PegaWorld iNspire 2023: Sutter Health Scheduling at Scale: Building Healthcare's Most Innovative Call Center

Bringing patients and providers together at mutually convenient times creates a strong foundation for patient and provider satisfaction. This kind of concierge scheduling is challenging to efficiently and effectively staff. At Sutter Health we are transforming the scheduling experience for our call center agents: they are now on a single application servicing many geographies.

Physician scheduling preferences are live on a single Pega application across our system, using first-of its kind real-time integration that leveraged FHIR standards and proprietary APIs to connect directly to our Electronic Medical Records. This project is on track to meet our goals of reduced training, labor savings, improved quality and better handle time.

Transcript:

- Good afternoon, we're gonna get started. First of all, I'd like to thank you all for joining us today. I am Dr. Dayo, Pega's, Chief Medical Officer. I've got the honor of introducing Steve Chambers, the vice president of a contact center at Sutter Health, as well as Michelle Sobin with Accenture. She's a managing director. Without further ado, let's clap our hands in warm welcome.

- Thanks. Well, I really appreciate everybody being here. A couple of things, I recognize my haircut is not conducive to these lights. Sorry for that. And I also recognize we're kind of that mid-afternoon slot. You've had one night in Vegas already. It's probably starting to catch up, but can't tell you how much I appreciate you all being here. Couple of thank yous, one... If we could get the deck up whenever. One, thank you Dr. Dayo, for that, and thank you to the Pega team. It is great to be here in person, haven't been in person for a long time. And you know, thank you Michelle, for being here with me. We're gonna hear a little bit more from Michelle here in a minute with Accenture. They have been incredible implementation partners over the last year or so for us, and excited to be able to talk about what we've done at Sutter, kind of what our business challenge was. So Sutter Health, fully integrated delivery care network in Northern California, and is really focused around five geographical markets or communities. And the first one is the greater Sacramento area. We then have the Palo Alto or Silicon Valley. We've got the East Bay centered around Oakland. And then we've got the Central Valley, and then San Francisco and the North Bay. We've got 23 hospitals and 33 ambulatory care centers. In that network, we've got over 12,000 physicians. We have another 2000 advanced practice clinicians and 16,000 nurses. I don't know if there's any nurses here, but I would like to give them all a thank you. And then all in, when you add all of that together as well as support staff, IT, those sorts of things. We're about 53,000 employees strong throughout Sutter Health. Our mission and vision within Sutter is from a mission perspective, we really want to be there to enhance the communities, enhance the healthcare in the communities that we serve. We do that through a commitment to compassion and excellence in healthcare. Our vision is that we'll be a leader in the healthcare transformation, and that we'll achieve the highest levels of quality access and affordability. We may not get to see it, but as all of our values, you'll see... Oh, there we go. Honesty. There we go.

- Yay!

- Biggest applause that we'll get today. So honesty and integrity, really at the heart of everything that we do, and we're gonna focus in on that value of affordability. So again, I'll come back to that in just a minute, but I want to give Michelle here a second to talk about Accenture and her role in this.

- Thank you. Just a minute, yeah.

- Yeah.

- So Accenture, we're Pega's premier partner. We've been working with Sutter, partnering with them for many years. Pega, you know, recommended us. We have a strong reputation, and Sutter came to us and said, you know, "This compressed transformation, we wanna hear more about this, and we need you to guarantee outcome. So we know what we need to get done and we need you to get it done really very quickly." So I think two and a half months, two months, two and a half months was our target schedule. So we said, "All right, give us a look." And we took a look and we said, "Yeah, we can do that, and we'll take on that risk and we'll guarantee you that outcome." Our leadership loves it when we do fixed price agile, and here we are today. So we successfully delivered that project actually a little early. We aligned on delivery methodology and then we aligned on governance and kept to it throughout the two and a half months and just accelerated and powered right through it.

