AMGA IQL22: Unlocking Access to Specialty Care with AI-Enabled Routing & Self-Scheduling

Clearstep Team

Booking specialty care is typically reserved for patients with a referral and facilitated through a call center. While most health systems have some form of online scheduling available to patients (often primary care, urgent care, and/or telemedicine visits), only 14% of health systems provide scheduling access to three or more specialty care types with even fewer health systems allowing access to all specialty care types. 

The inability to book specialists online often results in missed patient acquisition opportunities, yet health systems continue to choose to prevent patients from scheduling specialty appointments online. Their primary concern is that patients will book the wrong visit type, and end up canceling at the last minute or worse attending an unproductive appointment because pertinent steps were missed prior to seeing the specialist. With these issues in mind, how can health systems gain confidence in their online scheduling capabilities to permit patient consumers to self-schedule their specialty care needs? 

Clearstep takes a comprehensive approach to enabling specialist care routing, ensuring that every workflow correctly directs patients to a specialist when clinically relevant and operationally qualified, based on our customers' existing workflows. The process for routing patients correctly follows three steps:

  1. Leveraging our out-of-the-box routing logic for specialists, based on the industry standard nurse triage protocol best practices. In addition to the core nurse triage protocol standards, we leverage a team of clinicians across several specialties to review and determine the correct criteria and symptoms that should clinically route to a specialist. Our practice of the dual review for each protocol provides certainty to our customers in that only clinically validated patients are able to schedule with a specialist directly, given they meet all criteria.

  1. Expanding on our core clinical logic by working with our partners to incorporate existing specialty care scheduling workflows. While enabling our core triage protocols helps route patients to specialists when clinically relevant, we understand that many organizations have already defined when a patient should go see a specialist. Working closely with our customers, we build upon the clinical logic to add any in-house workflows that have been created for specialist routing. By doing so, we ensure we have an exhaustive decision tool that supports complex workflows and will route a patient based on the symptom, procedure, and even patient type.

  1. Enabling self-scheduling for specialty care types, using Clearstep to resolve the correct provider options and visit types for care. Clinical logic and workflows get a patient to the correct specialist type but understanding provider options and the different visit types that exist within a customer’s care environment helps us ensure that providers’ visits aren’t disrupted by the patient’s ability to schedule online. We work with our customers to define each preference for visit types and provider options for all specialists offered in specialty care routing and incorporate them into the scheduling logic.

Improved patient experience, reduced call volume to call centers, and new patient acquisition marketing strategies are all potential value-adds directly attributed to enabling specialist care routing. By taking the Clearstep approach, health systems can be assured that the transition to online specialty care scheduling is not only beneficial for patients but also seamless for providers. 

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