Inbox Health reinvents the patient billing experience with twilio < pay > and IVR

Patients find themselves in a familiar place after interacting with the U.S. healthcare system—faced with confusing bills, opaque health plan policies, and with only poor support options available. In a field that still relies heavily on a paper-based and cumbersome process, Inbox Health works to personalize patient billing through intelligent interactions. To achieve this, Inbox Health partners with healthcare providers, equipping them with a patient communication and payment solution that improves the experience for both providers and their patients.

For Inbox Health clients and their customers, understanding a bill and paying over the phone can happen easily and transparently, powered by Twilio < Pay > and Interactive Voice Response (IVR).

Personalized patient outreach matters

As a patient, the highly de-personalized, one-size-fits-all nature of the current healthcare billing landscape can be demoralizing. “What drove us here was personal frustration with how we were being treated as patients and consumers,” says Inbox Health CEO Blake Walker. “Our health plans are incredibly opaque. It’s hard to understand why we owe what we owe.”

Tired of calling support agents who had no answers and being shuffled around without making progress, Inbox Health’s founders envisioned a “robust communication platform to help facilitate the transfer of information from providers to patients in a more transparent, more digital way,” says Walker.

Using available data to contextualize every patient’s communication helps Inbox Health personalize not only the conversation, but also the outreach channel. They take many factors into consideration to decide what to send to patients and how to send it. For instance, understanding details like the patient’s insurer and why they did not cover a certain procedure enables Inbox Health to customize their messages; while understanding the patient’s communication preferences allows them to share information over the channel that works best for each patient (email, paper billing, text, phone call, and so on).

Explains Walker: “That’s what we mean by personalizing the experience. We make it specific to the person’s circumstances. Your insurance was billed and didn’t pay for some reason. What was the reason? How can we engage you to fix the problem instead of just sending you a bill for the wrong amount to see what happens?”

Improving patient experience runs throughout Inbox Health’s practices. For instance, patients working with one of Inbox Health’s hundreds of healthcare practices are also able to respond to text messages by calling, or vice versa, as well as submit payments over the phone—courtesy of Twilio-powered IVR and Twilio < Pay >.

A solution with Twilio < Pay >, IVR, and more

The Inbox Health team considered building an in-house IVR payment solution before discovering that with the introduction of Twilio < Pay >, they now had the right combination of integrations—with their existing Twilio-powered IVR and Stripe, their existing payment platform, (also Twilio’s first payment gateway partner)—to now build it themselves without the heavy lifting they initially envisioned.

In the IVR build, the team uses Twilio < Gather >, < Say >, and < Play > verbs, as well as Twilio’s out-of-the-box Amazon Polly functionality, to which they switched from basic text-to-speech (TTS).

Principal Engineer Kevin Yuliawan diagrammed each step and endpoint of the IVR and took advantage of Twilio’s documentation during the process. “Learning about it was really easy,” he says. “The documentation was great for the initial understanding of how everything works, especially the < Gather > verb.”

From the exploration and architecture phase to a working proof of concept, Yuliawan estimates it took approximately three months, even considering the Inbox Health team’s caution due to the delicate nature of the use case. “While our payment flow is complex, nearly 50% of it is handled by the < Pay > verb out of the box,” Yuliawan explains.

Inbox Health’s IVR has reduced call load into their call center by 800 calls per month, as well as reducing average call times from 5 minutes down to 2 ½ minutes, a relatively short period of time for something as complex as healthcare billing. Walker also found an additional benefit: “[The IVR] allowed us to maintain the same support success rates with a smaller number of agents.”

Using Twilio < Pay > as an over-the-phone payment option has also resulted in $100k in payments processed in just the first three months, as well as 61% of callers paying without needing to speak to an agent at all. The company’s fastest payment ever? The caller called, went through the Twilio < Pay > prompts, and paid their bill in just 94 seconds.

Today, Inbox Health uses Twilio to power outbound and inbound SMS text communications and voice calls, in addition to the payment function with < Pay >. The company uses Twilio SMS exclusively for its ticketing system, which allows for more personalized interactions such as having billers and doctors conduct conversations through the SMS-based ticketing system (when patients opt-in to doing so), a huge efficiency over slower and less synchronous forms of communication.

Critical PCI compliance: why it pays to partner with experts

While Inbox Health had for years considered building their own payments IVR, Twilio’s PCI compliance offered a key advantage over the PBX server with PCI self-certification that they originally envisioned, ultimately saving them hundreds of thousands of dollars in development investment.

The use case as built on < Pay > would have required Inbox Health to “invest a lot more in PCI compliance than we otherwise had to,” says CEO Walker.

CTO Simon Kaluza recalled the company’s estimates were up to $200,000-300,000 in investment per year to build in-house.

“And this is necessary at the outset, not only as you scale to a large volume,” he adds, “it involves building a real relationship with the voiceover IP providers for secure, non-standard SIP trunks, setting up a virtual, scalable PBX with large potential attack vectors, and that is just the beginning of becoming PCI compliant without a partner like Twilio. There aren’t really that many direct competitors to Twilio in that regard. At least none that have their functionality and ease of use over expansive REST APIs and configurable webhooks.”

What’s next for Inbox Health

The company intends to continue its patient-centered reinvention of healthcare billing, including further refinements to its contact center productivity, and more emphasis on building customized in-house solutions on Twilio APIs and the platform. The team is also exploring additions like sentiment analysis and personalized IVR responses. “Twilio’s been the backbone of the whole infrastructure,” adds CTO Simon Kaluza.

Principal Engineer Yuliawan and team are working on additional initial IVR flows using < Gather > and < Say > to help provide patients with more information about their account through the IVR, resolve basic issues, and better categorize calls for live call center reps.

Overall, Inbox Health continues to see success with its model of improving efficiencies through better experiences. It’s paid dividends for their client businesses and their patients. From an economic standpoint, healthcare facilities naturally want to optimize how much is spent to reach a patient and factor in how much they owe; at the same time, patient satisfaction with the experience can affect how patients respond to that outreach and how likely they are to pay.

“You can’t just tune for economics, you have to tune for both economics and patient satisfaction,” says Walker. “Healthcare is about caring for people. Industry-standard billing systems are designed to not care about our unique circumstances and just send a bill, and if you don’t pay, send you to collections. But everyone is unique, and we need to be building billing systems that are very thoughtful about giving patients the treatment they deserve, from a billing standpoint and a care standpoint.”

Interested in learning more about how Inbox Health built their PCI-compliant payment experience—and why you need to know about the Payment Card Industry Data Security Standards (PCI DSS) global standard set if you’re taking payments over the phone? Check out our Twilio < Pay> and PCI compliance webinar featuring Stripe and Inbox Health! WATCH THE WEBINAR