Healthcare administration in the United States has many challenges as medical offices grow and more patients need care. Tasks like checking insurance, setting up appointments, getting prior approvals, and answering patient questions take a lot of time and effort. Many healthcare providers have used Interactive Voice Response (IVR) systems to handle simple phone calls. IVRs try to help by reducing staff work and making operations smoother. But new artificial intelligence (AI) tools, like AI agents and Intelligent Virtual Assistants (IVAs), can do these tasks in a smarter way, saving time and making patients happier.
This article compares IVR systems with AI agents for healthcare tasks in the U.S. It looks at how these tools affect staff work, office efficiency, patient experiences, and costs.
Interactive Voice Response systems are common in healthcare to handle basic phone tasks automatically. They use recorded messages and keypad inputs to guide callers through menus. Callers can hear office hours, check appointments, or find billing info.
IVRs handle tasks like:
The main benefits of IVRs are fewer live calls during busy times and consistent answers. Routine questions get answered faster, so staff can focus on other work.
Still, IVRs have limits that hurt their usefulness for complicated healthcare issues:
These issues can lower patient satisfaction and staff productivity. This has led healthcare groups to look for better tools.
New AI agent technology uses virtual assistants that talk in a natural way. They rely on methods like Natural Language Processing (NLP), Machine Learning (ML), and AI models such as GPT-4 or Google Gemini. These AI agents talk or chat with users and handle many healthcare tasks on their own.
Key features of AI agents include:
Many healthcare companies now use AI agents. For example, Infinitus Systems handles over 100 million voice AI healthcare calls yearly and works with many large U.S. healthcare firms. Their AI agents do complex phone tasks that IVRs cannot handle well.
IVRs use fixed scripts and keypad input. This works for simple requests but can’t handle calls needing many steps, like verifying several coverage types or working with different insurer systems.
AI agents, like those from Infinitus and Retell AI, can do many steps by themselves. For example, they check drug coverage, pharmacy benefits, prior approvals, and handle related follow-up calls. This lowers the need for human help and speeds up patient care.
Advanced AI tools learn and improve during interactions. They can predict claim denials, negotiate with payers, and automate claim recovery. Some eye care groups saved millions by cutting errors and improving claims with AI.
This automation shortens process times, lowers human mistakes, and removes problems common in IVRs.
Healthcare staff often feel tired from answering many similar phone calls. IVRs help by handling routine calls but can frustrate when patients don’t find answers or must repeat info.
AI agents better reduce staff workload by fully managing complex calls. Staff can then focus on unusual cases and personal patient care. Studies show healthcare groups using AI see less repetitive work and happier staff.
Support workers using AI report about 14% higher productivity. IBM reports that mature AI users in customer service get 38% shorter call times and 17% higher customer satisfaction. Healthcare might see similar gains.
IVRs often upset patients with limited menu choices and long waits. Lack of personalization and real-time benefit details add to problems.
AI agents offer better experiences by:
For instance, Retell AI cuts average claim intake calls from 12.4 minutes to 5.8 minutes. This increases call capacity by 37% and lowers costs by 92%, leading to quicker and smoother service.
IVRs offer a low-cost way to automate simple tasks but have extra costs from call transfers, manual help, and long calls.
AI agents cut costs more by shortening calls, automating after-call work, and handling many calls at once. This scales up without needing many more staff.
Some healthcare groups report 30% better process efficiency with agentic AI versus IVRs. This helps handle more patients without growing administration staff or systems, important in the U.S. healthcare market.
Healthcare data is very sensitive and needs strong security and rules follow-up. IVRs provide limited protection beyond secure access.
Top AI companies like Infinitus use multimodal AI, custom knowledge maps, and human checks to keep data safe and accurate. They follow HIPAA, GDPR, and other rules using encryption, audit logs, automated personal information removal, and AI checks to lower bias and mistakes.
These safeguards make AI agents safe for automating healthcare tasks while protecting patient privacy and rules compliance.
AI agents do more than handle calls. Healthcare admins and IT staff benefit from smooth AI integration with Electronic Health Records (EHR) and Customer Relationship Management (CRM) systems like Salesforce Health Cloud.
Examples of workflow automation:
These automations lower errors, speed work cycles, and improve patient and staff experiences. IT managers find AI platforms easier to manage by uniting controls in one system.
Healthcare leaders deciding between IVR and AI agents should think about these points:
AI agents that make decisions and learn on their own will keep changing healthcare admin in the U.S. Experts say by 2028, one-third of big software will have agentic AI, and 15% of daily choices may be made by AI.
New trends include:
As AI systems get stronger, old IVRs will be used less, and AI will be key for competitive, patient-focused healthcare.
This comparison shows AI agent technology is a major improvement over traditional IVRs for complex healthcare tasks in the U.S. Using AI agents helps improve how work flows, makes patients and staff happier, and provides scalable, cost-effective admin tools for healthcare providers.
Infinitus AI agents automate complex administrative phone-based healthcare tasks such as verifying coverage for drugs, pharmacy, and medical benefits, prior authorization status, and follow-up calls. This reduces staff burnout and accelerates care timelines for patients.
They launch directly from Salesforce platforms like Health Cloud and Life Sciences Cloud through MuleSoft connectors and Agentforce, allowing seamless automation of routine administrative phone calls without disrupting existing workflows.
Key use cases include verifying medical and pharmacy benefits, checking prior authorization and appeals status, and following up on product coverage and formulary exceptions with payors.
By automating routine calls and providing near real-time updates on benefits and coverage, these AI agents reduce human workload, improve response times, and minimize patient wait times, thus enhancing satisfaction and operational efficiency.
FastTrackTM initiates calls to payors and enables users to bypass Interactive Voice Response (IVR) systems and hold times, saving valuable time and improving access to information compared to conventional IVR phone systems.
Infinitus combines multimodal AI, a proprietary knowledge graph, discrete action spaces, and human-in-the-loop guardrails, which collectively ensure safe, accurate, and compliant handling of sensitive healthcare data during AI-driven conversations.
Infinitus is a trusted solutions partner to 44% of Fortune 50 healthcare companies and works with consulting partners such as Accenture, Slalom, and ZS to serve a broad range of healthcare and life sciences customers.
AI agents offer personalized, intelligent handling of complex tasks without frustrating menus and delays typical of IVRs, resulting in faster verifications, fewer errors, higher scalability, and improved patient and staff engagement.
The partnership enables automated verification of medical and pharmacy benefits, prior authorization checks, and follow-up calls from within Salesforce, supporting bulk and individual transactions with real-time updating of patient records.
Electronic pharmacy benefits verification is currently available, with out-of-the-box medical benefits verification via clearinghouses and expanded Agentforce verification actions expected by October, allowing broader automation and integration at scale.
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