This post was originally published Aug. 7, 2017, and updated March 11, 2020.
At HealthJoy, we know better than most the impact of choosing the right medical facility or provider on healthcare outcomes and cost. Sure, choosing the right provider or facility can mean less out-of-pocket spend for your employees and lower employee costs for your company. More importantly, though, finding a highly-rated provider can mean a better healthcare experience. That’s a responsibility we don’t take lightly. Our sophisticated internal processes and technology deliver superior results compared to review sites or referrals alone.
How it startsWe direct members to the highest quality, best priced, and most convenient facilities based on their needs. We’re able to do this because our platform integrates health plan information, medical needs, member preferences, and past interactions to guide our research. Whether a member needs a general practitioner, specialist, surgery facility, or imaging center, all provider search requests begin the same way. A member opens the HealthJoy app and selects “Find a Provider” or “Find a Facility” from the buttons in our main menu.
From there, our AI-powered virtual assistant, JOY, leads them through a series of questions. She’ll ask about the type of provider they’re seeking, and inquire about other preferences like gender, affiliations, and maximum distance from a location like their home or office. Once they finish telling JOY what they want, our healthcare concierge team can get to work.
How a search works
Our team of healthcare concierges comes from diverse backgrounds, including customer support, healthcare, and medical claims. They spend time doing deep research on behalf of each member’s request—valuable time saved by our members. Armed with our recommendations, members can be certain they’ll see a provider or visit a facility that is highly rated by fellow patients, in-network, and appropriately priced.
To get started, we consider all the information the member provided to JOY. They might want to see a female OBGYN, or need to find a CT scan within 10 miles of their home. JOY passes all their preferences along to a healthcare concierge so they can begin working on the request.
First, it’s important for our team to consider the member’s specific health insurance plan. Going outside a healthcare network for care can cost employees hundreds or even thousands of dollars. This step is easier said than done, though, because in-network qualifications are not straightforward. While the facility where a procedure is done might be in-network, the specific provider might not be—or vice-versa. That’s why we start our provider search using the specific health plan’s search tools. Our diligence in assuring an in-network recommendation is one of the biggest ways we save members money. However, we don’t stop there.
Once we’ve located an in-network provider near the member’s preferred location, we begin to dig deeper. We look into the provider’s patient ratings and reviews across several websites. We make sure there are no malpractice claims against them—something that might be difficult for members to check on their own.
Next, whenever possible, our team will find an estimated cost for the visit and compare it to the estimated costs in the area. We’ll only recommend facilities that are at or below the average cost in the area. Since a lack of price transparency makes pricing a guessing game, our researched estimates are a significant piece of the cost-saving puzzle for our members (see Make Healthcare Shoppable with Price Transparency for more).
Finally, we take the extra step of calling the provider to ensure all the details we’ve uncovered, from the provider’s specialty to their availability, are still true.
Within 24 hours, a concierge sends their recommendation to the member. It includes an estimated cost (when available), contact details, and location. If the member needs help, we can even book an appointment on their behalf.
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Why nurse lines alone won’t cut it
We’ve spent five years developing a healthcare engagement platform that leverages artificial intelligence and virtual assistant technology for a reason.
Over 80% of our inbound and outbound client interactions are handled by our virtual assistant. This frees up our staff to perform higher-level tasks that “Old School” services must do manually. Things like asking members’ form data, submitting prescriptions, uploading medical bills, and more are all handled in a more efficient manner than the nurse line model.
Think about it this way: if the average registered nurse has an hourly rate of $32.66 an hour in the United States, how many outbound calls can you really expect them to make? If the average call lasts just 15 minutes, it would cost them $8.16 per outbound call. This doesn’t even take into account busy signals, unanswered calls, time to dial, call-backs, etc. Would you expect them to really make outbound calls and engage your members? Yes, they might do a little claims data analysis every quarter or at the start of the program and reach out to the members who spend the most, but what about the rest of the members? What about the rest of the year?
We’ve designed our system to be proactive from the start, engaging all members consistently before there’s even a problem. While nurse lines might focus on managing care for the most expensive 10% of employees, our process allows us to redirect care and cut costs for every member.