The Future of Healthcare: Empowering Case Managers with Cutting-Edge Tools

In the ever-changing landscape of healthcare, case managers play a pivotal role. They are the quarterbacks of care management—coordinating care, advocating for patients and ensuring optimal outcomes. But with the increasing complexity of cases and growing demands on their time, additional resources are needed to level the playing field.

Fortunately, there are innovative tools designed to increase efficiency and effectiveness. Here are just a few technologies helping improve patient engagement, prevent delayed recovery, enhance communication and mitigate psychosocial barriers.

SETTING THE FOUNDATION WITH SENTIMENT SCORING

High-quality case management is predicated on meaningful interactions with patients. An innovative software known as sentiment scoring is now changing the way phone calls with patients and other key stakeholders are answered and audited. Through analyzing the tone and content of these interactions, sentiment scoring helps ensure patients feel heard, understood and cared for, setting a positive foundation for the recovery journey.

One Call, an ancillary services care coordination leader within the workers’ compensation industry, is currently using sentiment scoring software to monitor all service-related phone calls. Thanks to natural language processing, we can capture and analyze data from every interaction we have with our stakeholders—currently, that’s more than 30 million calls each year. But the technology’s true power is in its ability to gauge an unbiased sentiment score for every interaction.

Illustration of sentiment scoring software. IMAGE COURTESY OF ONE CALL

Powered by AI, the software measures the empathy and emotion of all our customer service interactions. Here’s how it works:

• Each call begins with a score of 0.
• During the conversation, key words, sentence structure and inflection of voice are evaluated.
• When the call ends, a sentiment score is assigned—with scores ranging from negative 100 to positive 100.
• Interactions that receive a negative score are reviewed by our quality team to determine next steps for a better customer experience in the future—whether that be additional follow-up for that specific interaction, care coordinator coaching or even changes to our processes.

These powerful insights are also enabling our team to identify trends across our customer base, such as billing issues, communication breakdowns and knowledge gaps. From there, our team can proactively intervene with solutions that benefit everyone.

For case managers, tools like sentiment scoring help provide a more accurate understanding of how the patient is feeling. Establishing a strong keyword set is also beneficial for flagging potential issues in care or service. With this data, case managers can make better determinations on next steps and look for ways to improve upon their patient interactions.

CREATING EFFICIENCIES THROUGH AI TOOLS

AI is also helpful for identifying individuals at risk of delayed recovery. Machine learning models use optical character recognition and natural language processing to sift through vast amounts of documentation, highlighting keywords and phrases that indicate potential risks. This process allows case managers to focus their attention and resources on these high-risk cases, ensuring they receive the necessary care and support.

One Call incorporated such tools into its At-Risk Program—a data-driven initiative that identifies potentially at-risk/high-cost cases early on, helping to mitigate costs, reduce delayed recovery and drive better outcomes. Since its initial development in 2018, this iterative process has been refined with AI, leading to improved precision and identification of injured workers who would benefit from early clinical intervention.

At-risk claims require collaboration among all parties involved—the case manager, adjuster, provider and care management company. Coupling technology with a collaborative approach increases our potential to redirect these claims to a more desirable pathway.

When examining the program’s results, we found nearly half of the at-risk claims involved shoulders and backs. Sixty-five percent of the program’s participants were discharged within industry benchmarks. At the end of care, 74% had full and functional range of motion, 88% had full or functional strength and 86% reported moderate or no pain.

REVOLUTIONIZING COMMUNICATION WITH AI-ASSISTED MULTILINGUAL CALL HANDLING

When communicating with patients, language barriers can sometimes impede progress. However, AI-assisted, multilingual call handling is helping make such obstacles a thing of the past. By integrating real-time translation services into a cloud-based phone system, language barriers are eliminated, thus enhancing the individual’s experience and overall satisfaction. As a result, efficiency is increased, allowing call agents to assist more people.

A multilingual call solution was recently implemented by eBay, leading to a 10% reduction in customer handling time. Not only did the company broaden its customer reach, but it improved its services levels, as well.

A case manager’s work is never done, and caseloads sometimes seem insurmountable. Imagine being able to make an even greater impact by using technologies that eliminate obstacles and lead to more effective communication and understanding.

MITIGATING PSYCHOSOCIAL BARRIERS

Psychosocial barriers can significantly interfere with a patient’s recovery process. In these situations, tools like Wysa, an AI-powered mental health app, are invaluable. Wysa provides anonymous support to patients via a conversational agent (chat bot) and self-guided cognitive behavioral therapy exercises. While case managers do not have direct access to the information shared on Wysa, knowing that their patients are receiving this support can give them peace of mind and allow them to focus on other aspects of their job.

In August 2023, Travelers launched a full-scale implementation of Wysa’s application. To date, more than 58,000 injured employees have been screened, with 40% exhibiting one or more psychosocial risk factors. When evaluating the application’s effectiveness, 82% of users said it made them feel better, giving it a five-star rating.

LOOKING AHEAD

The future of healthcare lies in the successful merger of human empathy and cutting-edge technology. By equipping case managers with these innovative tools, we can enhance their efficiency, improve patient outcomes, and transform the industry landscape.

REFERENCES

One Call national data. Reflects results from customers participating in One Call’s At-Risk program.

Marr, B. (2019). The Amazing Ways eBay Is Using Artificial Intelligence To Boost Business Success. Forbes. https://www.forbes.com/sites/bernardmarr/2019/04/26/the-amazing-ways-ebay-is-using-artificial-intelligence-to-boost-business-success/.

Iglesias, M.; Sinha, C.; Vempati, R.; Grace, S.; Roy, M.; Chapman, W.; Rinaldi, M. (2023). Evaluating a Digital Mental Health Intervention (Wysa) for Workers’ Compensation Claimants Pilot Feasibility Study. Journal of Occupational and Environmental Medicine. 65(2):p e93-e99, February 2023. https://journals.lww.com/joem/fulltext/2023/02000/evaluating_a_digital_mental_health_intervention.25.aspx.

Michelle Despres, PT, CEAS II, REAS, CETS, is the vice president of product management at One Call. Focused on physical therapy, she leads her team to deliver a high-quality experience for injured workers and provider partners. She also serves as a mentor to clinicians to improve their delivery of treatments and maximize return-to-work outcomes. Michelle’s expertise goes beyond traditional PT to include functional capacity evaluations, work hardening, work conditioning, post-offer employment testing, employer-based initiatives and ergonomics.

Sarah Grace, RN, is the managing director of medical innovation and strategy at Travelers. Upon graduating from the University of Connecticut and Goodwin University in Connecticut, she worked at a local hospital both in mental health and orthopedics. Having now spent nearly 14 years in the workers’ compensation industry, she carries her deep passion for supporting and caring for people directly into her work at Travelers. She specializes in implementing countrywide initiatives and pushing for innovative and industry-leading strategies that are focused on improving the recovery experience for an injured employee.

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