The Impact of AI Technology and Automation on Healthcare Call Centers
Enhancing the access experience and preserving human resources
Abstract
Healthcare call centers are increasingly critical as the first point of contact for patients, handling everything from appointment scheduling to patient inquiries. However, these centers are facing mounting challenges due to the healthcare labor shortage, rising operational costs, and the growing complexity of patient needs. With high call volumes, long wait times, and staff shortages, call centers are under immense pressure to maintain efficient operations while ensuring a positive patient experience. At the same time, healthcare organizations are being asked to do more with fewer resources, all while controlling costs and improving financial outcomes. As the front door to both patient care and revenue, call centers play a vital role in shaping the patient journey and influencing the financial health of an organization.
AI and automation technologies present a powerful solution to these challenges, offering the potential to significantly improve operational efficiency, reduce costs, and streamline patient access. By integrating AI-driven solutions, healthcare providers can automate routine, low-touch tasks such as patient verification, appointment scheduling, and basic inquiries, freeing up valuable staff time for more complex, high-touch interactions. This not only reduces wait times and increases call center capacity, but it also improves the overall patient experience by providing faster, more consistent service.
This white paper delves into the transformative impact of AI and automation on healthcare call centers, emphasizing how these technologies can address key challenges and unlock substantial benefits for providers. Specifically, it explores how AI can help healthcare organizations reduce labor costs, optimize staffing levels, and improve key performance metrics like first-call resolution and average handling time. By embracing AI and automation, healthcare systems can enhance their operational performance, reduce strain on their human workforce, and ultimately deliver more personalized, accessible care without the need for expanded staffing or increased operational expenses. In this way, AI and automation not only help meet the growing demand for healthcare services but also empower call centers to drive both improved care outcomes and financial sustainability.
Part One: The Healthcare Call Center Challenge
Healthcare call centers play a critical role in ensuring patient access to care, handling everything from appointment scheduling to medication inquiries and post-care follow-ups. These centers are essential in managing patient interactions and improving access to services. However, traditional call centers are often overwhelmed by fluctuating call volumes, resulting in longer wait times, frustrated patients, and stressed staff. With an annual turnover rate of 60% for call centers across industries, maintaining a stable workforce is a significant challenge—one that is compounded by the growing shortage of healthcare workers.
Training and retaining skilled staff is a considerable investment for healthcare providers, especially when managing the complex patient inquiries that are common in the healthcare sector. High turnover rates create a cycle of inefficiency, leading to increased operational costs, a workforce that isn’t always operating at the top of their capabilities, and difficulty in providing consistent, high-quality care.
Beyond the workforce crisis driven by the pandemic, rising operational costs and inflationary pressures are further challenging healthcare organizations. The cost of medical supplies, equipment, and prescription drugs is expected to remain high, placing added financial strain on the sector. In this environment, payer-provider contracts—already under pressure due to ongoing evaluations—may need to be renegotiated to
cover these rising expenses. However, many payers are offering minimal increases, often only 2-3%, which may not fully offset the impact of inflation.
Restoring pre-pandemic profitability is a significant challenge. To achieve long-term success, healthcare organizations must balance high-quality care with financial sustainability. Healthcare call centers play a key role in this recovery, contributing to revenue generation and improving patient interactions. By leveraging technology, call centers can implement strategies that reduce financial pressure, streamline operations, and enhance service delivery, helping healthcare organizations navigate post-pandemic challenges while securing a stable, sustainable financial future.
Part Two: The Rise of AI and Automation
AI and automation are rapidly gaining traction across industries, and healthcare is no exception. Currently, about 20% of healthcare organizations have already adopted some form of AI. The integration of AI technologies in healthcare call centers offers immense potential to automate routine tasks, provide intelligent insights through data analytics, and enhance the overall patient experience. In fact, with a remarkable growth rate of 36.1%, the AI healthcare market in the USA is projected to increase from $11.8 billion in 2023 to $102.2 billion by 2030.
