Healthcare operations, such as customer care contact centers and revenue cycle departments, often face significant challenges: high volumes, stressful environments, and heavy manual workloads. These teams manage complex, repetitive tasks—like explaining insurance coverage or guiding patients through financial decisions—which can result in inefficiencies and burnout.
AI is proving to be a game-changer in addressing these burdens. When applied effectively, AI can reduce workloads, cut costs, and improve staff experiences. These opportunities were the focus of a recent roundtable discussion at Becker’s Hospital Review 15th Annual Meeting, sponsored by EXL and moderated by Keri McCrensky, Vice President for Digital Transformation at EXL.
Three Key Takeaways
- AI is driving operational transformation.
Contact centers, where patients and members seek help with tasks like renewing ID cards or understanding coverage, are ideal for AI-driven improvements. AI can streamline processes, reduce manual effort, and improve the overall experience for both staff and members. - Automation is simplifying healthcare workflows.
One example shared during the roundtable involved a health plan leveraging natural language processing (NLP) and AI-driven authentication to automate the ID card renewal process. Organizations are also exploring advanced automation—including OCR (optical character recognition), RPA (robotic process automation), and AI—to improve coverage determinations.
The goal is to empower customer service representatives by reducing time spent on repetitive tasks like authentication and post-call processes, lowering average handle time without increasing labor costs. - Measuring AI’s impact requires clear metrics.
To evaluate AI’s return on investment (ROI), healthcare organizations focus on four key metrics in the contact center:
• Cost to serve
• Average handle time
• Call rate per member per month
• Customer effort score (CES)
Narrowing AI implementation to specific call drivers allows for more targeted insights and better tracking of monthly improvements across these metrics.
Expanding AI Beyond Contact Centers
AI isn’t just transforming contact centers — it’s making waves in other areas of healthcare, such as:
- Automating medical coding
- Enhancing pre-authorization workflows
- Strengthening cybersecurity
- Structuring data from contracts
- Reducing medical expenses
To ensure responsible adoption of AI, many organizations are forming governance committees to oversee these transformations. These committees focus on aligning AI initiatives with organizational goals and maintaining ethical standards.
As one roundtable participant put it: “The future of AI in healthcare is bright—especially in areas like authorization and claims denial management.” With the right tools and strategies, AI is poised to revolutionize healthcare operations, improving efficiency and delivering better outcomes for both providers and patients.
