bcg -用人工智能改造患者访问中心 Transforming the Patient Access Center with AI

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HEALTHCAREPAYERS,PROVIDERS,SYSTEMS&SERVICES

Transformingthe

PatientAccessCenterwithAI

By

NatashaTaylo

r,

MatthewHuddle,MD

,LukePurcell,

RyanShain

,ScottWilder,KevinFleming,andMichaelBernstein

ARTICLEJULY14,2026

Theaccesscenterisboththefrontdoorandthebeatingheartofapatient-centrichealthsystem.AIstandstotransformhowpatientaccesscentersfunction,butnotinthewaymanyexecutivesimagine.

Consumerscall,chat,andtextwithaccesscenteragentstoscheduleappointments;manage

referrals;navigateauthorization,billing,andinsurancetopics;andseekanswerstoamultitudeofquestions.Despitethisheavyuse,asubstantialshareofpatientdemandsslipsawayatthe

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accesschannel.Thousandsofcallsgounansweredorareabandonedduetolongwaittimes,

failedtransfers,andlimitedafter-hourscoverage.Upto40%ofscheduling-relatedinteractionsgounresolvedonfirstcontact.Missedannualvisitsandvaccinesarenotsystematicallyand

proactivelyaddressed,andspecialtyreferralsarenotaggressivelytrackedandconverted.

AIcanperformmanyofthesebasictasksandaugmenttheworkofhumanagentsformore

complexissues.YetwhensystemleadersconsiderdeployingAIinaccesscenters,theyviewit

merelyasawaytoreducecostsandincreaseefficiency.ThisperspectiveoverlooksasignificantopportunitytouseAItoreshapetheaccessfunctionfromendtoend—shiftingitfromacost

centertoarevenueengine.

ManyofourclientsaredeployingAItoautomatelower-complexityprocesseswhilereorienting

hardworkinghumanstafftohigh-value,high-impactconsumerengagement.TheyunderstandthattheaccesscenterofthefutureshouldbeanAI-enabledplatformtodrivegrowth,manage

consumerrelationships,enablevalue-basedcare,andgenerateorganizationalintelligence.Theyalsoseetheaccesscenterasa“proofcase”fortheirbroaderenterpriseAIambitions.

OpportunitiestoTransformtheAccessCenter

WeseethreekeyopportunitiesforsystemstopursuewhentransformingaccessthroughAI.

Automateroutineschedulingandreferralworkflows.Augmenthumanagentsduringcomplex

interactions.Amplifyaccess-relatedrevenuegenerationstrategies.(SeeExhibit1.)SystemsthatpursuethesethreecomplementarystrategiesinparallelwillseethegreatestreturnontheirAIinvestmentthroughimprovedconsumerexperience;easieraccess;improvednavigation,quality,andoutcomes;andfinancialupside.Let’slookcloselyateachoftheseactions.

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Automateandfullycontainend-to-endaccessworkflows.

Acrosshealthsystems,theinteractionsthatconsistentlydemonstratethehighestpotentialforend-to-endautomationareappointmentinformationandconfirmation,schedulingand

rescheduling,andcancellation,aswellasrequestsforreferralandauthorizationstatusandgeneralwayfinding.Theseintentsarehighfrequency,heavilyscripted,haveclearresolutionpathways,requirenoclinicaljudgment—andtheytypicallyrepresentmorethanhalfoftotalinboundvolumeatlargehealthsystems.Thesearegoodtargetsforcontainment,inwhichAImanagestheinteractionsindependently,withouthumaninvolvement.

Nosinglevendorcurrentlyprovidesafull,end-to-endsolutionvirtualagent,andnosingle“best”approachwillworkforeveryhealthsystem:eachhasdistinctbenefitsandlimitations.(See

Exhibit2.)OptionsincludevendorsolutionssuchasHyro,Sierra,Decagon,andAvaamo—orbuildingacustomproductwithin-housetechtalent.