- Okay, thanks Michelle. Yeah, I can't say enough about Michelle personally and then Accenture as our partner. So as we go in, now I'm gonna drill into the contact center specifically. The contact center for Sutter Health answers about 14 million calls per year. We try to instill with our patient service representatives from the very beginning that they're doing work that matters. If we recognize that if you're calling us, with very few exceptions, if you're calling us, there's something wrong in your life. You're not feeling well, your loved one's not feeling well, maybe you've been through it and you're quote unquote "healed," but now you've got all of these bills that you weren't necessarily anticipating. So we recognize that we're often that first step in the patient healing process, and to the extent that we can answer your phone call and set you off on the right foot, you'll have just that much better outcome and experience along the journey. We also recognize that we've got a unique opportunity as a contact center to connect the system and drive efficiencies through standard processes. And we also pride ourselves in being an organization that's continuously improving services and our offerings through lean, through automation, and through cross affiliate or in words, cross-region collaboration. So we've come up with the slogan, do work that matters. As we started the journey with Pega and really the project of transforming our contact center, we had a couple of objectives, and I view these all as equal legs on a table. The first was to provide a more seamless patient experience. The second was to improve the employee experience. So in our current state, there's a couple of things that had to happen. From a patient perspective, we're transferring calls quite a bit. I'm gonna get into the variation that we have throughout our system or had throughout our system that would sometimes manifest itself in the patient experience. From an employee experience, we were using diverse set of systems, employees had to bounce or swivel chair from system to system. And so we wanted to really make sure that that was a better experience for them. We had an opportunity to increase the operational efficiencies. So one of the goals of this is really to reduce the cost and be affordable, as I mentioned before. And then we also recognize that the contact center can be a big pain point for physicians. If we do something wrong, if we don't load insurance correctly, if we, worst case, send a patient to a clinic and that physician doesn't take that insurance, they have to turn 'em away. You've got just disruption in the care center setting. And so to the extent that we can really deliver on the expectations, we'll increase the physician satisfaction, their joy of work. We also recognized that simplification was a key strategy in the cost reduction objectives. We'll talk about what led to Sutter's complexity in the contact center and how we were hoping to simplify that. We had very aggressive timelines, like many of you, this was pre COVID, I'll talk about our timeline, but pre COVID, we were starting to see all sorts of external pressures hitting our system, different payer mixes in northern California, different regulations, increased competition, all of the things that we all deal with. And so we knew we needed to adapt quickly and start to reduce those costs. And then the other key criteria that we had is, we have a long-term vision of developing a concierge agent. An agent that can schedule your appointment, take your payment, reset your password, do all of these things. And so one of the key things was that whatever solution we designed, it had to have the potential to spread to other areas. And what you're seeing on the screen is some of the complexity. So on the left, you've got a workflow, standard workflow, that our agents have to follow. The challenge with these workflows is, there's little variations with each one. So I can say, "Hey, we need to schedule an appointment," but that's gonna be a slightly different process if you're an adult. It's gonna be slightly different if you are under 18, it's gonna be different if you're a returning patient than if you are an existing patient. And it's gonna be different if you've just exited surgery and it's a follow up, than if it's just my run of the mill physical. It'll be different if you're ordering a medication and I could go on and on. All in, by the time you add up all of these different workflows, there's about 625, 650, that an agent has to pick the right one if they're going to do it. And on the right side, you're starting to see an example of our physician preference pages. So in addition to all of the different workflows, there's then a set of preferences that the physicians have when they want to see their patients. Just like we may have a set of preferences for how we want our meetings on Monday, maybe we don't want a meeting first thing Monday morning, we want it a little bit later. Our physicians have preferences. Maybe they don't want back to back physicals. Maybe they don't want certain procedures in the afternoon or late in the afternoon, maybe they only do certain procedures on certain days because they're covering in different locations. So when you add all of this up, we're asking an agent to A, decipher which workflow of these 620, 650 there are, and then look at, once we've landed on that, look and make sure that it fits with the physician preferences. So that was really the challenge that we had is all of this complexity. And we came up with the mantra or the goal of, "Hey, we want to absorb this complexity, we wanna push down simplicity." And that's really been our guiding principle throughout the entire project, absorb complexity and push down simplicity. And we recognized we needed to start looking at other industries to simplify, and as examples of how to simplify. So you're looking here at Marriott, right? Marriott has lots of different brands. They've got the luxury brands, they've got the more budget friendly brands. They've got brands that are geared towards those that are 21 and older, and they've got brands