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Automated agent will aid enrollees in Medicare

By Nancy Reardon Stewart
Globe Correspondent / October 3, 2011

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It is a typical telephone conversation between a sales agent and a consumer who wants to sign up for prescription drug benefits under Medicare Part D.

The agent asks for basic information, such as name and date of birth. The elderly caller speaks slowly and his words are barely intelligible. When he gives his birth date, only the word “seven’’ - for July - can be understood.

But the agent quickly responds: “I’ve got that date as July 1, 1980. Is that right?’’

“That’s right,’’ says the caller.

The quick-thinking agent, however, is not an actual person. It’s a virtual sales representative from an automated call system developed by Franklin-based Interactions Corp. Equipped with advanced voice recognition software, the system is designed for the health care industry and tailored for an older demographic, many of whom may have speaking challenges. The company says it gives callers an experience that feels more like an interactive conversation, not a one-way call with a limited set of options and prompts.

“It’s automated speech recognition, but with human understanding,’’ said Interactions spokesman Dan Fox.

When the Medicare open-enrollment period begins Oct. 15, thousands of people across the country who contact Humana, a Kentucky-based health care company, will be routed into the automated service. Interactions has no New England clients, Fox said.

Such voice recognition programs have become standard for banks, credit card companies, and cable providers. But in the health care arena, where the conversations have a more personal, and even emotional, quality, consumers have not yet encountered such systems and tend to expect an actual person on the other end of the line.

Voice recognition experts say the cost-savings and efficiencies created by such programs make it inevitable that more and more health care providers will follow suit. They point out that the technology is advancing quickly, and the systems now are capable of understanding complex medical terms and drug names, and can even pick out key health facts from a caller’s narrative.

Interactions launched its first automated portal last year, to enroll people into one of Humana’s Medicare Part D programs. In two weeks, Humana will be expanding the service to its two other Medicare prescription drug programs.

The system is not entirely human-free. Interactions employs 150 people in Texas, Indiana, and at its Franklin offices who serve as a backup if the voice recognition program cannot understand a response. When the system needs help, it routes the question and a recording of the consumer’s answer to an agent with headphones who types in what the caller said. The agents can handle 700 questions an hour in this way, all taken out of context, said Fox.

“They only hear snippets of calls and their job is just to derive the intent of the individual portion of the calls,’’ he said. The callers never know that a person has intervened.

Callers who become frustrated can get to an operator, but only if they are detected as saying a set of prompts, such as “Operator’’ or “I want to talk to someone.’’ Use of profanity, Fox noted, will also work. However it is never explained to the caller that certain words or phrases can get them to a person.

Despite these built-in backups, consumer health advocates are concerned that such automation risks robbing consumers of the assistance they need to navigate the system.

“Enrolling in health care programs can be complicated and allowing people to ask questions as they are reflecting on choices is incredibly important and really requires a human touch,’’ said Amy Whitcomb Slemmer, executive director of Health Care for All, a Massachusetts nonprofit.

“I can imagine lots of wonderful uses that would bring efficiencies into a system by using a computer and automated voice recognition, but enrolling in health care programs seems like it would always require human interaction.’’

Mike Iacobucci, chief executive of Interactions Corp., acknowledged the advocates’ concerns are valid. “If you’re not careful about how to make the transition [to an automated system], then the overall approach for a company like Humana won’t be very successful, and we’re very careful with that,’’ he said, adding that his company’s system creates an “atmosphere of trust’’ for the caller.

“It’s got to be designed properly so you don’t offend the callers and you are respectful,’’ he said.

More health care providers are looking to adopt this technology for dealing with customers. “They almost have to go in that direction to keep pace with the population, as the baby boomers get to that age and place more demands on the system,’’ said Iacobucci, adding that in the past 18 months, his company has doubled its number of employees.

Nuance, a Burlington-based company that has created the popular Dragon speech recognition system, as well as products for everything from automated calls and smartphones to physicians’ dictation, is working with the University of Pennsylvania Medical Center to develop an online patient portal that would allow people to keep track of appointments, prescriptions, and medical issues using a combination of voice recognition and online forms, said Joe Petro, senior vice president of research and development.

“We have to make it easy for folks to access health care in the way they want to do it,’’ he said.

The way to serve the needs of aging populations, he said, is to offer several options: voice recognition, websites, and humans. “We’re going to have to do different things for different people.’’

Nancy Reardon Stewart can be reached at nance.stew@gmail.com.