The healthcare industry is buzzing about the possibilities around next-generation artificial intelligence agents.
Health tech company Cedar unveiled an AI voice agent to tackle one of the more frustrating parts of healthcare—the medical bill. Developed in collaboration with Twilio, the solution is trained on Cedar's proprietary healthcare billing data.
Cedar, a patient financial platform for healthcare providers, developed the AI voice agent, Kora, to automate patient billing calls for providers. Cedar executives contend it's the first AI voice agent purpose-built for the patient billing experience, building off Cedar’s healthcare ecosystem and real-time data integrations to answer patient questions and offer personalized financial pathways.
Currently, patients experience a lot of friction when trying to resolve billing questions. They often spend a long time waiting on hold to speak to someone at a call center or they can only call between certain hours, say 8 a.m. to 5 p.m. Monday through Friday.
Healthcare providers are inundated with thousands of daily inquiries from patients seeking clarity on their financial obligations, driving up administrative costs. Hospitals and practices are looking for ways to use technology to improve call center efficiency, resolve billing inquiries quickly to increase patient collections and reduce manual workload for their staff.
"One thing that that we heard pretty consistently from providers, from the market at large, is that there is increased budgetary and financial constraints and pressures and removing friction and delighting patients is as important as ever, but simultaneously, like they are looking for opportunity to improve efficiency and to reduce the burden on their staff for low value-add activities," Dugan Winkie, head of commercial strategy at Cedar, said in an exclusive interview with Fierce Healthcare about the new voice AI agent.
"We spent some time thinking about where are some additional areas that we can expand our product offering outside of the direct digital patient financial experience. And, funny enough, call centers rose pretty quickly to the top of the list. Why is that? For providers, this is a very challenging, complex business unit to manage. There are staffing shortages, there are highly irregular patient volume spikes, there's inflationary pressure, and there really hasn't been as much technological innovation as maybe in some other areas of revenue cycle, like coding and clinical documentation," Winkie noted.
Cedar's AI agent understands natural language, identifies underlying issues and responds conversationally, much like a human agent, according to the company. It’s designed to be compliant from the ground up, including HIPAA privacy and security safeguards. The agent will be able to detect sentiment and tone, support multiple languages, and provide empathetic, real-time support without hold times, escalating to a live agent whenever necessary.
Cedar’s AI voice agent is now live with medical practice group ApolloMD, which partners with more than 100 hospitals to provide multispecialty physician, APC and practice management services.
Providers face resource shortages and escalating costs. Cedar's AI voice agent improves efficiency to help quickly resolve billing inquiries while offering an empathetic approach when communicating with patients.
"Patients do want to pay their bills, but they need to be able to do it in a way that they can manage their finances," Amy Katnik, chief operating officer at ApolloMD, told Fierce Healthcare. "We have a problem of reducing reimbursement constantly, and you don't want to put a lot of pressure on people to pay, but you need to do it in a way that makes sense and when it makes sense. AI agents made perfect sense in terms of handling this. They sound just like people. They don't get angry. They just handle it very smoothly."
ApolloMD, a long-standing partner of Cedar, works with 138 hospitals, supporting over 4 million patient visits. "As you can imagine, that's a lot of volume potentially going through the call center. The impressive thing about Cedar is they are always looking to upgrade and do more and they're constantly pivoting with technology," Katnik said.
The company is seeing reduced hold times for patients as the AI agent can quickly resolve their billing questions. ApolloMD expects to have about 30% of its calls handled by an AI agent by the end of the year, Katnik noted.
Cedar launched nearly 10 years ago to modernize the medical billing process and remove pain points for patients around confusing, difficult billing and administrative processes. The company built out patient-personalized medical billing and offers Cedar Pay, a billing and payment solution. Cedar says it has served more than 50 million patients nationwide and processed over $10 billion in payments.
Cedar developed Kora as a modern solution for patient collections and call center operations. It's available 24/7 to autonomously resolve common billing inquiries on the first interaction, going beyond traditional IVR tools by clearly explaining charges, identifying payment options, and connecting patients with financial assistance, according to the company.
