AN AUTOMATED APPOINTMENT SCHEDULING SOLUTION

USE CASE

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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.

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AN AUTOMATED APPOINTMENT SCHEDULING SOLUTION

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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

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