that are geared towards the family, kind of all inclusive resort. And it would be really time consuming and really difficult if we were expected to look at the Westin website and then make a determination and then go to Four Points and then go to Sheraton and go all the way around all of these. Instead what they've done is they've presented us with a very simple interface that allows us to pick the destination, pick the dates, and on the back end, it's searching all of the different things. They might know a little bit about us because of our profile. They might know a little bit about us because of where we're going. They might know a lot about the area because of time or events, that sort of thing. At the end, they're only gonna push to us the results that really matter, that we're most important to us. And that's what we want to do with the agents. We want to be able to take and sift through all of that stuff, let the system handle that, and only present to them, to the agents, the appointments that meet A, the physician preferences, and most importantly, the patient preferences. And so this is the process that we started to go through as we started to evaluate that we had our business criteria in place, we had the vision. And so we went out to market, and the first thing we did is, we spent a considerable amount of time developing an RFP for that. And we went through and tried to solicit as many written responses as we could. And from there we were able to make a preliminary determination. And there were some potential vendors that just didn't meet the mark, didn't either answer the questions or respond fully. So we took them out and we were left with a handful of potential candidates to bring into a business demo. And the business demo for us was really all about, what is the system capable of doing? Show us maybe what the interface would look like, show us, you know, kind of the art of the possible, I guess. And from there, we really were left with two, Pega being one, and we decided to take it one step further and we really wanted to see a technical demo on top of that. And I can't think our IS team enough for doing this. The IS team developed a set of APIs to connect to. They created a data warehouse on the back end of that, and let these two really connect and go, not overly complicated, but to showcase the capabilities and really say, "Yes, we can do what we say we're going to do." And that left us with a clear choice in Pega, not only for their ease of being able to connect and being able to do things there, but also for the automation capabilities, the ease of business users being able to do it. And what we were seeing as a simplified agent screen. And so we ultimately decided to move with Pega. And this is what we then started to work very diligently with Pega on, is getting to, what does that future state look like? We knew that we wanted to have a single screen that was able to do, just like I explained with Marriott, able to do all of the things, take our call controls, be able to look up a patient, look at any patient notes. We knew that we wanted to rely on the software and automation to help absorb all of that complexity and drive decisions and really produce the best results. And we also knew and expected that the results of all of this simplicity would be kind of fourfold, aligning back to those objectives. One, that we would decrease cost, two, that we would have a greater experience of work from the employees. I mentioned all of those systems, they were pain points for us on employee surveys. And so we were under the belief and it's proved true, that if we can get to a single screen and make their jobs easier, we'd be able to increase their experience of work. The next one is, increase the patient satisfaction. At Sutter, we believe that the greatest respect you can have for an individual is the respect of their time. And if we are keeping an individual on the phone when all they want to do is schedule an appointment, that's not very respectful and at least from our perspective, not very respectful. So we were under the impression or the expectation that if we can really speed up this process for the agents, we're ultimately respecting the patients and it will lead to a increased patient satisfaction. And then lastly, I touched on it a little bit. Anytime we make an error in the contact center, it has a downstream impact for the care center setting. So if we can eliminate those errors, we would lead to a greater joy of work, a greater physician satisfaction. So again, no one of those is more important than the other. They're really four legs on the table, and imperatives for us as we set out on this journey. We finally got to it. We finally got to the single screen. So what you're looking at now is Sutter's scheduling screen, obviously with a test patient on there, but it's one place where you've got the call controls, you've got the ability to look up a patient, get all of their demographic information. You've got a couple of simple controls over on the side to help, but it's one clean interface. We segment by call type and then by geography. So example, scheduling is a major call type. And then under that, because of the variation from region to region, we segment by region, and I'm gonna talk about that a little bit more, but we are now on the path to that universal or concierge type agent because we've got a similar look and feel for all of our different regions. It's now very easy to train and go back and forth from region to region. It's the same look and feel, although the rules behind it may vary. They're all built into the solution. So the summary of where we're at so far, we're about 49% complete with our initial implementation scope. So those of you that were paying close attention, I did mention that we started this journey in 2019 and you're looking at this slide saying, "I don't understand, 2019, why you're only 49% complete." So I want to hit that right on the nose as we go here. We were literally in... We did our first phases of discovery in November of 2019. We were in training in March of 2020 when the system came down and said, "Hey, we