Healthcare Provider Increases Preventive Care, Boosts Efficiency with Speech Solution

Based in Monterey Park, California, Care1st Health Plan is a growing healthcare network of physicians and hospitals. The organization provides medical benefits to more than 200,000 low-income and disabled members. Care1st has had to meet state regulations that require new network members to schedule health evaluations with their primary care physician. Reaching out to these new members to help them schedule appointments was a difficult, manual process that cost the organization time and money. Care1st worked with 4PatientCare, a California-based interactive patient communication company, to create an automated patient contact and scheduling system based on Microsoft® Office Communications Server 2007. By using this system, Care1st nearly tripled its member preventive care adherence rates. Care1st has also experienced a reduction in time and expenses related to member contact efforts.


Care1st Health Plan is a Health Maintenance Organization (HMO) based in Monterey Park, California. The organization has 306 employees and has developed a network that includes 3,000 physicians, 50 medical groups, and 69 hospitals throughout Southern California.

Care1st provides Medi-Cal health benefits to more than 200,000 members that live in Los Angeles and San Diego counties. Under the Medi-Cal program, low-income families in California receive healthcare coverage.

The California Department of Health Care Services (DHCS) requires primary care physicians to complete an Initial Health Assessment (IHA). This means that any newly enrolled Medi-Cal member over the age of 18 months must be scheduled for an IHA by his or her primary care physician within 120 days of enrollment. For those under 18 months of age, the IHA must be completed within 60 days of enrollment. “The regulations clearly state that there has to be a documented good faith effort to encourage patients to get this assessment,” says Dr. Jorge Weingarten, Chief Medical Officer at Care1st Health Plan.

However, complying with the regulation by scheduling members for their assessments was a very difficult undertaking. “It is often hard to keep up-to-date contact information, because if members move, we might not have their new phone number,” says Weingarten.

Also, the process of calling members was labor-intensive and used valuable time. “There are thousands of new members each month,” says Weingarten. “It was very difficult to contact all of them just by mail or by phone.”

In spite of the time and money spent on attempting to contact members, compliance rates were disappointingly low. “Compliance was well under 30 percent for all of Southern California,” Weingarten says. “We also had insufficient documentation of the attempts we made to contact our members.”

Because it needed to increase compliance rates, Care1st wanted to find a solution that would help automate member contact and scheduling processes.


In late 2005, Dr. Weingarten attended a healthcare conference in Washington, D.C., where he met representatives from Los Angeles–based 4PatientCare. 4PatientCare develops systems that provide multimodal (unified Web, e-mail, phone, and print) automated communication among patients, health plans, and providers. These clinical messaging solutions, now based on Microsoft® Office Communications Server 2007, help ensure that patients make and are reminded of appointments, and that those patients arrive on time, prepared for their visit. “Our systems read the information already in healthcare information systems,” says Dr. Jeffrey Guterman, Chief Medical Officer at 4PatientCare. “We then create an intelligent, fully automated, interactive speech-driven call to the patient.”

With Office Communications Server 2007, companies can create and deploy automated software applications that combine software-powered voice over IP (VoIP) and built-in speech capabilities to send outbound phone calls to patients. By using the Microsoft Speech Server 2007 role in Office Communications Server 2007, 4PatientCare developed an automated speech recognition (ASR) telephony application that features professional voice talent.

The 4PatientCare speech-based contact system uses voice prompts to encourage patients to make appointments for new physician visits. The system’s inbound calling features give patients an easy way to schedule health evaluations and provide feedback to Care1st. “We knew this Office Communications Server 2007 solution could help us,” says Weingarten. In late 2006, Care1st began to work with 4PatientCare on a customized version of this solution that features patient contact and automated scheduling capabilities.

This rich but simple-to-use unified communications solution contains an automated decision tree, which gives patients different action options. For example, patients are automatically sent to a schedule area of the system if they say they want to make an appointment for a specific time and date. Or they can specify if they want to have the IHA but are not ready to schedule an appointment. They can also state their reason for not being ready. “Altogether, we created more than 100 ‘nodes’ on this decision tree to accommodate the multitude of possibilities that the system might encounter interacting with Care1st members,” says Guterman.

Each month, Care1st sends 4PatientCare an electronic file containing names and phone numbers of new members in the Care1st network. 4PatientCare loads that file into the application, which automatically starts sending out calls. Information gathered during calls is sent directly to Care1st through a Web service, from which the organization can download the data into Microsoft Office Access 2003 database software.

