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What is knowledge management in healthcare?

KM in healthcare explained

Knowledge management in healthcare encompasses KM from both a health insurance or payor perspective and from a healthcare provider or hospitals/clinics perspective. Some healthcare companies are vertically integrated across these two spaces. Knowledge for healthcare includes transactional data, policies, procedures, compliance, insights, and functional expertise, among other things. Here are some examples.

Data

  • How much of the expenses I incurred last month at the hospital was applied towards my deductible?
  • What is my health insurance premium for next year?

Policies

  • Health insurance coverage for out-of-network providers
  • ACA individual mandate and penalties
  • Does Medicare cover eye exams?
  • Emergency care for the uninsured
  • FSA eligibility of medical expenses

Procedures

  • How do I renew Medicaid?
  • How do I apply for PPP?
  • How do I get a permit for adding another room to my house?

Compliance

  • HIPAA compliance
  • Health care decisioning process for patients with proxy (durable medical power of attorney) and patients without
  • PSQA (Patient Safety and Quality Improvement Act) compliance
  • Privacy and security in communications
    • Examples
      • Require insured person to be on the line even when communicating with an authorized representative
      • Secure portal access to health care information/records

Insights

  • Patients, who follow fitness advice, as evidenced by their physical activities recorded in payor’s mobile app, incur ZZ% less in health care expenses
  • Health care providers in Region A charge X% more for the same services as Region B
  • Fatalities in clinic X is Y% higher than in clinic Z in the same provider chain for the same surgery
  • Patients, who take statin, are X% less prone to cardiovascular disease, all else being equal
  • Residents living close to gas stations are X% more prone to disease XX than others, all else being equal
  • Ethnic group X is Y% more prone to disease X, all else being equal

Expertise

  • Service expertise
    • I have already fulfilled my deductible. Why am I paying out of pocket for X?
    • Are dental implants eligible for FSA claims?
    • Is it ok to drink fruit juice the day before procedure X?
    • Is there a generic substitute for drug Z?
    • I have small business with 10 employees. Do I need to offer COBRA coverage?
  • Sales expertise/advice
    • I am 25 years old and single. My latest physical checkup was good. Would you recommend a PPO or an HMO plan?
    • I am 70 and plan to live in Nebraska after retirement. I have health issues X and Y. Should I get long-term care insurance and if yes, what are the options?
  • Diagnosis and treatment expertise
    • Patient X has a higher-than-normal fasting glucose number of Y and hypertension stage 1. Should I put them on drug Z or try out exercise first?
    • How do I figure out the root cause of chest pain for patient X, who has normal readings for BP, cholesterol, and A1C numbers?
    • Patient X is 80 years old, has osteoporosis, and reports severe knee pain. Should I recommend knee surgery?

Knowledge management in healthcare: The current state

The healthcare industry consists mainly of two sub-sectors: healthcare payors, which are health insurance carriers and healthcare providers, which are clinics and hospitals. The state of knowledge and customer experience needs much to be desired in this sector with healthcare insurance being ranked in the bottom-most quartile of all industries evaluated by the Forrester CX Index evaluation in 2022 and with 65% of consumers complaining that they get different answers from different customer touchpoints for the same question, whether it be on the payor side or the provider side (Source: Dimensional Research, 2022). The latter clearly points to disparate knowledge silos that healthcare companies need to eliminate and replace them with a single Knowledge Hub of trusted data, content, knowhow/expertise, and insights.

Knowledge Hub for healthcare

The question then is what is a knowledge Hub? It is a one-stop platform for modern knowledge management that includes and orchestrates all the essential building blocks needed to help healthcare and other organizations to take self-service automation to the next level while guiding employees to provide better service to their constituents: Content management, profiled access to content, intent inference, search methods, conversational and process guidance, analytics, and integrations, informed by the best of a healthcare organization’s expertise, and powered by AI and ML.

Knowledge management in healthcare: Success stories

eGain’s healthcare clientele includes the who is who of healthcare insurers and providers. Here are examples of their at-scale success, powered by the eGain Knowledge Hub™.

Health insurance

  • A premier health insurance firm successfully consolidated 17 knowledge silos into a single Knowledge Hub of trusted information and expertise. The eGain Knowledge Hub helped them reduce agent training time by 33% even as its agents—over 2,000 of them—had to start working from home due to pandemic lockdowns. The platform helped them meet all 30 of their goals, slashing Average Handle Time and improving First Contact Resolution
  • Knowledge-powered member service earned them a spot among the top 5 health insurers in the Forrester US CX Index, 2020 and 2021

Healthcare providers

  • Mammoth government healthcare agency experienced “phenomenal success” with eGain Knowledge deployed across five different organizations. The eGain Knowledge Hub empowers over 25 million users and 150,000 contact center agents and other customer-facing personnel across five divisions in their enterprise with consistent and accurate information and guided customer service processes, compliant with regulations
  • A preeminent US retail healthcare chain, which is a household brand name, provides proactive digital customer service to over 100 million consumers through knowledge-powered notifications across digital and voice channels on topics such as prescriptions, enrollment, and benefits. The company sends over two billion notifications per year, dramatically reducing incoming calls and improving customer satisfaction at the same time

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