AI technologies, including conversational AI, predictive analytics, and automation tools, are transforming the way healthcare call centers operate. These technologies enable more efficient resource allocation, reduce costs, and improve patient satisfaction by providing timely and accurate responses to inquiries. Additionally, 23% of healthcare executives in the USA believe that AI and machine learning are effective tools for improving clinical outcomes, while 15% of US hospitals are prioritizing AI applications to enhance clinical documentation and dictation processes. This increasing reliance on AI not only optimizes operational efficiency but also sets the stage for significant improvements in patient care and clinical practices.
Applications of AI in Healthcare Call Centers
Better for Providers, Better for Patients
Provider Benefits
Operational Efficiency: By automating routine tasks, healthcare call centers can significantly reduce staffing costs. Virtual assistants and chatbots can handle a large volume of inquiries that would otherwise require human agents. This leads to a more streamlined operation and lower labor costs.
Scalability: As patient demand fluctuates, AI-driven solutions provide scalability without the need for proportional increases in staffing. This is particularly valuable during peak times, such as flu season, when call volumes can surge unexpectedly.
Reduced Training Costs: Traditional call centers require extensive training programs to ensure staff can handle various inquiries. With AI handling routine tasks, the need for such training is reduced, leading to cost savings and faster onboarding of new employees.
Focus on Complex Cases: By automating routine inquiries, AI allows call center staff to focus on more complex cases that require human expertise. This ensures that patients with urgent or complicated needs receive the attention they deserve, leading to better outcomes.
Reduced Burnout: High call volumes and repetitive tasks often lead to burnout among call center staff. By offloading routine tasks to AI, staff can work in a less stressful environment, reducing turnover rates and the costs associated with recruiting and training new employees.
Data-Driven Decision Making: AI provides valuable insights through data analysis, enabling healthcare providers to make informed decisions about resource allocation, patient care strategies, and operational improvements. These insights can lead to more efficient and effective healthcare delivery.
Compliance and Risk Management: Automation of data entry and record-keeping reduces the risk of human error, enhancing compliance with regulatory requirements. This is particularly important in healthcare, where accurate record-keeping is crucial for patient safety and legal compliance.
Patient Benefits
24/7 Availability: AI-driven solutions ensure that patients have access to support at all times, even outside of regular business hours. This is particularly beneficial for patients who need assistance during emergencies or those in different time zones.
Reduced Wait Times: Automation of routine tasks and inquiries leads to faster response times, minimizing patient frustration and improving overall satisfaction.
Tailored Interactions: AI can leverage patient data to personalize interactions, offering responses that are specifically tailored to the patient’s history and preferences. For example, when a patient calls about a medication refill, an AI system can automatically reference the patient’s medical records to provide accurate information on dosage, timing, and potential interactions with other medications.
Proactive Health Management: AI-driven automation enables healthcare providers to proactively manage patient health by sending reminders for upcoming appointments, medication adherence, or routine check-ups. This ensures that patients are engaged in their healthcare journey, leading to better adherence to treatment plans and improved health outcomes.
Seamless Experience: AI can create a more cohesive and streamlined experience for patients by integrating various touchpoints across their healthcare journey. For instance, a patient could start an inquiry through a chatbot on the healthcare provider’s website, receive follow-up information via email, and then confirm an appointment through a phone call—all orchestrated seamlessly by AI systems.
Empowerment through Self-Service: AI-driven self-service portals give patients more control over their healthcare interactions. By providing easy access to their medical records, appointment schedules, and other resources, patients can engage with the healthcare system on their terms. This empowerment leads to higher satisfaction and a stronger sense of partnership between patients and providers.
Part Three: Part Three: Case Studies and Real-World Examples
Case Study 1: AI Picks Up Verification Process Improving Handling Speeds
A small physician group sought solutions to improve patient access and scheduling without increasing full-time equivalent (FTE) staffing, as their call center's budget was already maxed out while struggling to keep up with rising patient demand, resulting in poor service levels. The problem was a matter of scale, with the number of agents failing to match the organization's growing patient base, causing delays and longer wait times during peak hours, which negatively impacted the patient experience. To address this, the group collaborated with a technology partner to develop a step-by-step solution, integrating a customized technology build that incorporated conversational AI into the existing phone tree. This automated the patient verification process, allowing calls to be answered immediately, guiding patients through verification, and routing them to the appropriate agent.
