Is the healthcare contact center ready to impact value-based care?

A patient discharged from the hospital after surgery needs to schedule follow-up appointments, manage medications, and monitor symptoms. Scheduling a follow-up appointment should be simple, right? Not if the patient’s attempts to reach the provider go unanswered. The office staff? Overwhelmed. The front desk? Swamped. And the patient? Left to navigate the system alone.

This scenario is too common as healthcare contact centers are flooded with more calls and chats than they can handle, often leaving patients feeling lost and frustrated. And point solutions and portals that offer self-scheduling refer patients who have inevitable questions or concerns back to the same overwhelmed teams. With limited staffing and outdated tools, most contact centers can do little more than react to the high volumes of patient inquiries as quickly as possible, but this is clearly not the solution.

The healthcare industry continues to shift to value-based care, with a focus on improving patient outcomes while controlling costs. This shift where outcomes matter more than volumes extends beyond clinical settings and affects every aspect of the patient journey, including the often overlooked but crucial role of healthcare contact centers. However, they can’t continue to be overburdened, reactive, and disconnected. Fragmented interactions, inefficient processes, and disjointed teams are only a few of the challenges faced in delivering value-based care.

Most organizations shifting from fee-for-service to a value-based model focus on addressing these issues within the four walls of the health system. But they also reflect the state of patient experience (PX) in healthcare beyond those walls, where fragmented digital solutions and disconnected scheduling teams force patients to navigate a complex system on their own. Healthcare contact centers, key players in facilitating care coordination and patient access, are set up to react to high volumes of inquiries as fast as they can. In addition, outdated tools and limited staffing keep them from delivering the proactive, value-driven care that patients deserve.

So, the question remains: Is the healthcare contact center ready to impact value-based care? For the majority of health systems, the answer is no—or at least, not yet. But with the right technology, process transformation, and vision, they can evolve from being just a call-handling hub to a central, proactive component of the patient care journey.

Transforming the healthcare contact center from cost to value.

Traditionally, healthcare contact centers have been seen as cost centers with a typical focus on handling high volumes of interactions quickly to keep operational costs low. Those are important goals, but as healthcare players shift to value-based care they should also address contact centers as strategic assets that can drive value-based care by improving patient experiences, facilitating timely interventions, and enhancing care team communication.

One of the most powerful enablers of this transformation is AI. The ongoing evolution of AI and automation technology paves the way for healthcare organizations to transform their contact centers from transactional cost centers into proactive, value-creating hubs that directly impact patient outcomes. In fact, 90% of provider organizations say that their contact centers will play an integral role in driving great patient experiences in the next two years. Automation is completely changing how contact centers work, offering opportunities to personalize interactions, provide proactive support, and automate routine tasks—enabling human agents to focus on higher-value patient conversations.

Tasks such as refilling prescriptions, managing appointments, or resetting a patient portal password, while crucial, are simple, repetitive, and time-consuming for human agents. AI-powered automation enables healthcare providers to automate up to 45% of call volume while human agents handle the more complex patient needs.

AI also serves as an assistant for contact center agents, boosting their ability to support patients with relevant and personalized conversations. AI can provide human agents with real-time recommendations based on a patient’s data and the organization’s knowledge base, making interactions faster, more accurate, and tailored to each patient’s needs. For example, when a patient calls, the AI can immediately retrieve their prescription history, suggest refills, and offer relevant health insights allowing the agent to focus on delivering empathetic and personalized care.

Democratizing access to AI for the healthcare contact center.

Innovations like agentic AI, which leverage low-code/no-code technology, empower organizations of all sizes to implement AI solutions without needing expensive IT projects or highly specialized data scientists. The operational experts within the organization—those who understand patient needs and workflows—can provide clear instructions, and the AI agents can execute them.

For example, automating a contact center interaction as simple as resetting a patient’s portal password has traditionally required careful planning to account for all possible patient interactions: what if the patient needs to hear instructions again? What if they don’t have their medical record number? What if they want to switch to Spanish language midway through the interaction? Each of these scenarios required extensive configuration and testing.

Each of these scenarios required defining the automated system’s responses by detailing specific tasks, creating a flow to outline conversation paths, developing the dialogue, manually integrating with backend systems, etc. Today, with a prompt as simple as the one below, AI agents will design an AI virtual agent, give it tools to integrate with other systems like the EHR, and deploy it.

“You will assist patients in resetting their patient portal passwords after asking them for their name, date of birth, and ID number. Always be helpful, professional, and empathetic. Request a password reset only after verifying patient identity and maintaining HIPAA compliance at all times. Escalate to a live agent if the patient becomes distressed or requires immediate medical assistance.”

This is a massive breakthrough in automation and scalability, significantly reducing setup and configuration time while saving hundreds of staff hours to focus on optimizing patient interactions to drive health outcomes.

Improving the role of human agents in the healthcare contact center.

Human agents still play a vital role in healthcare and are critical to driving value. AI can handle routine tasks, but it can’t replace the empathy, judgment, and nuanced understanding that human agents bring to patient interactions—especially when it comes to sensitive or complex issues. Automating repetitive tasks frees human agents to handle more meaningful, high-impact conversations with patients, engage with the care team, and provide personalized support.

A U.S. Consumer Healthcare Survey conducted by Talkdesk revealed that patients prefer a blend of AI and human support, depending on the complexity and sensitivity of their issues. Patients prefer AI for routine issues because it is fast, accurate, and never rushes the conversation. In contrast, for a serious or complex medical issue, they want to speak with a human who can provide tailored, compassionate care.

The shift from focusing only on efficiency to prioritizing value-driven, meaningful interactions gives healthcare organizations an opportunity to significantly improve patient experience. Patients will feel heard, valued, and supported in a way that promotes trust and engagement.

Ensuring responsible AI.

AI is undeniably one of the most transformative technologies in healthcare, but any serious conversation about its potential must also address the complexities, regulatory challenges, and risks. When computer systems handle patient communications, providers must carefully navigate the ethical and compliance challenges to ensure safety, accuracy, and trust in AI-driven interactions. Although AI has been used in clinical and non-clinical applications for years, agentic AI is still relatively new, and many providers find themselves in uncharted territory and need to find a balance between the benefits of AI with rigorous oversight to ensure ethical, accurate, and safe outcomes.

Healthcare contact centers are a great proving ground for AI as a high-impact area of the business where success can yield meaningful results, but it avoids the complexities of AI in clinical settings. Contact centers already have systems to test, optimize, and correct automated workflows, so they are the most suitable department to establish and enforce guardrails for AI self-service.

AI solutions tailored for healthcare providers‘ contact centers come with built-in safeguards, such as pre-configured connections to electronic health record (EHR) systems, AI templates, and workflows. This allows staff to focus their effort on optimizing AI systems for safety, accuracy, and helpfulness—instead of building the basics from scratch—making the transformation effort faster and smoother.

The healthcare industry has reached a defining moment. It can try to shift to value-based models while clinging to outdated patient experience and service processes, burdened by inefficiency and reactive measures, or it can embrace the transformative power of AI. Recognizing the contact center not as a cost to be minimized, but as a driver to create value and a proactive hub of patient-centric care is the way forward to embrace the transformation. The contact center of tomorrow will be defined by how boldly we forge a new path in patient experience, how thoughtfully we balance innovation with responsibility, and how diligently we safeguard the human connection at the heart of the patient journey.