Health Robocalls People Want to Receive

Kaiser Permanente's Mid-Atlantic group had high hopes for its Thrive Healthy Living, an online effort aimed at helping patients improve their health by reducing their weight or kicking cigarettes. But participation was weak. "There is so much medical information available online, and our Web site just wasn't standing out from the herd," says Dr. Amy Compton-Phillips, physician director of Population Care Management at the Oakland (Calif.) health organization Kaiser Permanente.

But since 2007, participation in Kaiser's smoking-cessation Internet program has quadrupled, and the number of people enrolled in Kaiser's weight-management and stress-management programs has more than doubled.

The turnaround began when Kaiser hired Eliza, a 10-year-old company with 130 staffers and a track record of using automated phone calls to communicate health tips or reminders. The Beverly (Mass.) company counts 90 clients, all in health care, including nine of the top 10 HMOs, leading pharmaceutical companies, and pharmacy benefit managers, as well as big employers such as Wal-Mart Stores (WMT).

Companies hire Eliza to reach out to customers or employees, reminding them to get a cancer screening, say, or notifying them of a cheaper prescription-drug alternative. "Not everyone has access to the Internet," says Compton-Phillips. "But everyone has a phone."

a more sophisticated system

Automated voice-recognition systems aren't new, of course; travel companies, banks, and even corporate HR centers have been replacing agents with automation for years as a way of cutting costs. Most such systems are "inbound," meaning customers call in and answer a series of increasingly specific questions until they've completed a task or received requested info. The interactions may be commonplace, but they're often frustrating.

Worse are outbound robocalls that bombard citizens during political elections and robo-scams that the Federal Trade Commission says are deceptive, such as a recent one pitching car warranties.

Eliza's interactive technology is more sophisticated than most robocall systems, and its outreach efforts don't aim to sell customers anything. But to a consumer answering the phone and hearing a recorded voice, they may sound like just another telemarketer. Given that, Eliza's ability to rise above such phone-spam and get people to willingly spend five or more minutes conversing with its automated phone system is significant. It suggests new uses for such technologies—and new opportunities for companies to interact with their customers.

Eliza's success is built on a combination of technology and a deep understanding of how people converse. The company holds 40 patents, including its first—a powerful speech-recognition engine developed at California Institute of Technology—and its most valuable—a patent on using speech recognition for outbound calls.

Eliza co-founder and CEO Lucas Merrow is coy about the private company's financials, saying only that Eliza has been profitable since 2002 and that annual revenues are "in the neighborhood of $25 million to $50 million and growing nicely." The company charges from 20¢ per interaction to $2 a month per consumer, depending on the type of outreach; a good-sized project involves several million consumers.

humor breaks the ice

As Eliza develops a program for a client, it draws on its library of best practices. In general, people are more likely to be engaged by a humorous message than one emphasizing risk data, even when the subject is something as serious as heart disease.

"It helps to 'tickle' people first with a call that doesn't ask for anything," notes Alexandra Drane, Eliza's president and other co-founder. She mentions a call in which recipients heard a little jingle about eating beans. "One hundred percent of customers who received the call remembered it and were open to more contact," Drane says. "It earned the HMO the legitimacy to call back and ask something of their members."

Eliza might follow up a call by sending information by mail, e-mail, or text. When necessary, it can also pass a person over to a clinician. One of the advantages of the system is that clinicians have more time to spend on the phone answering patient questions because they aren't spending time on the initial outreach. (Another, according to research by Dr. Warner Slack of the Clinical Informatics Div. at Beth Israel Deaconess Medical Center in Boston, is that people are more honest if they are conveying health-related habits to an automated system rather than a person.)

To help Kaiser increase participation in its Thrive Healthy Living programs, Eliza created different phone calls for different at-risk groups. The calls used inclusive language to make the messages seem nonjudgmental, as well as a warm, empathetic voice, which the company has found is most effective for lifestyle-management topics. The smoking call, for example, led with the statement: "It doesn't really matter if you smoke, or just know someone else who does, we all know how hard it can be to quit."

The result: 28% of the people reached either said they smoked or that someone close to them did, greatly exceeding Kaiser's previous benchmark of self-reported smoking behavior; 45% of those respondents wanted information on smoking-cessation tools, and 79% of people who were offered a follow-up mailing said yes.

cost savings for companies

Many clients see financial upside from Eliza's programs. Pharmaceutical companies that use Eliza to remind patients to take their prescriptions report higher drug sales. A program Eliza ran for an HMO alerting members to less expensive drug alternatives saved those members $11 million over 18 months. And companies that shift calling duties from clinicians to Eliza save costs.

For Kaiser, the estimated $2.5 million it spent on the Eliza outreach didn't lower operating costs. But the program was much cheaper than hiring nurses to reach members.

For the moment, Eliza is focused on health care, an industry co-founder Drane has worked in for decades as a strategy consultant, entrepreneur, and, immediately prior to Eliza, founder of Tesseract, a developer of health-related software and services that is now part of Empower Software Solutions in Orlando, Fla. But while Drane's passion is health care, she sees broader opportunities for Eliza's technology. "Eventually we may look beyond health care," she says. "We could license the system or just do it ourselves."

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