Case Study 2: AI Syncs With Agents For Automated Call Resolution
A large non-profit organization was facing increasing dissatisfaction with long handling times in their patient access center. Under pressure to improve key metrics like average handling time and first-call resolution without expanding their full-time employee (FTE) count, they sought ways to enhance performance while controlling costs. The root issue was a capacity gap: the number of agents had not kept pace with growing patient demand. This led to service challenges, such as slower response times and longer wait times, which negatively impacted the patient experience. In collaboration with a technology partner, they designed a phased solution that integrated conversational AI into the existing phone system. This automated patient verification and managed low-touch calls, allowing the system to handle incoming calls, guide patients through verification, and manage FAQs and appointments without agent intervention.
Case Study 3: AI Technology Clears the Line on Staffing Needs
A large southern non-profit organization was facing rising dissatisfaction with long handling times in their patient access center. Under increasing pressure to improve call center performance and enhance the overall patient experience, they began looking for solutions to boost key metrics like average handling time and first-call resolution rates. However, they were determined to make these improvements without increasing their full-time employee (FTE) count, as managing operational costs was a top priority. This led them to explore alternative strategies that would streamline processes while maintaining, or even improving, service quality.
Part Four: Challenges and Considerations
Integration with Existing Systems
Technical Challenges: Implementing AI solutions in healthcare call centers requires seamless integration with existing Electronic Health Records (EHR) and call center systems. This integration can be complex, requiring careful planning and coordination between IT teams and AI vendors to ensure compatibility and functionality.
Staff Training: While AI handles many routine tasks, staff must be trained to work alongside these technologies effectively. This includes understanding when to escalate issues to human agents, how to use AI-driven insights, and how to maintain a high level of patient care.
Patient Acceptance
Trust in AI: One of the challenges in implementing AI in healthcare is ensuring that patients trust these technologies. Concerns about privacy, data security, and the accuracy of AI-driven interactions must be addressed through transparent communication and rigorous security measures.
Balancing Automation with Human Touch: While automation can enhance efficiency, it is crucial to maintain the human element in patient interactions. Patients often seek reassurance and empathy, which are best provided by human agents.
Striking the right balance between AI-driven automation and human touch is key to success.
Part Five: The Future Outlook
Evolving Role of AI in Healthcare
As healthcare continues to evolve, leaders are increasingly focused on improving the patient experience, ensuring that care is more accessible, personalized, and efficient. From reducing wait times to enhancing communication, the goal is to create a seamless journey for patients at every touchpoint. A key part of this transformation lies in leveraging new technologies, including artificial intelligence (AI), to streamline operations and support healthcare teams in providing high-quality care.
Expanding access to care remains a top priority for many healthcare leaders, with an emphasis on overcoming barriers such as financial constraints, transportation, and the need for more providers in underserved areas. These efforts are aimed at ensuring that all patients receive the care they need in a timely and efficient manner, improving both outcomes and satisfaction.
In this context, AI is playing a pivotal role in shaping the future of healthcare delivery and innovative providers will be at the forefront.
Conclusion
The integration of AI and automation in healthcare call centers presents significant opportunities for both providers and patients, offering benefits such as improved operational efficiency, better resource allocation, and cost savings for providers. For patients, AI brings enhanced accessibility, personalized care, and an overall improved experience. However, as healthcare evolves, it's clear that the most successful solutions will be those that blend the power of technology with the irreplaceable value of human care.
While AI and automation will play a crucial role in streamlining processes and enhancing care delivery, the nature of healthcare means that human interaction will always be essential. Compassion, empathy, and the nuanced understanding that only a human caregiver can provide remain vital to creating meaningful patient experiences. As a result, the "Human plus tech" model—where technology empowers healthcare professionals rather than replacing them—will be the key to achieving sustainable, high-quality care.
