The clinics close at six, and the line stays open.

Nine clinics used to leave every evening call for the morning. Now booking is handled overnight, and anything clinical goes to a nurse.

The Canto knowledge screen: connected sources, answer coverage, and the questions it could not answer.

Patients call when they finally have a minute, and that is usually after six. Now somebody answers, the appointment is booked that same evening, and our nurses only hear the calls that need them.

Devan Okonjo

Head of Patient Access

The problem

Juniper Health runs nine outpatient clinics, and every front desk closed at six, leaving a recording that asked callers to call back tomorrow. Evenings are when patients have time to call, so rescheduling and coverage questions queued overnight and the day’s first appointments often sat empty.

For one winter, front desk staff took the line from home two evenings a week, and the schedule did not last. A booking form could move a visit but not say whether it was covered, so patients called anyway.

What Canto did

Juniper kept the number patients knew and put the agent behind it, reading the same records as the front desks.

The appointment books of all nine clinics, with every open slot visible and bookable.
Coverage guides for the 34 plans the clinics accept, which it cites whenever coverage comes up.
A standing rule that any question about symptoms, medication or results goes to the on-call nurse.

Canto routing rules for Juniper Health: booking and coverage questions go to the agent, and anything clinical goes to the nurse. A card reads Evenings: line open.

The patient line went first. Two weeks later it took texts as well, and chat on the booking pages came in the sixth week. Each channel adds to the same conversation, so nobody gives a date of birth twice.

What still goes to a person

The on-call nurse takes anything clinical on any channel, with a note of the conversation so far. Fee waivers beyond the agent’s limit wait for the practice manager, and the front desk picks up coverage questions the guides cannot answer. Anyone who asks for a person, or grows upset over two turns, is handed over with the same note.

What changed

The front desks now start the day with a short callback list. Across the nine clinics, most after-hours contact is settled before morning, and the nurses on call take only clinical calls.

Bar chart of Juniper Health's evening calls from 18:00 to 23:00, most resolved by Canto and a small share handed to a nurse. A card reads Nurse queue: clinical only.

One Tuesday, just before midnight, a mother called in Portuguese to move her son’s asthma review to Eastgate. The agent booked Thursday morning and confirmed a $20 copay from his plan’s guide. When she added that he had been coughing all evening, it put her through to the on-call nurse, who answered knowing about the review and the cough.

The two physical therapy practices join next. Two plans with outdated guides top the escalation reasons in the analytics, so those guides are being rewritten first.