need to start sending people home." And so Sutter Health, I don't want this in any way shape or form to be a reflection on Pega because they were more than willing to go. But we made some strategic decisions to pull back our IS resources and redeploy those to help A, respond to the pandemic, set up more clinics, and then in 2021, set up vaccine distribution hubs. So we really didn't kick off the project in earnest until 2022. So we're 49% complete with our initial implementation scope now. And as some of the results we've seen a 28% reduction in the agent error rate. So an error for us is any time that an appointment lands on the physician's schedule and the care center doesn't... Feels like there's something off there. Insurance wasn't loaded quite right, back to back physicals when the physician only wanted one physical in the morning and one physical in the afternoon. Things like that. Some of them may be minor, but it throws off the flow in the care center. Worst case would be we send a patient there and we don't accept their insurance, we have to turn them away. So 28% reduction in those errors. We've seen 11% increase in the agent productivity. So I mentioned that we segment by call type and then further segment by geography, as we have a similar look and feel in our training program, all regions look and feel the same. The rules are on the backend. We're able to now start blending those geographies and we're picking up economies of scale. So an agent who takes maybe in our Silicon Valley market is now able to take calls in two markets. We've seen them be able to take about 11% on average, 11% more calls. We haven't seen any noticeable increase in our handle time. That was important for us. In some companies, some applications you may build in, that you're going to really reduce handle time. That was not ours. We knew that by forcing people through a very rigorous... Forcing our agents through a very rigorous decision making process and really sticking to the script so to speak, that we wouldn't see a decrease in our handle time, but we certainly didn't want an increase. Now of course anytime you implement, you'll see an initial small bump, but it's come back down and we're back down to baseline. So no noticeable increase in handle time, that was a watch metric for us. We now have 446 active agents on the platform. By the end of the summer, maybe September timeframe, we should be right about a thousand agents on the platform. So it's been a slow ramp, but we're at the point now where we'll essentially double that. And the big one for us is we've now seen a 75% reduction in our training time. So as we previously would take an agent and say again, that Silicon Valley market, maybe we'll want them to now learn about calls and be able to handle calls for our Sacramento market. That process would take four to six days to get them up to speed, teach them the different variations from region to region. Now that most of the rules are contained on the backend through the system, we can really put them through that training in about six hours. Call it a full day to round up, just to be safe. So that 75% reduction in training time has been huge for us. It allows us to respond to any fluctuations in call volume or surges in one area or another. Relatively easy. I will say there have been some lessons learned with anything, and wanted to kind of wrap up here talking about a couple of those lessons learned. I would say first and foremost, spend as much time as you can upfront, documenting your different intents, and go deep on those. So in our world it was scheduling and you could say, "Well, this is the process for scheduling," but there's all of those fine details. And we also found there's the way that we anticipated they were going, and then there's all the sticky notes around the agent's computer of different things that they do as exceptions. Really take the time to understand those, document those and work with either your implementation partner or Pega, to make sure they understand them as well. Closely related to that, I would say resource your project team appropriately. It'll help you go much faster on the backend, if you're appropriately resourced, there's great partners to help you accelerate. Accenture was ours, to be able to do that. So do that. The next two go hand in hand. Whatever EHR you're using, I would get them into the discussion as quickly as possible, maybe even as early as the RFP process, so they know what you're trying to accomplish. They get a chance to weigh in, to be able to explain if there's any limitations or concerns from their perspective, if you're gonna start accessing the EHR and pulling information both in and out of it. And then again, closely related, these go hand in hand. Run the proof of concept with all APIs early to understand if there's capabilities or limitations of the EHR that maybe you hadn't previously known. I think it's fair to say we've been pleasantly surprised in some cases and we've been unpleasantly surprised in some of those cases. So proof of concepts upfront is key. And then the last one there, I would say offer multiple opportunities for Pega training and certification, as well as continuing education. We did an initial training, we had a pandemic, we didn't necessarily go back. So as we were finally going live, even though we had certified some folks, it had been quite a while since they'd been able to do some of those things. So multiple opportunities to do that. I'm gonna just call out my team really quick and I want to introduce you to all of the individuals that learned these lessons. I'm gonna start, if you guys can stand, we have Renee Woolford, we have Laura Hafner, Rob Leray, these are from the operations team. And then from an IS team we have David Odell, and we have Agus Hartono. All of them, I'm gonna take a moment of personal privilege and just say thank you. It is an absolute honor to work with each of you and thank you for getting us to the point that we're being. Having said that, we've left some time for questions, my team's available to help out, but Michelle, anything you'd like to say in closing?