Moving forward, AI will serve as a powerful tool to support healthcare teams, allowing them to focus on the human aspects of care while technology handles administrative tasks and streamlines processes. As healthcare systems adopt AI to stay competitive and improve patient outcomes, it will be essential to ensure that technology enhances rather than diminishes the human touch at the heart of care.
Sources:
AHA. (2024). 5 health care workforce shortage takeaways for 2028: AHA. American Hospital Association. https://www.aha.org/aha-center-health-innovation-market-scan/2024-09-10-5-health-care-workforce-shortage-takeaways-2028
Alowais, S. A., Alghamdi, S. S., Alsuhebany, N., Alqahtani, T., Alshaya, A. I., Almohareb, S. N., Aldairem, A., Alrashed, M., Bin Saleh, K., Badreldin, H. A., Al Yami, M. S., Al Harbi, S., & Albekairy, A. M. (2023, September 22). Revolutionizing Healthcare: The role of Artificial Intelligence in Clinical Practice. BMC medical education. https://pmc.ncbi.nlm.nih.gov/articles/PMC10517477/
Bernzweig, M. (2023, November 27). Ai’s healthcare transformation: Trends, stats, and future. Software Oasis. https://softwareoasis.com/ai-healthcare-trends-stats-future
Bongurala, A., Save, D., Virmani, A., & Kashyap, R. (2024, September). Transforming health care with artificial intelligence. Mayo Clinic Proceedings Digital Health. https://www.mcpdigitalhealth.org/article/S2949-7612(24)00041-5/fulltext
Deloitte. (2023, November 16). Deloitte: Consumers believe generative AI could make health care more affordable. PR Newswire: press release distribution, targeting, monitoring and marketing. https://www.prnewswire.com/news-releases/deloitte-consumers-believe-generative-ai-could-make-health-care-more-affordable-301989943.html
Dyrda, L. (2024, December 2). 11 top health system C-suite priorities for Better Patient Care in 2025. Becker’s Hospital Review. https://www.beckershospitalreview.com/hospital-management-administration/11-top-health-system-c-suite-priorities-for-better-patient-care-in-2025.html
Horizon. (2022). Ai in healthcare market size, share & growth report, 2030. AI In Healthcare Market Size, Share & Growth Report, 2030. https://www.grandviewresearch.com/industry-analysis/artificial-intelligence-ai-healthcare-market
Invoca. (2023, June). The state of the Contact Center - GT the state of the contact center report 2023. The State of the Contact Center. https://experience.invoca.com/the-state-of-the-contact-center-report
Mensik, H. (2022, September 15). Healthcare industry’s resiliency to surging inflation is poised to Ebb. Healthcare Dive. https://www.healthcaredive.com/news/inflation-delay-trickle-healthcare-costs-providers-payers-consumers/631873/
Rebelo, A. (2023, December 12). Wolters Kluwer Survey finds Americans believe Genai is coming to healthcare but worry about content. Wolters Kluwer. https://www.wolterskluwer.com/en/news/wolters-kluwer-survey-finds-americans-believe-genai-is-coming-to-healthcare-but-worry-about-content
Statista. (2021). AI technologies in use in healthcare worldwide in 2021 | statista. AI technologies in use in healthcare. https://www.statista.com/statistics/1225986/ai-technologies-in-use-in-healthcare-worldwide/
Swinscoe, A. (2023, July 31). Recent research suggests that something has to change in the Contact Center Space. Forbes. https://www.forbes.com/sites/adrianswinscoe/2023/07/26/recent-research-suggests-that-something-has-to-change-in-the-contact-center-space/
Tyson, A. (2023, February 22). 60% of Americans would be uncomfortable with provider relying on AI in their own health care. Pew Research Center. https://www.pewresearch.org/science/2023/02/22/60-of-americans-would-be-uncomfortable-with-provider-relying-on-ai-in-their-own-health-care/
Vogel, S. (2024, July 1). Healthcare Workers’ compensation rose in 2023 amid staffing shortages: Report. Healthcare Dive. https://www.healthcaredive.com/news/healthcare-compensation-increased-2023-mgma/720262/
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