A lot can be learned by monitoring individual customer service calls, analyzing patient experience, and optimizing call performance, but a systemic and scalable approach has always seemed out of reach.
But new AI technologies are flipping the script on this age-old roadblock.
In this episode of CareTalk, David E. Williams and John Driscoll are joined by Amy Brown, CEO of Authenticx, to explore how AI can improve patient experiences, efficiently gather and analyze data from call centers, and what the future of AI in healthcare holds.
This episode is brought to you by BetterHelp. Give online therapy a try at https://betterhelp.com/caretalk and get on your way to being your best self.
As a BetterHelp affiliate, we may receive compensation from BetterHelp if you purchase products or services through the links provided.
Episode Transcript:
David E. Williams: Healthcare executives can learn a lot by monitoring individual customer service calls, but it's not a scalable or systematic approach. The holy grail is to analyze and activate customer interaction data at scale. How can today's AI-based technologies make that goal attainable?
As kids, we're always learning and growing, but as adults, we can sometimes lose that sense of curiosity that makes life exciting. It's easy to fall into a routine. Therapy can help you break out of it. If you've been considering starting therapy, now is the perfect time to give it a try. BetterHelp offers entirely online therapy that's designed to be convenient, flexible, and tailored to fit your schedule.
Whether you're dealing with stress, anxiety, or seeking personal growth, BetterHelp connects you with licensed therapists who can support you on your journey to rediscovering your curiosity and becoming your best self. Don't miss out on therapy. Visit BetterHelp. com slash CareTalk to get 10 percent off your first month and take the first step toward enhancing your mental well-being.
That's BetterHelp, H E L P, dot com slash CareTalk. Welcome to CareTalk. America's home for incisive debate about healthcare business and policy. I'm David Williams, President of Health Business Group.
John Driscoll: And I'm John Driscoll, Senior Advisor at Walgreens.
David E. Williams: Today's guest, Amy Brown, is the Founder and CEO at Authentics, which is on a mission to help humans understand humans.
Join the vibrant CareTalk community on LinkedIn, where you can dig deep into healthcare business and policy topics, access CareTalk content, and interact with the hosts. And our guests, and please be sure to leave us a rating on Apple or Spotify while you're at it. Amy Brown, welcome to Care Talk.
Amy Brown: Thank you.
It's so great to be here.
John Driscoll: So Amy, how did you decide to take on patient, the wonderful patient experience that that U. S. healthcare represents today? How did you come to this particular journey?
Amy Brown: Yeah, you know, it was just something that I could no longer ignore because I was working for a couple of decades, actually, on the business side of health care spent most of my career at preauthentics in the payer space, but.
But dabbled in provider-owned health plans, as well as a little bit of pharmaceutical manufacturing. And through all of that, my role was to manage the teams that interfaced with customers all day long. And customers might be healthcare consumers, patients, and they might be other members of the healthcare ecosystem, like providers, healthcare providers, and you know, in, in managing those teams, I just saw firsthand the administrative.
The complexity of our system. And I also see. could hear from our customers through our contact center, just how confusing and complex it was. And, you know, we were, most companies are recording their conversations but they're not really using them at scale to help improve the system itself. And so I just got to a stage in my career and a stage in my life where I could no longer.
Kind of sit by and watch, watch that happen without trying to make an impact. And so in 2018, I left my corporate career and took the leap to build a company to help solve the problem of making sure everyone in the healthcare ecosystem has access to the literal voice of their customer and to learn from that in a way that can, can drive systemic change.
David E. Williams: So Amy is a, is an interesting time 2018. So you gave yourself a couple of times to get, a couple of years to get going before the pandemic hit and now we're a couple of years. Beyond that, how has the patient experience itself evolved? Are things now better? And if you were in 2024, you'd say, okay, I wouldn't have left what I was doing 'cause everything's been solved.
Is it worse? Is it, is it different? But what's, you know, what's, I, I have my own answer. Answer how patient experience is, but what's, what's the general state?
Amy Brown: I wouldn't say it's better. I'd say that there's been obviously a lot of innovation in the last six years of companies and startups trying to help improve access to customers.
So you see a lot of digital front door-type options being spun up and deployed. We see health systems trying to, you know, rebound from COVID massive cost pressure there. We see major competition amongst specialty brands and pharmaceuticals, a lot of you know competitive products out there, everybody trying to capture market share.