- Yeah, I think those are all great lessons. It's been a wonderful journey. You know, the thread that runs through here to me is, it's about the data. So your proof of concept with your EHR, the data has to be right. What you said earlier, you know, if you schedule it with the wrong insurance and they show up at the wrong physician's office, that's the data, right? Pega is the easy part. It's really how you organize yourselves around the data. So I think Pega as a platform has become very, very powerful. You know, we just gotta keep pressing on that data piece.

- Okay. Thank you.

- All right, thank you guys. Thank you Michelle. Thank you Steve for talking about the complexity of the call center. I think of oftentimes you just think, "Oh, patients call in and it's easy, you just plug them with their doctors, right?" But being a provider myself, you know that we have certain nuances, we have schedules, we're in the OR in the morning, or we prefer our patients seeing them in the evening or afternoon rather. Or we like to see them on Monday and Fridays, not on Wednesdays. We like new patients in the afternoon, not in the morning. And so, right? If they need a translator, then schedule them after lunch, first appointment. So the complexity and the nuance is huge. And so the fact that you're able to modernize your call center and to be able to really make it seamless, leveraging Pega, is substantial. To that point, I had two questions before Steve started. Now I have four. Does anyone wanna go before or may I go ahead? No? Okay. Well I'll go. All right, my first question to you, Steve, that I'd like to pose is that, when patients cancel appointment, that's revenue loss for the organization. Are you able to capture those appointments quickly and replace it with another patient in there? And if so, how?

- Yeah, I'd say there's a couple of things. One, through our EHR, we use something... We use basically a wait list function. So there's the ability there to notify a wait list of patients that there's a new thing. And I would also say, and this is probably not unique, access is a challenge-

- Yeah.

- Kind of everywhere.

- Yeah.

- And so there's typically no shortage of same day appointments. So you know, if it's canceling a 9:30 for a 10 o'clock appointment, the wait list is probably what will fill that appointment. If it's canceling something in the afternoon, in most cases that'll get snatched up fairly quickly by somebody who wants to see their physician.

- [Dr. Dayo] Okay, one more question and then I'll hand it off to John. Question about EHRs. I've grown up using Epic, I've seen the evolution of Epic from... Let me not say the age, for a while. And it's become more cumbersome, but it's still a great EHR for us to use. Now I wanna know from your point, from your standpoint in terms of implementation, what were some lessons learned from leveraging and integrating into EHRs? And it doesn't have to be specific to Epic, it could be Cerner or whatever.

- Yeah, so I'm gonna make blanket statements. We won't call any EHR out. You know, bringing them in early-

- Yeah.

- I think is key, right? And being... Not only bringing them in early, but having open and honest dialogue of, this is our challenge and this is what we're trying to accomplish, right? So that they have as much information as possible to be able to help you through that. I would really... And David's here, others from my team weigh in certainly, but I'd really say they can be a great partner, and oftentimes the mistake that we make is maybe not sharing exactly what we're trying to do or those pain points. So taking advantage of all of those, bringing them in early, letting them have a seat at the table if appropriate to talk through those. David, anything you'd want to add?

