Opkit has launched a solution that will automate many of the time-consuming calls that medical practices must complete, taking up time that might be better spent on serving patients. OpKit’s generative AI proactive call centre can already automate a wide variety of calls that include:
- Verification calls to insurance payees
- Authorization for medical insurance
- Confirmation of insurance claims calls
- Calls to pharmacies for prescription checks
- Calls to collect medical records
Sherwood Callaway, Co-Founder and CEO at Opkit, commented, “For better or worse, today’s healthcare system runs on manual phone calls. The industry has been slow to adopt electronic transactions, mainly because payers are not incentivized to streamline these processes. There’s also HIPAA, which makes it risky for healthcare companies to share data.
“Some back office phone calls are simple to automate, but others are very complex – too complex for current AI. What happens when the AI doesn’t understand a speaker’s accent, or when the person on the other end of the call refuses to speak to the AI and hangs up? That’s where Opkit’s human-in-the-loop approach comes in.”
An AI-assisted solution
The solution is not a black box automation as Opkit maintains the human-in-the-loop. It enables medical operations staff to monitor performance, handle exceptions and improve and train the AI solution.
Staff members control when the AI solution makes calls. Staff are assisted with the decision as to whether the AI solution should conduct the call or whether it lies outside its parameters. The user can confirm whether the AI should take the call. Perhaps the user might have a specific reason for making the call.
Staff are able to set up phone tasks and then let the generative AI handle the call. The solution uses interactive voice response to navigate through decision trees, asking and answering questions as required for each specific call. The system also comes with being placed on hold. It means that much of the time wasted by staff can be used productively.
If the AI call fails to complete the assigned call task, it will be automatically assigned to a human to undertake the call, highlighting the failed attempt.
As the AI learns through this process, it can take on more complex use cases as the Opkit AI improves. Each learning interaction enables the AI to take on more call volumes.
Justin Ko, Opkit Co-Founder, commented, “Conversational AI is incredibly powerful, but it isn’t a solution by itself. AI needs to be embedded in a useful product and supported by a team of humans that can monitor performance and step in when it fails. That’s where we invested our efforts.”
Automation and integration
The calls are always recorded and automatically transcribed, with staff able to review and update information. Opkit can also extract data from calls using pre-defined fields, and then users can extract the call results in a CSV or XLSX format. It is also working on integrations with EHR, CRM and PMS systems to provide a complete end-to-end solution for patient care.
Opkit has already announced a partnership this week with Tellescope, a HIPAA-compliant CRM platform for digital health and telemedicine companies. Opkit will enable Telescope users to deliver a digital patient experience.
Sherwood Callaway, CEO of Opkit, commented, “Opkit’s main goal is to automate tedious and time-consuming tasks for healthcare providers and their support staff. By teaming up with Tellescope, we can provide significantly more automation for our customers.”
The solution is supported with a developer open API, and is supported with a Trust Centre that details the security and compliance controls that the solution adheres to. These include HIPAA, SOC 2 Type II, and encryption. Software engineers can help build more integrations and support more complex use cases for their organization.
Fella and Flourish seeing the benefits
Opkit has already conducted beta testing for the platform. The virtual weight loss clinic, Fella has freed up employee time to focus on patient support and enrolment instead of back office tasks. It has automated prescription checking and also identifying hard to find medications such as Ozempic.
Virtual nutrition clinic Flourish is using the solution to verify patients’ insurance coverage and benefits during intake. Without Opkit they would have had to build a call centre from scratch to support the business use.
Devin Solanki, Co-Founder of Flourish, said, “We literally could not run our business without Opkit. I’ve been really impressed at Opkit’s reliability and accuracy. They consistently complete calls on time and deliver high-quality results.”
Pricing and business benefits
Delivering healthcare is expensive, and an article published in the Journal of the American Medical Association Network identified that it has double the 0.85 ratio of administrative support than other service industries. In a more recent article, Patil and Shankar noted, ”Artificial intelligence (AI) algorithms can examine operational data and patient flow patterns to spot inefficiencies, resulting in the simplification of administrative work, enhanced patient scheduling, and better resource management.”
They then add, “Partnerships that use AI technologies and integrate them with healthcare knowledge promote innovation, improve patient engagement, optimize diagnostic and therapeutic procedures, and ensure ethical and legal compliance.”
Opkit is achieving this with its solution, improving the efficiency of communications between medical offices, payers, insurers, and pharmacies that continue to rely on phone calls.
While it adds efficiency to operations, there is also a cost. Opkit charges are based on the number of calls and the duration of those calls. It has been estimated that the price makes a considerable saving over using a third party offshore call centre of a full-time employee to conduct the work.
This means that costs scale up and down with the work that it conducts. It also allows parallel calls, enabling backlogs or a surge in demand to be dealt with efficiently. The AI data extraction also makes it more efficient and accurate that humans, especially minimally trained call centre staff. Opkit has not, however revealed details of charges, what uplift from call costs it charges, not whether there is a scaling price on the number of calls. The information available does not give any indication of onboarding time or the savings that existing customers have made.
Enterprise Times: What does this mean
The Opkit solution enables medical operations to take a step forward in digitization. However, it also recognizes that this solution will have a shelf life as intercompany systems become more electronic.
There is little to stop the direct integration of medical practices with pharmacies and insurance company systems. Yet there is a reluctance to develop and implement these partly because of security concerns. What Opkit delivers is a solution that can bridge those gaps. Still, it will also be able to develop new use cases, notably around patient engagement and processes such as onboarding.
The Tellescope announcement should also be one of many, and it will be interesting to see what other integrations Opkit creates and which vendors it partners with.