On the payer side, a lot of competition on the Medicare Advantage side. And so everybody's trying to figure out how to deliver a positive customer experience at, in the cheapest way possible. And sometimes those two things conflict with each other. And there's a lot of hope that's been put on the back of AI to solve the world's problems.
And, you know, we are an AI company, but I see a lot of. Turning and paralysis in the market right now around the topic, of adoption and deploying AI to solve problems. And there's a bit of a mismatch right now between what executives think AI can do for customer experience and the bottom line versus kind of the reality of deploying AI in a way that actually drives to those changes.
So it's an interesting time to be in this space.
John Driscoll: But, but Amy, to be fair to the health care system, we're, we've got a wealth of data now on the patient experience. There's all the press Ganey stuff, which I was involved in for a few years that takes information on patient experience that hospitals pay a lot of attention to.
There are rankings of hospitals. There are the, the the healthcare, the Medicare HCAP scores that are now much more focused on what was your. What was the customer experience that feeds into STARS, which is how people get paid in Medicare Advantage? Shouldn't we be in the golden age of patient experience, notwithstanding David's constant complaining about things not working for him?
David E. Williams: John, I forgot you were going to get sensitive about the fact that you're on the Press Ganey board and it was supposed to have solved all problems. Yeah, it was, you know.
John Driscoll: No, no, we just, we just, we just, we call, we call him as we see him. We don't, you know, we're, we're, we're responsible for reporting. You're responsible for helping make change, David. Yeah.
Amy Brown: Well we're certainly not at a loss of, of, of data where we're almost drowning in data. And, it's easy to kind of get overwhelmed by the amount of data that the health system has access to. Our view is that historically there's been a really significant missing piece of the puzzle. You know, through this, the, the, the CX customer experience evolution, there are many solutions out there aimed at understanding, you know, customers feedback and not only their feedback on satisfaction but also, you know, we survey them to tell us what their social determinants of health are the problem with all of that.
And why I believe it's incomplete is that it's a skewed data set. When you survey someone, you're, you are dependent on, first of all, a subset of humans to respond to surveys. You're also designing the questions. That you, the company wants to know, which biases the input that you get, the reality is, is that there are almost a billion customer conversations that happen in this country alone every year that are recorded, where customers are unsolicitedly telling you in the moment.
What their frustrations are, how they're getting stuck, why they have a gap in care, why they can't get access or start their therapy, why they haven't started their mental health care plan, why they're not going to follow their discharge plan. I mean, they're telling us. All day, every day, and they're,
John Driscoll: Amy, you're, you're kind of saying that, that patients are talking and providers in the system aren't listening.
Amy Brown: They're not, they're listening to survey data, which is incomplete. And I think there is a belief that, well, these call centers are, they're administrative, they're transactional. There's nothing to glean here from these conversations that can help the care. And that's just wrong. We know that from listening to the data.
David E. Williams: One of the interesting things that you describe is that you know, with all these, this billion conversations, all these things that are happening and all the different complexity, you got to boil it down to something you'd call the Eddie effect and described as the, as the quote from yours, you say the most, the most reliable metric to identify customer friction points.for healthcare leaders. What is this eddy effect? And is it like the grand unifying theory to explain the customer problem?
Amy Brown: Yes. Well, I'll first tell you where the Eddie effect idea came from. When we were just getting started in analyzing some size of critical massive data as a company, I went home one day and shared with my husband, Hey, we're seeing this trend in the data where.
Customers are just having to work really hard to get from point A to point B, and we see that through callbacks. We see that through going from chat to call. We see people saying, Hey, you told me I would get this thing. I'm not getting this thing. Now I have to call back again. And it's just the circle circular experience that we're seeing.
And my husband, who is an outdoorsman and a river guide said, well, that sounds like a river Eddie, which is, you know, when you think about the current and a river flowing downward when there's an object that falls in the river, like a big boulder, it actually creates a current. Counter circular effect on the current and things get stuck there.
And that made so much sense to me because, you know, we think of our customer journeys, we design a map, right? And we think that they're beautiful. And we assume that customers are flowing through the customer journey without obstacles. And the reality from listening to the actual customer journey is people are getting stuck all the time.