- I guess just to add that, you know, I won't say which EHR vendor, but they believe they're a CRM too.

- Oh.

- A lot of times they'll ask, "Why do you need this? We do this in EHR." And that's just flat out through all variation that we need to model respecting the requirements for scheduling, we can't do that in EHR.

- Yes.

- It's too much. And we model a lot of those preferences in an external database that was managed by agent leaders. Can't bring that into the EHR. You bring that in you know, through the data link, . So I mean, I'd probably bring in the EHR vendor early but don't necessarily accept their answers.

- Okay.

- Okay?

- [Dr. Dayo] Great point. A great point.

- Well said.

- [Dr. Dayo] Michelle, did you have something to add?

- We also, you know, have a very strong relationship with the EHRs, and so we were able to also help and leverage that behind the scenes, right? And so a lot of times when people look at a Pega project, they're thinking they're screwing in a widget, and it's really about all the things that have to come together to make this successful. And the EHR is really just one of them. It's the big one, but it is one of the things that have to come together. And so making sure that all those things happen is the job.

- Thank you.

- And so my... It's a related question. Your hospital system, how many EHRs do you have to integrate with? And is it just like one or two major facilities or are you also doing it with the individual smaller practices?

- Yeah, so we've got one EHR that we had to deal with in this case. I think it's fair to say though that we had, I don't know if I wanna go as far as saying different flavors, but the templating from region to region was a little different, but it was one EHR.

- Different workflows.

- Different workflows. Yeah, that's probably a better way to say it. We are not... So with Sutter Health, all of the physicians are part of medical groups that are part of Sutter Health. We are not, at least right now, in scope or out of scope would be any independent affiliated physicians. We're just working with kind of the employed physicians.

- [Audience Member] Right, so you have one EHR vendor, was that also one IT team that was supporting the one EHR vendor or was there multiple different IT teams?

- One IS team supporting the vendor, yeah.

- Yeah. Thanks.

- You're looking at the guy already.

- You're looking at him, right over there.

- No, good question. Thank you. And I realize that's not probably the case for everyone. We are fortunate in that respect.

- [Audience Member 2] The metrics were great, Steve. What about the satisfaction level, employee, provider and patient? Were you able to track that and measure some of that?

- Yeah, so our employee satisfaction survey we do once a year, and that will roll out... So this next cycle will be the first time that we'll have a large population on Pega. We did see an increase from 2021 to 2022 and we're hoping that we'll see something similar here. I will say that we... So that's the one formal survey, and then throughout the year we're doing touch bases with our employees and the feedback has been really amazing, right? "Oh, it's so easy. It's a single screen. I love how fast it is, I love how clean it is," those sorts of things. But we're really hoping to see some big bumps in this next employee survey, which goes out at the end of the summer.

- [Audience Member 2] And then you'd mentioned time, so average handle time didn't go down from the patient's perspective. Any way to track that. And then from the provider perspective, you had mentioned the reduction in error. So we just have to assume that that would be very beneficial on the provider side as well.

- Yeah, so I know we have at least one physician in here. I don't want to offend any other physicians, but with physicians it's typically, no news is good news. So 28% reduction in the areas there, and no complaints recently. So there we go. I'll take it as a big win. And then, you know, from the patient satisfaction, we've seen that go up. There's a couple of initiatives there, so I didn't put it in the slide as directly attributable to Pega, but we have seen an increase over the last year in our patient satisfaction scores.

- [Audience Member 2] Well you'd have to assume if the scheduling was wrong, that obviously the provider's not happy, the patient's not happy. So you have to assume that would affect-

- Right, I mean, like I said, worst case scenario and I've had this happen to me, I am not in the Sutter footprint so I can say this, but I've had it happen to me where I've shown up at a specialty office and they said, "Hey, we don't take your insurance." It's like, "Well, I've waited three weeks for this appointment and now I've got start over." So that would be absolute worst case. And if we're not doing that, yeah, you would intuitively assume that it's going up. Good question and good call out.

