24/7 answers: Southwest General's success with HOPE AI voice
HOPE (Hospital Outreach & Patient Engagement) is an AI voice assistant that answers 100% of inbound insurance FAQ calls, saving the health system $4 per call.
Per call savings
Call inquiries resolved without a live agent
Availability for insurance FAQs
As payer contract negotiations dictate shifting coverage terms and network restrictions, patients are often directly affected by resulting financial and access uncertainties. During these negotiations, Southwest General experienced a surge of call center inquiries from commercial and Medicare Advantage members who grew concerned about their billing, coverage, and network status.
Patients expected clear, accurate answers at any hour to understand their coverage and avoid confusion. The organization needed to meet patients where they were, answering calls 24/7, without hiring more staff or risking conflicting messages.
“HOPE helps patients get the information they need while easing pressure on our call center staff. It’s become an important part of how we deliver the patient experience, and we’re confident we can scale HOPE strategically as we continue improving our operations.”- Jae Zayed, Chief Information Officer at Southwest General
The challenge
All insurance‑related calls, including payer FAQs, were handled by the existing call center and managed care staff.
- 82,263 inbound calls annually across the contact center
- 8–11 schedulers or live agents covering those calls
- Long hold times
- Frustrated patients and staff
Call center agents struggled to keep up with the status of negotiations, so responses sometimes became outdated or inconsistent as contract discussions progressed. Southwest General could not support after-hours or weekend calls without adding more shifts, so some patients had to call back or search online for answers when staff were unavailable.
In addition, the staff experience needed a reset, as agents spent significant time answering repetitive insurance questions, reducing their availability to address urgent patient needs.
The solution: HOPE AI
To address these challenges, Southwest General implemented HOPE, an AI Voice project designed to give patients faster answers to important insurance-related questions. HOPE is deployed on Southwest General’s centralized phone line for insurance inquiries, serving patients system‑wide rather than being tied to a single clinic or hospital site. Further, as an AI agent, HOPE provides 24/7 response capabilities, extending crucial support beyond traditional call center hours.
“Any patient calling the designated insurance line during the payer negotiations could be greeted by HOPE and receive automated help, regardless of which facility they typically visit,” says Zayed. The AI Voice project posed a low risk to clinical care and could send calls to staff if needed. The calls followed a set script using approved FAQs from marketing, managed care, and leadership.
Due to its flexibility, Southwest General began fine-tuning HOPE to better serve patients. Many callers feel anxious or confused about insurance changes, especially older adults and those with complex health needs. Southwest General customized HOPE to help these patients by:
- Speaking in simple, voice‑friendly language
- Staying strictly within approved FAQs
- Offering a clear path to a human when appropriate
Because the information was tied to ongoing payer contracts and plan lists, the team had to rapidly update HOPE’s knowledge as new information came in. They ensured those time-critical updates were reflected in the voice assistant’s responses.
Implementation strategy
The team used a structured testing and content governance process to guide deployment, including leveraging approved content only, running organized test cycles, and following escalation call processes.
Every answer about insurance coverage and network status aligned with official messaging because the centrally maintained FAQ was the only source of information. Stakeholders made test calls and documented their feedback, which helped the team make targeted changes. Test scenarios were created where callers wanted to speak to a representative. Southwest General verified that follow-up tasks were created correctly and that staff knew which calls needed attention.
Results
By having HOPE answer insurance FAQs, Southwest General saw immediate operational improvements. HOPE provides patients with real-time, accurate answers to insurance questions 24/7, reducing wait times and freeing staff to resolve more complex issues.
During the project, HOPE handled 40-60% of inbound insurance inquiries and resolved many calls without involving a live agent, leading to a savings of $4 per call projected at full scale.
A strategic implementation process lets Southwest General move quickly while still keeping control and safety in mind. “The organized implementation, clear follow-up process, and strong content management now serve as a model for future AI projects at Southwest General,” adds Zayed. The initial AI project built trust and momentum for expanding AI Voice into other operations, such as scheduling and general inbound inquiries.
HOPE is helping Southwest General build a more efficient, patient-centered contact center while maintaining the high-quality experience patients expect.