So we've designed and built a proprietary machine learning model that knows how to detect. Customers who are getting stuck in their journey, it's called the Eddie effect. And not only have, do we have a model that, that can listen for that? We actually can quantify it.
We can tell you what the root causes of the Eddies are, and we can measure over time, whether systems.
Companies are making a positive impact on reducing the Eddie effect rate, which, by the way, has an impact not only on customer satisfaction and retention, but it also has an impact on profitability for the business, because by definition, Eddie effect interactions are preventable if you're just listening and listening.
Solving for those issues,
John Driscoll: I, I just think it's so wonderful that you can so systematically break down what happens in rivers because David never gets out of the house and it's, it's, it's that, that whole recursive function of customer service, everyone has experienced, whether you're calling your, you know, United or Delta, where you're trying to get through your auto claims.
What, what do you think? different about healthcare? I mean, it sounds like your solution would your, your, your approach would create solutions throughout the customer service that the, the, the barren desert of customers solutions what, what makes it particularly important or relevant in healthcare?
Amy Brown: Yes. Well, I've been asked many times by investors, you know, why not go more horizontal with your solution? And the answer is two things. First in order to have really effective AI to help listen for things, you need to, the AI models need to be fed data that is specific to the context of the industry.
And so we've been committed. To building high quality using healthcare-specific conversations. And we think that that's what makes us competitive in the healthcare space.
But the other reason is because the implications for Eddie's in health care are so much more severe than in other industries. I mean, We can measure patients who literally are dropping off therapies that are sustaining their lives because of administrative burdens.
And that obviously has implications for the patient's lives, and it also has implications for the business. And so it just, it's. It makes sense that we should be focused here because the stakes are so high.
David E. Williams: Amy, let me ask you a little bit about that one about therapies, because a common business process for a healthcare provider is prescription renewals, and they devote a lot of effort to it.
And there's a lot of calls that are coming in about that. Can you talk about how, like, what is that issue there? Where are the eddies and how does an organization learn from you know, this sort of insight at scale? What kind of insight did they get from that other than Yeah, my prescription renewal line doesn't work too well.
Amy Brown: Yeah. So we actually just completed a pretty significant research effort where we took a million conversations that were patients stuck in Eddie's. This is from all of our client data and we serve payers, providers, and pharma, right? So we took all that. We found a million patients who were stuck in Eddie's from a six-month period of time.
And we examined what was going on there. And the number one issue was the prior authorization process. And, and in terms of where, where in the, you know, in the journey, is that getting stuck every single part of the healthcare ecosystem is touching the prior authorization process. They are. So the provider is, the one that, you know, makes the request for care or therapy.
But there are forms, there are appeals, there are financial implications, like just because you get a prior authorization doesn't mean that a patient can actually afford that. So then they call their pharmacy manufacturer to get copay assistance. And then there's. Step therapy, you know, there's, there's all of these steps that have been put in place that we think are there to protect the patient and ensure that the provider is following, you know guidelines.
But the reality is we're wasting billions of dollars just managing that process as an entire health care ecosystem and the burden is mostly born on the providers because they're the ones having to, to, to, to sign and to appeal and to follow up and it's just, it's, it's a mess. I
John Driscoll: mean, do you think, I think it's the bigger burden is on the, the administrative burden is on the provider, but the bigger burden is on the patient. So, most of us who've been looking at healthcare feel that as a problem. How do you start to structure A solution. I mean, in, in, in, in, you know, if you're, if you're in a river, you, you, you sort of spin around in the Eddie, but then you spin back out into the current currently, you know, for, for patients, it's more like a roach motel than an Eddie in many cases, which is why they're falling off of.
Therapy, they're, they're stuck and they, they're, they're falling and they can't get up. I mean, how do we structure something that, that versus just defining it solves it?
Amy Brown: It feels overwhelming, doesn't it, John?
John Driscoll: Well, to people like me and David, yes, but probably to clever people like you, no.
Amy Brown: Oh, it's, it's overwhelming for sure.
And, and for us, you know, our world is listening to healthcare consumers. And when you hear the actual voices telling their stories. Over and over and over again, that weight of responsibility that I feel and that our company feels just as even is even heavier because it's one thing to have the data point.
