PLAN TYPE
National Multi-line (Commercial, Government, Dental, Medical)
PLAN SIZE
4,000+
GEOGRAPHY
National
120K
Calls deflected in 3 months
24%
IVR adoption Improvement
38%
Improvement in containment and resolution rates
1.5M
Projected annual cost savings
Issue
A multi-line health plan serving members and providers nationwide faced rising call volumes and increasing pressure on its contact center due to limitations in its existing IVR experience. While several self-service features were already available, providers continued to seek live-agent assistance for inquiries that should have been resolvable through automation, resulting in low containment rates, longer wait times, and increased operational burden. Additionally, the IVR lacked capabilities to address several high-volume, low-complexity provider inquiries, creating unnecessary demand on the experience center and contributing to a fragmented customer experience.
Drawing on its nearly 20-year partnership with the client and deep healthcare provider engagement expertise, Sagility was engaged to assess the current IVR environment, identify gaps in self-service adoption, and develop opportunities to enhance containment while improving the overall provider experience.
Action
Leveraging its healthcare operations, provider servicing, and digital engagement expertise, Sagility conducted a comprehensive call analysis, IVR assessment, and gap analysis to understand both why providers were bypassing existing self-service options and which inquiries could be effectively automated. The assessment revealed that 55% of contact center calls were low in complexity and suitable for self-service resolution.
Sagility approached the opportunity from two perspectives:
- Enhancing existing IVR capabilities by identifying friction points, navigation challenges, and gaps that caused providers to transfer to live agents despite available self-service functionality.
- Introducing new self-service use cases for high-volume, low-complexity inquiries that could be automated to improve containment and reduce contact center demand.
Using an Impact-Effort Matrix, Sagility prioritized high-value opportunities and identified three provider-related use cases that accounted for 27% of the overall call volume — chosen for their potential to improve experience outcomes and operational efficiency.
Sagility analyzed successful interactions handled by agents and leveraged best practices from real provider engagements to replicate the most effective elements of the live agent-service experience. Intuitive self-service journeys eliminated unnecessary steps, aligned with existing servicing practices, and provided a seamless transition between automated and live-agent support when needed.
The resulting Virtual Agent solution strengthened the client’s IVR ecosystem by handling routine transactional inquiries, increasing self-service containment and resolution, reducing provider effort, and enabling agents to focus on more complex interactions.
Impact
By applying its healthcare domain expertise, transformation capabilities, and customer experience design knowledge, Sagility helped the client maximize the value of its existing IVR technology, resulting in:
- Approximately 120,000 calls deflected within three months
- IVR adoption increased from 34% to 58%, a 24% improvement
- Containment and resolution rates improved from 16% to 54%, a 38% improvement
- Projected annual cost savings of approximately $1.5M
Rather than introducing a new technology platform, Sagility provided the strategy, design expertise, and implementation support needed to optimize the client’s self-service experience, improve provider satisfaction, and enable live agents to focus on higher-complexity interactions where human engagement delivers the greatest value.