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Selectingtherightimplementationapproachforavirtualagentisoneofthemostconsequentialdecisionsahealthsystemwillmake.Leadersmustweighseveralfactors,includingspeedtovalue,long-termflexibility,abilitytointegratewithcustombusinesslogic,totalcostofownership,and

anypotentialtrade-offs.Thisanalysisrequiresagranularunderstandingofaccesscenter

interactionsandconsumerintents,clarityontheenterprise’soveralllevelofAIambitionandlong-termstrategicroadmap,anddetailedmodelingoffinancialimplications,including

potentiallyuncertainvariableslikefuturetokencost.Therightsolutiondependsonahealth

system’spriorities,existingtechnologyinfrastructure,thecomplexityofitsschedulingbusinesslogic,itstoleranceforvendordependency,anditsinternalproductandengineeringdepth.

Augmentandenablehumanagentefficiencyandeffectiveness.

Whilemanypatientaccessinteractionscanbeautomated,somewillneedescalationtoa

professionalandwell-trainedhumanagent.Whetherduetoschedulingcomplexity,coordinationofreferralsandauthorizations,sensitivetopics,orconsumerpreference,about40%to50%of

callswillstillrequirehumaninteractioninthenear-term.Forthesecalls,healthsystemsshouldpursueagent-assistcapabilitiesthataugmentthelegacytoolsthathumanagentshaveattheirfingertips.DeployingAItoolsthatmakeeveryagentbetter,smarter,andfasterattheirjobscandrivemeaningfulenterprisevaluewhilemaximizingjobsatisfactionforhumanagents.

Amongourclients,upto60%ofhumanagenttimeiscurrentlyspentontasksthatcouldbe

augmentedbyAI.Agent-assisttoolscandrivereductionsinaveragehandletime(AHT)by30%to40%anddramaticallyimprovepatientexperiencebyfreeingtheagenttofocusonempathic

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listeningandcreativeproblemsolvingratherthanbasicknowledgeretrieval.Agent-assisttoolsdelivervalueacrossallstepsofaconsumerinteraction,including:

Intentdetectionandidentityverification.Withorwithoutastandalonevirtualagent,a“narrow”agent-assisttoolcanconfirmapatient’sreasonforcallingandconductidentityverification,handingoffrelevantcontexttothehumanagent.

Patientinformationgathering.Patienthistory,priorcallreasons,opencaregaps,andsuggestednextbestactionsareidentifiedanddisplayedbytheAItoolbeforetheagentspeaksaword,eliminatingtheneedformanualelectronichealthrecord(EHR)lookup.

Callguidanceandnextbestaction.Astheconversationunfolds,AIguidancesurfaces

relevantpolicyinformation,schedulingavailability,andnext-best-actionrecommendations,providingagentswithreal-timepromptstoaddressqueriesinstantlyratherthanplacing

callersonhold.

Handoff.Whenacallmustbetransferred,AIsummarizesthefullinteractionhistorysothereceivingagentorclinicisfullybriefed,eliminatingtheneedforpatientstorepeat

informationandreducingtheAHTpremiumthattransferredcallstypicallycarry.

Afteracall,AIauto-generatescallsummaries,in-basketmessages,e-mails,andanyrequired

downstreamtickets,reducingafter-callworkbyupto2minutesperinteraction.AIcanalso

supportQAandtrainingbyanalyzingcallstoidentifysystemicandindividual-levelperformancehotspots,suchasworkflowinconsistenciesandoff-scriptmessaging,anddeveloppersonalizedtrainingforagents.(See“SpotlightonAccessCenterQualityAssuranceandTraining.”)

SpotlightonAccessCenterQualityAssuranceandTraining

Oneofthemostunderutilizedleversinaccesscentermanagementisqualityassurance.Mosthealthsystemssamplefewerthan5%ofinteractionsfor

manualreview,meaningmostagentbehavior—includingcompliancegaps,patientsafetyescalations,andcoachingopportunities—goesunobserved.