- That's your competitive advantage in the market too with the physicians.

- Right.

- You allow them that flexibility, right? You're not trying to streamline them and re-engineer them into doing everything the same way. You're accommodating them and Pega can do that.

- Yep, exactly.

- [Audience Member 3] One clarification and then one question. The scheduling that you're doing is being stored in the EHR, is that correct? The physician schedule is in the EHR?

- So we're not storing a lot of the data within Pega. Pega is the interface going out and we are grabbing that appointment in the EHR. We're reading the EHR, bringing the data back to the agent, yes.

- Updating the EHR.

- Yes.

- So the EHR should love Pega, because Pega's never the system of record for that. They should absolutely be all on board. Yes, let Pega manage that lifting and that simplified workflow for the agents, where you absolutely need to keep it simple so that you can... If you have turnover, you can have that really fast.

- Yeah.

- Training time and who doesn't have turnover in the contact center.

- [Audience Member 3] And then my question to you and doctor here and others talked about these sort of complex rules. You know, doctor only wants to see person with a translator after lunch or this procedure only in the morning. Where is your source for all that data and how do you manage it?

- So that's a good thing.

- That's a great question.

- That's where the IS team has been integral. Over the years we had multiple different sources of that. We could build some of that into our EHR, but then there was other things. So for example, a classic... And what I've learned is there's always a good reason, or there was at one time a good reason for this. So for example, we had a physician that said, "Hey, I will not see any male patients after 3:30." It's like, well that's kind of random, why is that? Well as you get into it, the reason behind that is they see a high percentage of mental health patients, female provider, security guard goes home at four. And it's like, okay, well now we can get in to solve that. So where do we keep that, was your question. A lot of those for years had been written down in binders. As we started to centralize the contact center, we built SharePoints and and other data sources. So the IS team was great and this was one of the reasons we went with Pega, and one of the reasons we didn't want to store the information in Pega, we wanted the ability to go out to all of these systems because we had a system of record for all of these physician preferences. Pega can go out, pull those and bring them back in. We've got the EHR where all of the appointment data is, we can go out and pull that. We've got, you know, agent stats for the phone system. Pega can go out and pull that. So we have a centralized... Long story short, we've got a centralized warehouse for all of the physician preferences.

- Because Pega's not the only user of that information. So you can't just take it and put it over into Pega unless you're prepared to give those users access a way to get to it, right?

- Yeah.

- Because it's not just about the Pega workflows having access to that.

- Yeah, that's a good point. Over time as we started to centralize these preferences or provider pages, you started to have other resources within the company say, "Oh, we finally centralized all of this." How can we get at that? Good question. Any more?

- Dipak?

- Okay. Oh.

- [Dipak] Okay, so the use case is primarily around scheduling, correct? The use case for this implementation?

- Right now, yes. So our biggest call type of those 14 million calls that I mentioned, about 70% of them are scheduling related, or I'll even go a step further and make it broader and say calling my physician office, right? So that could include medication refill, general questions, about 70%. So we started with that, but then as I mentioned, our vision is to expand it out and start doing billing, start to do, my health online patient portal where we can... Yeah. But we started with scheduling because that was gonna be the biggest bang for our buck and influence the most amount of calls.

- [Dipak] Now do you have any other channels or is it only catered towards somebody calling in for an appointment?

- Yeah, so our -

- I mean, can I go a member portal and schedule an appointment without talking to anybody?

- We've not implemented on our patient portal yet. The vast majority, and when I say vast majority, about 95% of our contacts are inbound phone calls. So we started there. We do have chat as a function and then other channels that we would be looking at would be our email or patient portal messaging, and then interface in the patient portal after login.

- Thank you.

- Good question.

- These are my long time clients sitting right here.

- Good deal.

- Any other questions?

- Yeah, they have a 7-year-old contact. 7-year-old, your contact center, Pega contact center application's seven, eight years old now, right? Going strong.

- Okay. Yes please.

