About
Care gaps occur when members miss recommended preventive services, screenings, or follow-up care essential to their health management. Healthcare payer organizations prioritize closing these gaps to improve health outcomes, reduce costly complications and emergency visits, meet quality metrics, enhance HEDIS scores, and ultimately deliver more effective, value-based care to their members.
The Challenge
This major payer organization was manually reaching out to members each month to address gaps in care. Their skilled nurses spent thousands of hours annually on administrative tasks such as searching for contact information, calling wrong numbers, and manual documentation rather than having meaningful conversations. This manual process was not only time-consuming but also diverted nursing time away from tasks that actually required medical expertise.
The Solution
Amitech, a Naviant Company, partnered with this customer to implement an intelligent automation solution, reimagining member outreach. The comprehensive bot system automates the entire workflow by gathering member details from CSW, completing the required forms, scheduling follow-up tasks, and generating opportunity letters when needed, freeing their nurses from unnecessary administrative burden.
Implementation
The process for implementation is as follows:
- UiPath Task Capture: The manual process was analyzed for automation by UiPath Task Capture.
- Internal Member Information System: The bot is provided with a list of members to be contacts and it retrieves details for each from the internal system.
- Information Sent: The bot sends member information to the assigned nurse’s workstation for the outreach call.
- Affinite (Case Management): If contact is unsuccessful, the bot updates the information in Affinite and creates a follow-up task for a later date.