AIfundamentallychangesthisparadigm.AutomatedQAcapabilitiescanevaluatesignificantlymoreinteractionsandprovidereal-timedataonquality,compliance,resolution,andconsumersatisfactiontobothagentsandtheirmanagers.

Importantly,thearchitectureusedtoautomatehuman-agentQAcanbeusedtoevaluatevirtualagents,enablingaccesscenterleaderstocompareoutcomes

acrosschannelsandprioritizeareasforimprovement.

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ArobustAI-drivenQAcapabilitycanfeeddirectlyintopersonalizedtrainingtools

thathumanagentscanusetoimproveperformance.Ratherthangenericgroup

trainingsessions,theAIidentifiesthespecificcalltypesandinteractionphases

whereeachindividualagentunderperformsandgeneratestargetedlearning

planswithconstructivefeedback.Withnew“synthetic”callingcapabilities,these

learningplanscanbeusedtodevelopmockcallsthathumanagentscanhave

withvirtual,buthighlyrealistic,callers,reinforcingtrainingwithreal-world,

human-to-AIconversations.

Together,automatedQAandpersonalizedtrainingco-pilotscreateacontinuous

improvementloopthatcompoundsovertime:betterdataonagentperformance

drivesmoretargetedcoaching,whichinturnliftsperformanceandgenerates

betteroutcomes.

TogetthemostfromAIaugmentation,systemsmusthaveadetailedunderstandingofhowagentsspendtheirtimeandadoptahuman-centereddesignapproachtodevelopingagent-assisttools.Introducinganothertoolorinterfacetoanagent’sworkflowisonlyvaluableifitaddresses

existingpainpoints,enablesagentstobetteraddresspatients’needs,andimprovestheoverallconsumerexperience.

Amplifyaccess-relatedrevenuegenerationstrategies.

Reconceptualizingthepatientaccessfunctionasadynamicgrowthenginemeanstreatingeachcallnotasalow-valueinteractiontoresolvequicklyandinexpensivelybutasademandsignaltoconvert,arelationshiptodeepen,andacaregaptoclose.Keygrowthleversinclude:

Demandcapture.AI-powered24/7coverageandautomatedfollow-uponunansweredand

unresolvedcallsconvertsdemandcurrentlylosttostaffinglimits,after-hoursgaps,andfailedcallbacks.

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Ancillaryattachment.AIsurfacesrelevantimaging,lab,pharmacy,andpreventivecare

opportunitiesinrealtimeduringeveryinteraction,enablingagentstoofferappropriate

ancillaryservices,providingnewopportunitiestomeetpatientneedsandhelpingpatientsaccessrequiredservices.

Referralmanagement.AItracksreferralstatusandtriggersfollow-up,reducingleakage

withinthenetworkandimprovingclosed-loopvisibilityforcareteams(especiallycriticalforhigh-margincommercialpatientsandspecialtyprocedures).

Proactiveoutreach.AI-poweredoutboundagentscanengagepatientswhohaveknowncaregaps,overduescreenings,orpost-dischargeneeds,convertinglatentdemandintoscheduledvisits.

“Segmentsofone”.AIcananalyzeavastarrayofdatatodeveloppersonalized,360-degreepatientprofilesandcreatedifferentiatedpathwaysforhigh-needandhigh-valuepatients,

enablingsystemstobetterguidepatientstotheappropriatelevelofcareandprovideenhancedservicelevelsinstrategicallyimportantservicelines.

Forourclients,incorporatinggrowth-relatedstrategiesintotheirroadmapincreasestheprojectedmarginupliftofAI-drivenaccesscenteroptimizationby3–5xversusfocusingoncostalone.It

alsoprovidesconsumerswithaseamlessaccessexperience,supportsprovidersinseeingmorepatients,andimprovesthetimelinessandresponsivenessofcare.

TheCriticalEnabler:ClinicalOperationsandChange

Management

Technology

models,vendors,architecture,andinfrastructurerepresentonlyabout30%ofan

AI

transformation.

