Closing care gaps requires the right tools, clear processes and measurable results. Below, we've answered the most common questions health plans have about our advanced member engagement and AI-supported scheduling feature QRM Connect™ — from how it engages hard-to-reach members to the proven outcomes you can expect across different lines of business.
What is QRM Connect™?
QRM Connect is an integrated platform experience that eliminates appointment scheduling and provider selection barriers for health plan members. The platform enables health plans to notify members when they’re due for annual provider visits, assist in new provider selection within a member’s preferred criteria, provide scheduling support to reduce gaps in care and send post-visit communication to drive members back to their primary care provider (PCP) for follow-up care.
For members unable to visit their provider’s office, QRM Connect facilitates in-home assessment scheduling, then guides members back to their PCP for in-office follow-up visits.
What are the benefits?
QRM Connect delivers measurable results that improve both member health outcomes and health plan performance. Payers can more easily reach hard-to-engage populations who either don't receive care regularly or delay care until later in the year. Members are more likely to complete annual preventive visits, which often comes with the completion of other necessary health actions, such as vaccinations, securing medication refills and scheduling other routine preventive screenings, like mammograms, during the appointment.
Each line of business has different first attempt success metrics based on the unique challenges of their populations:
- Medicare Advantage: 57% of members connect with the agent, 73% success rate in scheduling an appointment, 79% of those appointments are kept
- ACA/Commercial: 71% of members connect with the agent, 44% success rate in scheduling an appointment, 68% of those appointments are kept
- Medicaid: 33% of members connect with the agent, 22% success rate in scheduling an appointment, 34% of those appointments are kept
By getting members to provider visits early in the year, health plans ensure better quality of care all year long while avoiding costly end-of-year outreach campaigns.
How does it work?
QRM Connect guides members through a seamless provider navigation and scheduling experience. Here’s how it works:
1. Health action triggered: The member’s provider visit health action is populated, alongside a reward if incentives are being applied. Health actions are determined by data files provided by the health plan.
2. Member notification: The member is sent an email or text alerting them they’re due for a provider visit and offering support with scheduling or finding a new provider.
3. Provider search: Members can search for providers in their area based on preferences like language, gender or location. Results display in both list and map views for easy comparison.
4. Appointment request: After selecting their preferred provider, members indicate their available time slots for an appointment.
5. Backup option: Members can select an alternative provider if their desired appointment times are not available with their preferred provider.
6. AI scheduling: Once the member confirms their provider and time preferences, QRM Connect’s AI agent calls the provider’s office and speaks conversationally with the front desk staff to schedule the appointment.
7. Confirmation: Members receive a confirmation email or text with their appointment date, time, provider name and office address. This information also lives in Healthmine’s rewards app for easy reference.
8. Easy rescheduling: To reschedule, members go through the same process.
See provider selection and scheduling in action with our online interactive experience.
How is it different from other member-facing AI solutions?
Most AI agents have limited use cases. Either they’re only chat bots, IVR agents, texting agents or other use case with limited scope. Our agent works across these use cases, assisting members via email, SMS or over the phone via inbound and outbound channels.
What are the current use cases for AI-supported phone calls?
Our agent can do the following:
- Speak to a member over the phone to help them find a provider and understand appointment availability.
- Call provider offices, including navigating phone trees and waiting on hold, to speak to front-desk staff to schedule in-office appointments.
Will this help me reduce my plan’s costs?
Yes, appointment scheduling facilitated with AI brings operational cost savings to payers in two primary ways.
First, the implementation and training of an AI agent is much faster and cheaper than training call center agents.
- Average time to hire and fully onboard call center agents: 19 weeks
- Average time to implement and train an AI agent: 4 weeks
- Improvement with an AI agent: 15 weeks or 105 days faster
Implementing an AI agent is 79% faster (15 weeks or 105 days), giving you more time to pursue meaningful gap closure at scale and reducing training and onboarding costs.
Second, typical call center pricing models include a per call cost and an additional charge for every successfully completed call, which in this case is for every scheduled appointment.
- Outbound call base cost ($25/call) + cost of successfully scheduled appointment ($17) = $42 per call per member
- AI agent flat cost per appointment scheduled = $15
There’s a 64% cost reduction using AI-assisted scheduling.
Other ways this solution can impact your bottom line:
- Easily predicted total costs with flat fees and no surprises
- No agent overtime costs
- No employee turnover
- No need to scale up or down to meet demand during peak hours or times of year
What if the AI agent cannot complete calls?
For member interactions, the agent is trained based on an individual plan’s requirements, which includes knowing when to pass off a member call to a live agent to minimize friction with members and provider offices.
For calls to provider offices, if a call is unsuccessful (unable to schedule the appointment) the agent will automatically try the backup provider selected by the member. If no backup provider is selected and scheduling is unsuccessful, the member is notified and given the option to provide updated scheduling preferences, have a call center agent help them schedule or call the provider office directly themselves.
Do members have to speak with the agent?
No, it is possible for members to find providers and schedule appointments without ever having to make a phone call. The full experience can be completed via texting and in the app. However, members can choose to provide provider preferences and appointment availability over the phone with the agent, if preferred.
How does the AI agent communicate with non-native English speakers?
The agent can communicate in 14 languages which allows members and providers to navigate appointment scheduling in the language they are most comfortable with and avoid miscommunication.
How long does it take to get started?
For existing Healthmine platform clients, it takes 30 days to implement after contract expansion is signed. For non-platform clients or plans that are new to Healthmine, it takes a standard 90-day implementation. Training of the AI agent is included in these timelines.
What reporting will I receive?
In addition to Healthmine’s standard reporting in Quality Relationship Management™ (QRM®) to track ongoing engagement and deploy campaigns, any plan using QRM Connect will also be able to track:
- The number of scheduled appointments
- Modality used for scheduling
- Appointments rescheduled or canceled
- Outreach performance and engagement
All AI calls are recorded and automatically transcribed.
Is this solution industry compliant?
Absolutely! The AI agent is HIPPA compliant and features enterprise-grade security.
Connect with Healthmine
Let us show you QRM Connect in action! Contact us to walk through the full experience and hear how the AI agent conducts calls with a representative at a provider office.
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