It's another to hear it. Right? And that's how we help. So we. Our, our solution is designed to help leaders who empowered to make change not only see data at the macro level, but be able to hear the patient friction. And we see something very, very powerful when those 2 data points are combined, when the qualitative voice of customer and the, the trends meet.
Combined. Suddenly people are not only triggered in their brains, but they're also triggered in their heart and their gut. And we're seeing people drive change. So within organizations, we're seeing more cross functional effort between compliance, legal, operations strategy start to remove complexity from their own journey.
But then there's a problem of cross functional, right?
John Driscoll: Before you go there, Amy, I think you're on something super important. When I took over as CEO of care centrics and I was running into a lot of customer service patient challenges. One of the things I started every management meeting with was one very detailed, Failure for a patient and one very detailed success and if you can connect the statistics to people's stories, it's, it was incredibly, it was incredible for me how it just lifted, lifted up and then people self organize.
Around solving problems, because I think most people in health care actually want to solve those problems and they identify with the, with the, with the, with the challenges that people have and can can can come up with solutions, but it needs to be prevented in a, in a human context. And I, I think that that the power of those specific stories, the voices.
Coloring in the details on people's lives really is, once you illuminate that, you illuminate the problem, you can also get people motivated, I think, to solve, solve the challenges. It's, it's a very powerful point you're making, and I've seen it happen in organizations I've led.
Amy Brown: Yeah, thank you, John. We actually have an entire practice within Authentics called Data Back Storytelling, and we, we offer a certification program for our clients to become Data Back Storytellers because it is, you're right, it's not just about getting the data.
It's about, you know, Using the data in an impactful way to inspire and enable human beings to solve problems and storytelling is such a crucial component of that and nowhere needs it. There is no industry that needs it more than corporate health care. So
John Driscoll: so, David, there's an opportunity for you to get certified.
David E. Williams: John, I'm feeling so bad, you know, not only am I, you know, not going to river, you got me in some sort of the desert or whatever. So I'd love to see if I could recover from that. But I want to talk about technology for a minute, Amy, because, you know, when you're dealing with all this amount, one of the reasons it's hard to deal with this data, there's a lot of it and it's unstructured.
It's in a format. That's hard to kind of analyze other than, hey, I listened to something and I, and I heard it. Yeah. It's pretty obvious that, you know, natural language processing is a good fit. And I assume, you know, in 2018, that's, that's definitely a focus. There's been quite a lot of movement in AI since then.
And I'm curious about how you deploy technology, whether it's AI or, or the technology and you know, where that's been successful and then, you know, where some of the challenges lie.
Amy Brown: Yeah at a very early stage in our business, I brought on my CTO, my chief technology officer, who pretty quickly said, Amy, like we need to build an AI company in order to really effectively analyze conversations at scale, but we're going to do so in a way that makes us both proud because I, you know, I was skeptical.
About the power of AI. So we decided that we wanted to 1st ensure that whoever was going to start adding structure to these unstructured data sources needed to be credible in our eyes. And so we employed our own. nurses, social workers and people who have worked inside of health care to listen and to start to tag and label the themes and the topics that we wanted to glean out of of conversations.
This is where the Eddie effect, for example, was invented. Our team said, look, this pattern is happening over and over again. And it's, it's so powerful that we're going to start kind of training a model. And so that's what we, we did. And so we have the way we think about AI. Is it is a think, think of AI as an umbrella term that is a set of tools.
The oldest of those tools available is NLP. I think about NLP in a very simple way. It's like word search and find. You can program it to find very specific words and it can do that at scale, which is really important when you're wanting to find something very specific, but sometimes you don't know what to listen for.
You don't know what the words are and you need AI to help you. By telling you here's the trends, here are the things that are happening. And that's where machine learning and deep learning comes in because they're pretty sophisticated algorithms that can identify patterns and themes that are happening inside of, of these conversations.
And so we've got about 15 machine learning models that have been used to identify very specific things in the healthcare space. Eddie effect is one of them, but we also have an adverse event machine learning model that identifies patients that are complaining of side effects.
John Driscoll: So, so Amy, when you, but I'm intrigued by those, those frameworks and it's really, you know, I love the fact that you've got contextual experts to kind of make sure that The semantics are dialed in the right way and the definitions and all that stuff.
Why were you a skeptic of machine learning? Everybody else, I mean, David and I are blind believers in technology.
