching information, and assisting members in real time.
"At that scale of random sampling, you'll never capture all of the scope of what our members are talking to us about, so that was the genesis of this project," Corinne Stroum, SCAN's head of emerging technologies, told Becker's.
In 2023, SCAN identified call center operations as a prime candidate for AI integration. Following a vendor selection process, the company partnered with Cresta, an AI tool designed to assist MSAs with real-time transcription, automated note-taking, and guided workflows. Cresta also offers suggestions for addressing member inquiries, helping MSAs resolve issues such as managing supplemental benefits or changing primary care providers.
"As we were going through this ideation process I thought, what are the rules of the game here for us? What would we do, and what would we not do, even if we could? One of the things I put first and foremost is to never put AI between us and our members," Ms. Stroum said.
In an Advisory Board case study published in November, the company detailed its phased rollout of the new technology, with a small group of employees testing the system during a one-week soft launch. SCAN gathered feedback and made adjustments before deploying the tool across the organization.
By September, 96% of MSAs had adopted Cresta, with AI assisting in 78.5% of calls. There was an 89% overall call satisfaction rate and a Net Promoter Score of 82. Nearly 99% of surveyed members said MSAs communicated clearly, and there was a 1.6 point improvement in single-call issue resolution from April to August. Call-related after-work times initially increased but eventually normalized as MSAs became more familiar with the AI-powered workflows.
"You don't have to wait for your agents to go search for answers, which ties into more consistent and reliable experiences," Ms. Stroum said. "I've been able to peek in on the calls and when the hints pop up, sometimes the member might say something like, 'Wow, how did you know that?' They seem delighted by some of the experiences. Some of the agents, we get feedback in both directions. It's a big workforce change and we need to manage this as a process and a personnel change as well."
SCAN then expanded the use of Cresta to its sales teams in August and is looking to scale the tool across other departments. Those plans include adding new features, such as generating talking points for common member inquiries.
Ms. Stroum encouraged other healthcare organizations, not just insurers, to leverage AI to improve operations and personalize the member and patient experience, starting with a review of untapped data sources such as unstructured call transcripts. She also noted the importance of fostering digital and AI literacy among employees to support adoption.
"We have a technology that allows you to infinitely change the way that you communicate with someone," she said. "That is truly the opportunity to meet the members where they are and for who they are."