- [Lisa] Hi, my name's Lisa from Bupa, Australia. A slightly loaded question if I may, around AHT. So I was very interested in the fact that there was no AHT benefit, which is also my experience, but in a slightly different environment and reasons from my own background is, more that that space gets used for value add conversation. Instead, I just wondered if that was your experience or if there were other reasons you felt AHT wasn't impacted?

- Yeah, so one of the things we found with our agent population, so... And I should back up, I showed you those Visio diagrams of the workflows. And so agents would have to go through this big document, find the Visio diagram and kind of follow it. Our more tenured agents got to a place where they just knew what to do and would do it, and 7, 8, 9 times out of 10 they were right. The problem was if we introduced a change, they're now going off of memory versus seeing that change. What we did by implementing Pega is now they are going through, very methodically, every step. The system is driving them through those questions. So, okay, it's Steve Chambers, is he a new or existing patient? They have to answer that question. That's why we believe that we didn't see the average handle time drop, but instead we've seen greater adherence to the current workflow. They're not able to really skip around it and less propensity for error, because they're being driven through. And if there's a change, it's seamless to them, they still just answer the questions and that's all taken care of on the backend, yeah.

- Thank you.

- Good question. Thank you.

- [Audience Member 4] Hi, I have two questions. One, you talked about documentation and I think that's a great lesson learned that you shared, but can you tell us if you leverage any of like the Pega capabilities for documentation in the application, and how did the engagement with business work? Was there, you know, the co-working with business to design those workflows on key designers or was it just, you know, creating requirements?

- Yeah.

- We used Jira as the project management tool because it's an enterprise application and we had a lot of people that needed to get in there more than just the Pega team, and so a lot of people. And then the business team is actually sitting right here that we collaborated with very much. I think I remember being on like a 2:00 AM or it was, right? That night we went into production. We were having trouble with the infrastructure, it wasn't Pega, to be clear, but yeah, they were absolutely with us, joined at the hip, and still are, I mean they're building these workflows themselves. They have a backlog and inventory that they're working through themselves and we have a skeleton crew that's just supporting their efforts. So yes, very much in collaboration with the business.

- All right, thank you.

- Great question. Okay. Oh, sorry.

- [Audience Member 5] I have an additional question. I know you just mentioned that you have great agent satisfaction scores so far, but then the previous question kind of brought up to mind, now that you are making your agents go through a specific process flow, has there been any pushback with like your more experienced agents that were like, "Hey, this is not what I want, I don't like change." And if so, how have you dealt with that?

- No, everybody was... No, I'm just kidding. Renee can attest, but there were some of our very seasoned agents that were like, "I know what to do." And it only took once of them kind of not following... This is fair to say, right? It kind of took once of them not following, having had a workflow change to realize, oh there's real value here in going through the process. So I think, you know, it took some of the discussions, they were few and far between with probably our most tenured agents who had been there for a long time and really prided themselves on being able to know everything to do in every situation. But you know, you sit down with them, you talk to them, you let them know the benefits. You know, good, bad or indifferent, we were coming out of the pandemic and we were making a lot of workflow changes very quickly. We were taking out COVID screening questions, we were doing other things. So it was very easy to make that connection back to those tenured agents of, "Hey, workflows are changing every day, and let's get you to use the system so you don't get caught doing something wrong." Yeah.

- Thank you. That's great. Okay. Oh, yeah?

- I'm mainly interested in the business side development of the process flows and like, how difficult is that? And you know, does it take much integration or collaboration with the IT organization? Or are you guys able to just go off and do it?

- I really feel like that's a question for Renee and Laura.

- Yeah. We're coming up right on time. Would you mind if I connect you, but I think short answer is, there's really, really good collaboration between the IS and the business side. Maybe you two you'd like to expand a little bit?

- [Renee] Yeah, and we're using custom questionnaires within the system that we're managing ourself from the business team. So anytime we need to develop a new workflow or update one, we're doing it through the questionnaires and in multiple environments. So we go through the same technical process that IS would with testing and validating, making sure it's accurate and a good experience for our employees.