Peopleandchangemanagementaccountfor70%—butareoftenoverlookedandunderinvested.

AttemptingtotransformtheaccessfunctionwithAIwillfailwithoutactivepartnershipfromthe

clinicalandoperationalteamswhocontroltheinputsthatthetechnologyneedstoperform.At

mosthealthsystems,theschedulingrules,bookingconstraints,visittypeconfigurations,and

provider-leveldirectivesthatgovernaccessareneithercentrallymanaged,consistently

documented,nordesignedforscale.Atthesametime,healthsystemsoftenhaveuniqueprovider-andclinic-specificbusinesslogicthatisnotcodifiedinanysystemofrecord—fromsharedExceltrackerstounwrittenknowledgethatagentslearnovertime.

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BecauseAIwillonlybeasgoodasthefoundationuponwhichitisbuilt,systemsmustcodifytheformalandinformalbusinesslogicthatsitswithhumanagents,MAs,andprovidersinto

structuredinputsforAItoconsume.Thisisoftenoneofthemostchallengingtaskswesupportourclientsinundertaking.Executivesandfunctionleadersconsistentlyunderestimatethe

operationaleffortrequiredtoexecuteasuccessfulAI-enabledaccesscentertransformation,including:

Expansionofagentbookingauthority.Inmanysystems,contactcenteragentsare

prohibitedfrombookingdirectlyintoasignificantshareofvisittypes—notbecausetheinteractionsareclinicallycomplex,butbecausepracticeshavehistoricallypreferredtocontroltheirownschedules.Relaxingtheserestrictionsisoneofthehighest-leverage

operationalfixesavailable,andonethatAIalonecannotunlock.

Accessibilityofpractices.Evenwithexpandedbookingpermissions,humanagentswillneedtocontactclinicsincertaininstances.Whilethereisoftenaphonenumber,e-mail,orEHR

messagechannelavailable,clinicsdonotalwaysanswercalls,respondtomessages,or

addresstheneedsofaccesscenteragents.Improvingtheclinic–accesscenterrelationshipandcommittingtoincreasedresponsivenessiscritical.

Provideralertandexceptionmanagement.Dynamicinformation,suchasaprovideron

leave,apracticethathasclosed,orachangeininsuranceacceptance,isoftencurrently

communicatedonanadhocbasis.OperationalteamsmustformalizehowthisinformationflowsintotheaccesscenterfornewAIsolutionstooperatereliably.

Templateandvisittyperationalization.VisittypemappingsbetweenwhatagentsseeandwhatlivesintheEHRarefrequentlymisalignedorincomplete.RationalizingtemplatesandestablishingcleanEHR-to-accesscenterlinkagesisaprerequisiteforreliableautomation.

Insuranceruledocumentation.Insuranceacceptancerulesareoftenmissing,inconsistent,orburiedinfreetext.Closingthesegapsrequiresdirectengagementwithclinicmanagers

andrevenuecycleteamstoensureappropriateroutingofpatientstoproviders.

Healthsystems

thatunderinvestinclinicalandoperationalchangemanagementwillseetheirAIcapabilitiesandfinancialROIunderperformrelativetoitstechnicalpotential.Thesystemsthatsucceedtreataccesscentertransformationasacross-functionalprogramofhigheststrategic

importance,notanITprojectakintoavendormigration.Seniorexecutiveandclinical

sponsorship,shoulder-to-shoulderengagementwithpracticeleaders,andclearaccountabilityfortheoperationalchangesthatAIenablementrequireiscritical.

ACalltoAct—Now.

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Theaccessfunctionistheprimaryinterfacebetweenthesystemanditspatients,thekey

channeltocapturedemand,andanunderappreciatedplatformforgrowth.InanageofrapidlyadvancingAI,systemsthatviewthetechnologyasmerelyameanstoreducelaborcostwill

quicklyfallbehindthosethatrecognizeitastooltosuperchargeakeystrategicasset.

AIcapabilitiesarech