Amy Brown: Well, because I used to be a purchaser of speech analytics and telephony platforms, and I bought into a lot of the marketing. around it and was disappointed, right? And I, I also believed, I mean, this was 2018 before ChatGBT and the real boom of AI.
I believed that we needed to go deeper. We needed to understand Things at a deeper level in order to drive real true change. It's not enough to have a data point. You have to understand the context. You have to understand the why behind a problem. And I really wanted to use conversation data to start getting at the why behind data and conversations are so rich with context about why.
David E. Williams: I want to ask a little bit about how you might. Ask call centers to do things differently, given a tool like yours being available. So you mentioned that you can analyze all those unsolicited feedback and get a lot of information out of that. If we know that the data is going to be analyzed in a sophisticated and powerful way, is there something else that would be done?
So, for example, I have plenty of opinions when John doesn't doesn't squelch them, but on a on a customer service call, I usually hold back. Because I'm just trying to do the minimum. I don't expect that the rep can actually do anything. I'm worried it's going to confuse it. Whereas sometimes you'll see at the end of the survey, some of the surveys look like, like anything else.
And, or if you could just say, just, can you just stay in your own words? Or, you know, would there be value to just say, Hey, just give me some other feedback and we'll record it. We've got a way to act on it with that. Would that make a difference? Or can you already deduce everything just from the nature of the conversations?
Amy Brown: There's a lot we can deduce. Honestly, we can, we can understand when a customer is experiencing something that they shouldn't have to, even if they aren't explicitly stating that. That said post call surveys and anything else comes into our system as well. So we can analyze that unstructured data. And then some of our clients use what they've learned from From listening to our conversations to restructure their conversations, right?
To say things differently, to simplify, to ask questions. And they, they do that because they know they're going to get to hear the impact of that at scale, using, using our platform. But I want to make one point because you, you mentioned like. You know, contact centers using this data to change contact center interactions.
And our vision certainly is to help the contact center, but it's bigger than that. Our vision is to use the insights that are in conversations to actually fuel the entire enterprise. Because there are things for marketers, there are things for UX teams, there are teams for there are insights for product development teams strategy, C suite in these conversation data.
An example, market events happen all the time. There was change healthcare a few months ago. The the IRA coming out. Right. These are things that the ground truth of what's happening can be heard and seen in your contact center. And we now have shareholders and boards of pretty big companies using Authentics to understand the ground truth of some of these market events to know how they need to react, how they need to respond.
And. And so our vision is to, is to make the voice of the customer accessible, digestible, and usable by everybody in the enterprise working together.
David E. Williams: Great. John, last question to you.
John Driscoll: I guess, I guess the, the, the, you know, if you're thinking about the power of what you're doing enhanced by context data and, and advanced tech, how do you, what's the line you have to draw between what people have today?
When they talk about the voice of the customer and the ground truth that you believe you can get at, how, how would you, what's your advice to leaders in healthcare as to how to get at that ground? Truth.
Amy Brown: I mean, our advice is to listen to the evidence that is existing with their actual customers by the millions on a daily basis.
I mean, perception is everything. Right? And, and the perception of your customers. Is crucial to understanding what their behaviors are going to be, what their intentions are.
They're telling you indicators of, of whether or not they're leaving you as a business and going somewhere else. They're telling you what the competition is doing.
They're telling you what their customer experience expectations are. And if you're not tapping into that, then you're missing out on being able to do something proactively, rather than just waiting for the lagging indicators to happen of your growth or your profitability.
David E. Williams: Well, that's it for another episode of CareTalk.
We've been speaking today with Authentics founder and CEO, Amy Brown, about analyzing and acting on customer interaction data at scale. I'm David Williams, president of Health Business Group.
John Driscoll: And I'm John Driscoll, senior advisor at Walgreens. If you like what you heard, or you didn't, we'd love you to subscribe on your favorite service.
And thank you, Amy, for joining.
Amy Brown: Thank you. It's been great.
Watch the full episode on YouTube:
ABOUT CARETALKÂ Â
CareTalk is the only healthcare podcast that tells it like it is. Join hosts John Driscoll (Senior Advisor, Walgreens Health) and David Williams (President, Health Business Group) as they provide an incisive, no B.S. view of the US healthcare industry.
FOLLOW CARETALK
Comments