“This solution gives us the opportunity to accomplish what we want to do without any human interaction,” says David Wedemeyer, QI Director at Care1st Health Plan. “Health plan members can automatically schedule appointments with their provider during the call, and we can use the system to easily determine if messages have been delivered and received, if service is refused, and if appointments have been completed.”

Care1st fully implemented the 4PatientCare ASR solution in early 2007.


With a new unified communications solution based on Office Communications Server 2007, Care1st now has an automated member contact system that has directly contributed to a major compliance rate increase for Care1st. By using technology that lends itself to customization, Care1st and 4PatientCare were able to create an easy-to-use system that helped Care1st eliminate time spent calling members. Care1st has also saved money previously used for patient calls and reminder mailings.

Automated Patient Communication

Care1st now has an entirely automated way to contact members about IHAs. The solution gives the organization a method of quickly viewing how many new members have requested appointments and how many were not reachable. The system also records the number of calls that had to be sent before contact was made. “The Office Communications Server 2007 solution is very thorough and advanced,” says Wedemeyer. “For example, the system automatically reprograms itself to call a member back at a certain time if we know, based on a previous call with another family member, that the member will be there at that time.”

With the advanced speech capabilities of Office Communications Server 2007, Care1st and 4PatientCare were able to build a very user-friendly automated ASR system. “People like interacting with this system, because they aren’t being asked to press numbers to go to more messages. The speech elements of Office Communications Server 2007 make that possible,” says Weingarten.

Tripled Preventive Care Rates

With the help of its new customer contact solution, Care1st has increased overall IHA compliance rates for all of its Southern California members. “We have seen an enormous increase in the number of members that have decided to schedule preventative health screenings,” says Weingarten. “That is directly the result of our outreach efforts with the 4PatientCare Office Communications Server 2007–based system.” Weingarten reports that compliance rates were about 22 percent in the organization’s San Diego region in 2006. Since the solution was implemented, that number has jumped to 59.6 percent. The compliance rate is now about 53 percent for Los Angeles County members—also a significantly higher number.

These increased rates were relatively easy to obtain because of the ASR system’s capabilities. “We can now easily document our patient contact efforts,” Weingarten says. “Because of the Office Communications Server 2007 technology, we are able to significantly improve compliance with DHCS requirements in a very effective and cost-efficient manner.”

Eliminated Time Spent Calling Patients

Care1st also no longer has to spend time trying to contact patients by phone. “We originally saw that a lot of physicians’ offices didn’t have the resources to make all these calls, so our own employees were spending a lot of time on that task,” Weingarten says. “Now, however, our employees no longer need to do that. The automated system handles it all, so our employees can concentrate on other duties.”

Although Cares1st does not have specific timesavings figures, Weingarten says that the solution has saved “significant time, both for us and for primary care physicians’ offices within the network. It really took the pressure off the physicians’ offices.”

Saved Money on Contact Efforts

Because the solution developed by 4PatientCare automatically contacts patients and documents call results, Care1st does not need to spend money on employee time for calls or mailings to patients. “We used to have substantial printing and mailing costs, but we have been able to really cut down on the need to send letters, which is saving us money,” says Weingarten.

Additionally, Care1st saves money because its own employees are not spending time calling patients. “We estimate the implementation of the 4PatientCare Office Communications Server 2007 ASR system has saved us the equivalent of two full-time employees’ salaries,” Weingarten says. “This solution has given us a way to cost-effectively increase preventative care using speech technology.”

Took Advantage of Customizable Technology

Care1st and 4Patient Care use a range of Office Communications Server 2007 features to create an effective, customized ASR solution. “Office Communications Server 2007 gives us the ability to use a very high degree of customization and personalization,” says Guterman. “For example, the solution’s development tools made it possible for us to create an interactive caller environment, through which callers can use voice commands to easily choose information options.”

With those capabilities, 4PatientCare and Care1st were able to create the 100-plus “nodes” within the system’s decision tree. “We can develop and deploy a patient contact system with Office Communications Server 2007 much more easily than we could with any other technology,” adds Guterman. “As a result, the patient can easily interact with the system and Care1st achieved the positive patient care results it was looking for.”

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Document published May 2008

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