Intelligent Virtual Agents in Health Care

Discover a revolutionary, efficient, and effective way to amplify the "high touch" of specialty pharmacy with the use of technology as patients embrace new tools to monitor their health.

Specialty pharmacies offer an extensive array of specialized services in their efforts to facilitate the most expensive and complex therapeutic regimens administered outside of the hospital. As a result, it is not atypical for them to interact with patients significantly more than the prescribing physician. Standard business operations include verifying insurance eligibility on a monthly basis and determining whether the patient is still taking the drug in question.

Specialty pharmacies also work to ensure that patients are free from unacceptable adverse events and are able to effectively administer prescribed therapies. Many specialty pharmacies have upgraded their service offerings to include measuring outcomes and administering complex Risk Evaluation & Mitigation Strategies (REMS) programs on behalf of manufacturers.

THE HIGH-TOUCH CHALLENGE

Specialty pharmacies continue to face decreased rebates and discounts from pharmaceutical companies and reduced payments from payers in an increasingly competitive environment where operational costs continue to rise and service levels have to remain high. The “high-touch” model requires highly trained health care providers—including pharmacists and nurses—to administer many of their services.

Given the competition for talent, their salary requirements are high and they face continuing educational needs for their employees, due in part to an ever-widening number of drugs for ever more rare conditions. With the convergence of rising costs, increased pressure on margins, increasingly complex drug regimens, and the pressure to deliver high service levels that drive improved outcomes, it is more than an imperative that specialty pharmacies utilize technology to become more efficient.

INTELLIGENT VIRTUAL ASSISTANTS: A STRATEGIC SOLUTION

An intelligent virtual agent for health care—or a virtual health assistant (VHA)— is an effective, infinitely scalable, and affordable way for specialty pharmacies to not only survive but thrive in the face of the industry’s ongoing service-level challenges. A VHA-facilitated interface can be designed and implemented—using existing technology—to take on many of the tasks currently being administered by the clinical and operational staff within the contact center.

In fact, with the increasing consumer interest in using the smart device as a health management tool, specialty pharmacies have a once-in-a-generation opportunity to use VHAs to exponentially expand and redefine the “high-touch” model. In addition to automating the more repetitive tasks, such as verifying insurance and the continued need for a drug, VHAs can engage patients on a daily basis and work intimately with them to improve medication adherence.

Tasks that VHAs can facilitate include gathering robust qualitative data on barriers to adherence, using personalized motivational interviewing techniques, and providing virtual coaching to assist patients at their most teachable moments. Adverse events can be uncovered and addressed in a similar fashion. Importantly, the VHA will also act as an always-on-duty early warning real-world interface for adverse events that were not discovered in pivotal clinical trials, and it can facilitate escalation of the interaction to the contact center or the appropriate health care provider at the appropriate time.

THE EMERGENCE OF ARTIFICIAL INTELLIGENCE AND NATURAL LANGUAGE PROCESSING

The history of intelligent virtual agents can be traced back nearly 50 years, beginning with the quest for artificial intelligence (AI). Creating an intelligent virtual agent, however, requires not only AI, but also the ability to recognize natural language.

Artificial intelligence is defined as the ability of a computer or other machine to perform actions thought to require intelligence. Among these actions are logical deduction and inference, creativity, and the ability to make decisions based on past experience or insufficient or conflicting information.

Natural language is using human written or spoken language to engage with a computer, as opposed to computer language. This differs from mere speech recognition, which is used for dictation and requires only that a computer recognize the word and insert it into a medical record. This technology goes back several decades. Intelligent virtual agents are trained to deliver value through user-friendly, humanlike interaction that is consistent, scalable, and personalized. Uniquely well suited for a smart device, the more advanced companies in this relatively new industry have created an unparalleled solution for smartphones and tablets by offering the ability to interact by typing or tapping on the screen, in addition to voice recognition, which has improved dramatically in recent years.

It is critically important to offer all 3 modes of input, for a number of reasons. Some users will prefer using drive time to converse with their VHA. Others will need to be able to communicate in a work environment that offers little privacy for speech, necessitating the use of typing and tapping to facilitate the engagement. In addition, the type and touch options serve as critical backup when voice recognition breaks down due to environmental or user impediments such as background noise, a challenging accent, or a speech impediment.

A brief Internet search uncovers a number of vendors who offer intelligent virtual agents. Many are based in Europe. Many are very small organizations and only a few are pursuing health care implementations. Top companies include:

• Next IT: Focusing on the patient interaction

• Nuance/VirtuOz: Focusing on medical records

• Creative Virtual: No obvious medical focus

• IBM Watson: Physician decision support

The big question this technology raises is whether a patient will engage with a VHA. Timothy Bickmore, PhD, associate professor at the College of Computer and Information Science, Northeastern University, has extensively researched and written on this topic (http://www.northeastern.edu/news/faculty-experts/tim-bickmore/). His assertion is that patients not only engage, but foster what he terms a “therapeutic alliance.” He has even created a personal lactation avatar!

To quote Dr. Bickmore: “Computer agents are designed to build and maintain long-term, social-emotional relationships with people. In order to use the same myriad cues that people use when relating to each other, I build agents that are capable of emulating face-to-face interaction with people. These agents are particularly effective for tasks in which long-term interactions and personal relationships are known to be important, such as in education, sales and marketing, and the helping professions. Of these, I have focused my recent work within the healthcare domain on health education and health behavior change applications.”

ADHERENCE

Tasked with becoming a personal VHA to many who face complex and disabling diseases, it is quite likely that an intelligent virtual agent could improve adherence to many treatments. A previous article in Specialty Pharmacy Times (http://www.specialtypharmacytimes.com/publications/specialty-pharmacy-times/2012/december-2012/Best-Practices-in-Adherence-in-the-Community-Setting) stated some of the results of better adherence, so I will not repeat the obvious except to say that better adherence leads to better outcomes.

A VHA could also assist those with treatments that require constant monitoring due to the normal adverse events associated with the treatment (interferon treatments for hepatitis and multiple sclerosis come to mind).

Deploying a VHA will enable specialty pharmacies to redefine the “high-touch” model for patient care. They could also gather an immense amount of data on real-world conditions, provide a robust platform for comparative effectiveness research, and reduce operational costs. In addition, they could reduce training expenses, reduce reliance on limited interactive voice response decision trees, optimize their human capital, provide 24/7 personalized access and resources to patients, and most certainly, improve overall outcomes for patients using their services.

Specialty pharmacies may also open new revenue streams by providing higher value to pharmaceutical manufacturers and payers. Through their ability to intimately engage with patients regarding the efficacy of medications, this technology could provide important data on how populations are benefiting.

In summary, the time is right for specialty pharmacies to consider deploying virtual health assistants to optimize contact center outreach, enhance the treatment experience, facilitate personalized adherence protocols, and improve outcomes.

About the Author

Author of “Tomorrow’s Medicine,” the longest running health care technology column in the United States, Thomas Morrow, MD, has been the founding medical director for 5 HMOs, a clinical lead for a national disease management company, and a National Committee for Quality Assurance surveyor. He currently works for a large biopharma company. The opinions expressed in this article are his alone and do not reflect the opinions of his employer. He has received no income from any of the companies mentioned in this article.