"One of the providers that we work with, over 97% of calls were questions about their bill. They weren't calling in just to make a payment via phone. They were calling in because there's confusion. 'What is a co-payment? What is co-insurance? I've paid this at the front desk, why am I getting a bill? I don't understand how deductibles work. I need a copy of itemized statements.' These are all examples of things that rise up, and the answer is both simple and complex," Winkie said. "What I mean by that it's simple in the fact that there is an answer. It's complex in the fact that oftentimes, no single healthcare entity has that answer. If it's a question about their deductible status, they're going to point them to the payer. The patient is oftentimes left in the middle navigating this complicated ecosystem of vendors."
"We think conversational and agentic AI is part of that answer where we can take all of our existing integrations with some of these ecosystem vendors that have been integrated into our digital platform and translate that to a voice-based context," he said.
He added, "Healthcare systems are spending millions of dollars on call centers to staff them. It is the primary modality that most patients jump to when they have questions and they feel like those questions aren't answered. We decided to meet the patients where they are and insert Kora as our AI voice agent as that first level of triage to really help the existing call center staff operate at the top of their abilities."
Cedar projects that Kora will automate a significant portion of providers' inbound calls, helping lower costs by reducing reliance on call center staff and allowing skilled operators to focus on complex interactions that benefit from a human touch.
Cedar sees potential for AI to modernize healthcare billing
Cedar announced a collaboration with Twilio, a customer engagement platform, back in March to integrate AI capabilities into the patient billing experience. By integrating Twilio’s Voice API and Stripe Pay Connector, Cedar enables patients to make secure payments over the phone with interactive voice response, including support for flexible spending accounts (FSAs) and health savings accounts. With roughly half of FSA account holders forfeiting funds due to lack of awareness, this will help patients maximize available resources.
Kora runs on Twilio’s ConversationRelay service, which enables developers to create natural voice AI agents by integrating real-time streaming, speech recognition and interruption handling.
"Conversational AI, especially when leveraging contextual data, is revolutionizing the way organizations and their end users can communicate across channels—making the experience better for all parties,” said Andy O’Dower, vice president of product voice and video at Twilio, in a statement. “Cedar’s solution combines Twilio’s leading communications platform, data, and AI to enable providers to offer personalized, efficient, and empathetic patient experiences at scale.”
Cedar executives contend that its AI voice agent addresses urgent challenges facing health systems: rising labor costs, staffing shortages and pressure to improve patient experience while managing operational overhead.
The AI market is rapidly evolving, which presents both a challenge and an opportunity, Winkie noted.
"We wanted to partner with Twilio in particular as we need innovation partners who have their own subject matter expertise. We always have an eye open on what are the vendors that have the best AI voice models. That is evolving on a weekly basis, and it directly impacts how human and lifelike the AI voice agent ultimately sounds. Our goal is to make this as good, if not better, as an actual human agent at solving a certain domain of use cases," he said.
The launch of Kora also falls in line with Cedar's broader AI strategy.
"We want to embed this throughout our platform. How do we get better at having, I almost think of it like a digital concierge or sherpa that's holding your hand through a very complicated healthcare financial journey. Answering questions about billing is one potential use case, but we're thinking about those other financial friction points," Winkie said.
Cedar sees opportunities to use data and AI to understand a patient's financial experience and present solutions to them. "It could be, 'You could qualify for Medicaid, or you may not qualify for Medicaid, but you would qualify for an ACA plan, or there’s actually this medication assistance program that you might qualify for,'" he said.
There's also the potential to use AI technology to assist call center representatives. "How do we arm them with the same sort of predictive data to make them more efficient and effective?" he noted.
Cedar is not a standalone voice AI company as its AI capabilities are integrated into its comprehensive medical billing platform, he added.
"The players that will win at the end of the day are those are a solution seeking to solve a problem. Simultaneously, for that problem, the answer could be agentic AI. But, ultimately, having somebody who has many, call it arrows in their quiver in terms of addressing the root cause problem, I think will be a more comprehensive and effective partner to healthcare providers," Winkie said.