AI Chat Triage & Care Navigation (Self-Service)

"In 2023, KLAS published an Emerging Company Spotlight report on Clearstep, a company offering AI chat-based solutions that simplify the triage process and aid digital health platforms focused on patient engagement. Following the report, ClearStep was voted by 35 provider thought leaders as one of the 2023 Top 20 Emerging Solutions for both improving outcomes and enhancing the clinician experience. 

While their technology is impressive, what stood out most to me was the leadership of Clearstep’s founders, Adeel Malik and  Bilal Naved. As we worked with them, I was struck by their remarkable ability to ask the right questions. In an era flooded with AI solutions searching for problems, Adeel and Bilal’s focus on identifying the right problems to solve is a pivotal differentiator. Their clarity and curiosity ensure that their innovations are grounded in real-world needs—a trait that defines great leadership in healthcare IT."

“The biggest value that the Clearstep Smart Access tool provides for Ochsner is getting the patient to the right place at the right time. So many patients end up in the ER for a simple rash. That is a waste of resources. Everyone wins when the patient ends up at the right level of care,” explains Ted Hudspeth, MD, Associate CMIO, Ochsner Health. 

Of the users that complete a Clearstep conversation and receive a care recommendation, 56% engage with one of the three presented options that is determined to be the right level of care. This far exceeded Ochsner’s outset benchmark goal of 35%.  

Clearstep regularly reviews user feedback to monitor and improve product performance of the core product. Ochsner also closely monitors the CSAT scores for the Ochsner instance to ensure that feature enhancements (e.g., displaying additional location services or appointment availability) enhance the user experience. Ochsner patients who have used this intelligent triaging chatbot have shared their positive experiences, noting that the chatbot was "easy to navigate" and offered "excellent service."  

Intelligent triaging uses the Clearstep Smart Access chatbot to guide patient navigation. 

Since Q2 2024, Ochsner’s use of Chatbots and Large Language Models (LLMs) has offered an excellent way to guide patients to the right level of care, while also enabling the healthcare system to dynamically meet the demand.  

When a patient goes to Ochsner’s website and types into the Clearstep Smart Access chatbot, ‘I have a headache,’ Ochsner seeks to understand the acuity of the condition to know when a patient needs to see a neurologist. To drive the matching algorithms, Clearstep starts with a clinically trusted triage protocol (built in partnership with Dr. Barton Schmitt, co-author of the Schmitt-Thompson protocols) and follows with a series of conversational questions to present patients with clinically appropriate, timely and convenient Ochsner care options based on their specific symptoms and location.  

“The use of Chatbots/LLM is a fantastic way to get patients to go through a decision tree and help them feel supported. When a patient types in ‘I have a headache’, the chatbot generates intelligent prompts to continue to triage, such as ‘Let’s get more information about your headache.’ ‘Does it seem like a migraine?’ ‘Have you had a longstanding headache for years?’ ‘Have you used medications without success?’ It is not just about a triaging protocol. It is about getting the information needed to match the patient with the right provider and care setting,” explains Dr. Jason Hill, Innovation Officer at Ochsner Health. 

While Ochsner recognizes that some patients may know where to go for care, many patient conditions can be appropriately managed by low-acuity care services. An 2024 Clearstep analysis on user intent found that 73% of users had an incorrect intent of where to find care, the majority of which were de-escalated to a lower acuity. Ochsner’s data supports this finding. Out of 7,500 completed chatbot interactions, 77% benefitted from a low-acuity care modality (e.g. Virtual Urgent Care, Primary Care) for their symptoms.

“At Ochsner, like other health systems, we don’t just have neurologists, we have movement disorder specialists. We don’t just have ophthalmologists, we have neuro-ophthalmologists. These people are super- specialized. Anytime you put them with a patient that is not in their field, you are delaying care for someone with an urgent need for that specialist’s expertise – in a way, wasting that expert’s value,” explains Dr Hill. “As a large health system, it is our challenge to create a funnel which accounts for that level of complexity to the individual patient/provider interaction.” 

The first step of creating the triage match is to set up the list of providers on the supply side. “We ask our super specialists to share common symptoms, complaints and situations. Then we try to figure out a way to get the patient to match those. We determine the questions that we need to ask to gather information that will enable us to make the right match,” says Dr. Hill.  

“We work on identifying the right destination of care and sorting out whether a problem is acute or chronic. We do this using existing structures, as the patient moves through a protocol. As these decision-making tools become more sophisticated, we can then determine the provider type, and then, the sub-provider type,” Hill says. “At first, we are using decision trees, but the ultimate goal is to use AI to understand the patient and provider scope, as well as provide dynamic questions that allow us to establish the patient’s ultimate destination.”

“We need to train a model about what patients are asking us for each type of specialist -- and with that information we can create different models which have access to different aspects of these complex algorithms (e.g. payor coverage, specialist expertise). The AI will learn from our data to help sort the patient to the right match. Of course, the patient has the right to go wherever they wish, but the models can help to direct them to the most appropriate provider,” says Hill. “Once the patient matches, the specialist has access to that patient’s record to provide needed care. We can say to the specialist, ‘This is the right patient for you.’” 

