AI fills front office staffing gaps, but who manages the AI?

Dividing the work between AI and people 

Astrana operates primary care and multispecialty offices alongside an affiliated provider network. The organization includes more than 20,000 providers across 16 markets.

The company also holds an ownership stake in Third Way Health, whose AI agents and human teams support front-office operations at Astrana's medical groups, including AMG Medical Group, Valley Oaks Medical Group and Southern California Heart Centers. AI answers patient calls and handles scheduling, rescheduling and general questions, while people take over when requests become too complex or patients ask for human assistance.

"You can have a process that is heavily AI, but there's still going to be times where you want to implement using a person," said Lucas Taylor, Astrana's chief transformation officer, in an interview.

The balance depends on both the request and the patient. Frederik Mueller, Third Way Health's co-founder and CEO, described certain situations that require human interaction, particularly those that require trust-building with patients or complex judgment. These could include encouraging an uncertain patient to attend an annual wellness visit or navigating a payment-policy exception.

Additionally, many front-office workflows divide responsibility within a single task, requiring both technology and human intervention to complete the task, Mueller said. For example, if AI schedules a next-day appointment, a team member needs to notify the provider through their preferred contact.

"We used to think it's either you automate…or you just hand it off to a person. What we've learned is that it's more of a hybrid middle. There are many scenarios that we encounter that ultimately require some part of a task to be completed by an AI agent and some part by a person," Mueller said.

Budgeting staff for the work AI creates

Mueller cautioned that practices may see AI as a way to fill staffing gaps without anticipating its ongoing management needs.

Historically, technology could largely be configured one time and left to run, he said. AI, on the other hand, requires continued supervision, creating a challenge for practices already struggling to staff their front offices.

"So they use AI as a way to bridge that gap. But they also don't have enough staff budgeted to review AI," Mueller said.

At Astrana, Third Way provides ongoing AI management as part of its service, Mueller said.

"We basically, for our clients like Lucas and others, we take over the ongoing management of the AI agent," Mueller said.

That oversight includes confirming appointments were booked, reviewing calls that went poorly and testing whether AI follows updates to a practice's procedures, such as changes to the way certain appointments are scheduled. Third Way assigns a dedicated team to each client to handle those responsibilities, he said.

Mueller said that Third Way Health has developed quality assurance tools to identify interactions needing review. Staff investigate flagged interactions and intervene when needed.

For Taylor, staffing decisions also depend on how much additional demand the team can handle with automation. He described AI as a way to manage more calls with fewer additional hires than would otherwise be needed.

Taylor reported a roughly 40% increase in visits per provider per day after Astrana improved its internal processes and worked with Third Way. While this has been a boon for the organization, he also hopes that greater efficiency due to automation makes the work less stressful for staff and care more accessible.

"And frankly, the more human element of that is now, more patients have access to care," Taylor said.

Elizabeth Stricker, BSN, RN, comes from a nursing and healthcare leadership background, and covers health technology and leadership trends for B2B audiences.