Médis and Infermedica: Reducing unnecessary urgent care visits with improved AI-powered Call Center Triage solution
Médis, the most recognized health insurer in Portugal, and Infermedica have established a partnership which resulted in the implementation of Infermedica’s Call Center Triage tool in Médis’ Clinical Contact Center. This partnership has allowed Médis to enhance their clients’ and nurses’ experience, and streamline operational processes, while Infermedica was able to improve the triage and recommendation capabilities of their Call Center Triage solution. The implementation has improved the interview process and prevented unnecessary urgent care visits and appointments.
Type:
Private healthcare provider
Location:
Portugal
Product:
About Médis
Médis has been on the market for more than 20 years and is part of the insurance holding Grupo Ageas Portugal. Complementing its health insurance products, Médis also offers additional services tailored to clients’ needs, emphasizing innovation and the use of modern technologies.
Médis’ mission is to provide clients with an outstanding experience that is relevant to their needs through its Personal Health Service®. The company offers an integrated system of medical facilities, including medical care, telemedicine, and online consultations, having successfully built a strong and integrated ecosystem.
- 800,000 patients
- 13,000 doctors
- 100 hospitals
- 750 pharmacies
- 1,000 health and wellness partnerships
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Key challenges of the project
Médis
Médis’ vision is to be the client’s partner in care. With that in mind, the organization has been providing triage services to clients since the company began more than 20 years ago. It was also this vision that motivated the company to look for a more modern solution to the primary issues of the current triage system, tackling two main challenges.
1. Need to improve user experience and efficiency
Although the previous Médis Contact Center solution was reliable and clinically robust, it was starting to become technologically nearly obsolete, given its more than two decade of existence. In some cases, this was a considerable obstacle to making improvements and adapting the system to the needs of its users – the nurses in the Médis Clinical Contact Center. By improving the user experience, Médis could benefit from an increase in usage of the tool by nurses.
2. Adaptation of clinical content and recommendations
The previous Médis Contact Center solution was based on “decision trees” – a defined structure which complicated the process of updating the clinical content and recommendations. However, available knowledge is constantly changing, and it is important for a clinical triage solution to be able to adapt to these changes in an easy and seamless way.
Infermedica
Infermedica’s mission is to guide users to the best possible care. For this reason, the company strives to perfect the triage and recommendation capabilities of the platform. Infermedica also develops new functionalities, adjusting the product to client’s needs and allowing it to reach a wider audience of patients.
1. Continuous perfection of algorithms
Infermedica's solution is based on machine learning processes, so the algorithm learns over time. The support of a large partner with more than two decades of experience can accelerate this process. The cooperation with Médis enhanced the further improvement of Infermedica’s triage and recommendation capabilities, which was resultantly beneficial for both sides.
2. Answering the contact center needs
Before the partnership with Médis, Infermedica’s solution was used mainly as a symptom checker for patients. The partnership with Médis allowed for a better understanding of telemedicine processes, developing additional functionalities, and adjusting the platform to the needs of medical contact centers.
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The solution: Call Center Triage
Infermedica’s solution is a powerful, cloud-based tool that uses Artificial Intelligence to help medical and non-medical consultants to direct clients to appropriate and cost-efficient care. The platform is customizable in terms of the triage logic and conversation protocol, so it can be applied in a variety of scenarios, including contact centers and emergency departments. Because Call Center Triage is developed in cooperation with a medical team, it is able to provide reliable and verified results and recommendations.
The goals of Call Center Triage are as follows:
- Assist contact center nurses with the prompt and accurate triage of clients
- Prevent unnecessary urgent care visits and appointments by recommending the most suitable health services
- Detect urgent cases quickly
- Standardize the triage interview process
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Call Center Triage in use
As a result of the partnership between Médis and Infermedica, a new solution was developed and implemented in the Médis Clinical Contact Center. Powered by AI and machine learning, this solution helps Médis’ nurses throughout the triage flow, from symptom reports to clinical recommendations.
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Incoming call
The client calls the Médis Clinical Contact Center for an evaluation of their symptoms. The system automatically identifies the client’s ID, gender and age.
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Main symptoms
The client provides information about their symptoms, risk factors, and chronic conditions, and the nurse enters this information into the AI system.
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Red flags
In the case of extremely severe symptoms (“red flags”), the triage process immediately stops and the nurse must inform the client that they may require immediate emergency help.
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Interview
Based on the information input, Infermedica’s AI-powered engine dynamically selects tailored questions for the nurse to ask the client.
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Recommendations
The results page of the interview provides care recommendations, including the most suitable type and level of care: self-care, medical appointment, medical appointment within 24 hours, urgent care, or emergency. As a result of the interview, the client is able to make an informed decision based on the recommendation given by the nurse.
Note: The information in the images shown is simulated, random information.
Results of the Call Center Triage implementation
Since initially implementing the system twelve months ago, Médis has applied Infermedica's solution in approximately 24,000 triage processes, with 99.4% of clients’ symptoms being covered by the tool. Call Center Triage allows for instant connectivity to other services provided by Médis and assists in providing care services adapted to the client’s needs (e.g. connection to the telemedicine service).
Comparison with clients’ initial intention before calling Médis Clinical Contact Center shows that the tool has prevented unnecessary urgent visits and increased the frequency of the self-care option. Additionally, the implementation of this new clinical triage solution has led to an improved experience for Médis nurses and clients.
17%
8%
Percentage of cases in which the client’s initial intention was to seek urgent care vs percentage of urgent care recommendations.
17%
35%
Percentage of cases in which the client’s initial intention was self-care vs percentage of self-care recommendations.
24,000
Number of triage processes completed with the use of Infermedica Call Center Triage.
99.4%
Percentage of all reported clients’ symptoms being covered by the tool.
One of the main advantages, compared to the previous solution, is that the Infermedica platform is dynamic. This means the system has a clinical update every 3 months, which makes it more and more accurate and improved with usage. Also, the solution has a solid clinical knowledge base, which is developed and constantly updated by Infermedica’s team of medical doctors.
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Partnership outcomes
Implementation of a technically improved solution
Thanks to the machine-learning capabilities of the new solution, the system improves over time, delivering more accurate suggestions and recommendations. Also, the new solution allows for an improved user experience for Médis nurses.
Extended triage and recommendation capabilities
The partnership with Médis allowed for Infermedica to increase the capability of its Call Center Triage solution to recommend the right actions for given symptoms. Infermedica's team enriched the database of risk factors, conditions and symptoms, with a special focus on pediatrics. During the project, Infermedica’s medical team, with the support of Médis, added and modified approximately 200 medical factors in the database, which is the heart and soul of Infermedica’s system.
Adaptation to unforeseen events
The project required the implementation team to adapt its activities and product to unforeseen events and circumstances. One of the necessities was to create a separate branch of services, the triage of pediatric cases, which was successfully created in partnership. Additionally, the solution had to be adapted so that it could be integrated with Médis’ current IT systems.
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Testimonials
The Infermedica team has always been very proactive and flexible in order to adapt the solution to Médis needs. During the whole project, they always respected the established deadlines.
Also, we were positively surprised noticing how the team understands the specific issues of working with a big corporate, which means that sometimes deadlines have to be adapted and project’s scope is modified unexpectedly.
The project with Medis was a great adventure for us - cooperation with a company experienced in telemedicine solutions allowed us to look at our platform from a new perspective.
We are pleased with the results of introducing the Call Center Triage at Médis' Clinical Contact Center - preventing unnecessary emergency visits, improving the user experience of nurses and supporting the work of call center coordinators.
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