First Contact Navigation: 

Patient navigation was an obvious first choice given rampant need both organizationally at Baylor but also to empower their consumers and prevent network leakage at the health system. Pete holds intense conviction that solving patient navigation, access, personalization, and convenience is paramount to Baylor’s consumer-centric strategy. It was a no-brainer to start here. Baylor’s First Contact navigation app is described simply, but complex logistically. From the user side, a patient enters symptoms. Then engages in a chatbot discussion. Later on, the patient has option to speak to human being if they need to. By the end of 5-8 interaction, the patient gets scheduled with the right Baylor provider or finds the right care setting.

In developing the First Contact app, Baylor conducted quite a bit of research, applying consumer business principles and looked at consumer journeys. In other words, Baylor asked themselves “what is the typical consumer journey here, and how do we reimagine that journey, and synchronize the care?”

“If we get that right - navigation, expand the ecosystem with more choices, and synchronize the patient journey, that the patient will be more delighted, and most importantly, you’ll have better outcomes over time.” More touchpoints lead to better outcomes.

In one of its trial runs, Baylor researchers asked the participants “if you didn’t have our navigation tool, where would have you gone?” 60% of the respondents responded that they would have picked a different location, and generally this pick would have resulted in a a higher cost, higher acuity location. Marinate on that point for a second. SIXTY percent of the people flowing through healthcare systems are entering the system at the wrong place. As Pete described it (and I think it’s pretty apt), it’s like going to buy an F-150 and ending up with a Ford Taurus.

Baylor re-routed something like 80% of patients who WERE going to go to the ED to urgent care or virtual visits. And so as Baylor’s demand for services shifted, and as the organization moves over time from supply-driven to demand-driven, that means Baylor’s supply side - their asset base - needs to respond. Now, instead of building solely for supply, Baylor’s healthcare asset additions relate to what customers want, and they have the data to understand those patterns.

Clearstep has been a trusted, collaborative partner in providing low acuity care navigation to our unauthenticated patient population. We experience over 6K webpage loads per month (~8% web traffic engagement rate) with a 80% average conversation completion rate. I have been pleased to see our CTA engagement rate hovering around 60%. We look forward to building upon this partnership as we work to expand to the authenticated environment.

We implemented Clearstep in 2024 as part of a broader initiative to simplify our ingress + better guide patients to the right care (virtual, in-person, etc.), accounting, dynamically for their needs, acuity, location, preferences, insurance, past history, etc., as well as the access we have available.

Our experience with both the product and the team has been great. We really appreciate the partnership we have with the Clearstep team, who have been collaborative in development of a shared vision for where their platform can be evolved to address a broader and deeper suite of needs within Ochsner. The core solution, itself, is intuitive and user-friendly; we appreciate the clincial accuracy and visibility we have into the traige pathways their platform recommends; it's been seamless to integrate into our unauthenticated spaces, and we've seen good traction in the call to action that Clearstep recommends. We're looking forward to positioning the core offering within MyOchsner as well as a host of expanded and more progressive use cases.

Overall, can't say enough positive things about Adeel, Bilal, Quin, and the entire Clearstep team.

ClearStep has been game changing in intelligently routing patients to the right care access points in a way that drives a great patient experience and optimizes access for the Healthcare system. The customer service provided by ClearStep as a company is second to none - they have worked hand-in-hand with us to evolve the product to solve multiple use cases (patient self-navigation and patient triage navigation). 

Smart Access Suite enabled our health system to get real time answers to our patients and direct them to the right care at the right time. It was super easy to deploy. The maintenence was also very straightforward and the vendor was incredibly helpful with any requests we would add to our roadmap. Would highly reccomend and they have so many next generation features that will help any admin heavy health system automate their back office functions. 

With Clearstep’s Smart Care Routing, Duly has an “easy button” for our patients that enhances the human relationship.

"Mount Sinai is committed to providing exceptional care that is timely and accessible; a seamless digital experience ensures that our patients take advantage of ongoing support and resources, proactively engage with their care team, and feel empowered to manage their health progress," Mount Sinai Health System CIO and Chief Digital Officer Kristin Myers said ... "Our latest digital tools, including the self-triage system created with Clearstep, enhance our commitment to innovation and ability to provide equitable patient care and services."

"We were looking for quick wins and easy changes. Clearstep was simple to implement and kickstart momentum for innovation."

Source: https://www.clearstep.health/case-study/duly-health-care

"This system saved lives."

"This type of AI made us feel more secure in our response to COVID-19."

Source: https://www.clearstep.health/case-study/baycare

"At Novant Health, we are always looking into solutions that combine our focus on purposeful innovation and human centered care (both patient and care team.) As we’ve invested a lot of time and resources into AI, Clearstep has helped us drive engagement in our targeted channels and get [patients] to the right level and venue of care, which has proven to be successful for us and a win for the patient."

Source: https://www.clearstep.health/case-study/novant-health-generates-4x-roi-with-clearstep-smart-care-routing