The Role of Call Centers Under the New Healthcare Law

By Charu G. Raheja, PhD

The new Affordable Care Act is starting to reach full swing, and new data is coming forward on how providing insurance to previously uninsured Americans may affect their behavior.

How Are New Medicaid Patients Using Their Health Benefits? According to the Wall Street Journal, a recent study followed Oregon residents who obtained health insurance through a special lottery. The study found these newly insured patients visited ERs 40% more often than those without insurance. Some of these visits may have been because of overdue healthcare needs, but many of the problems treated could have been addressed at doctors’ offices. These results show we still have a lot of work to do in educating and helping patients before we can evaluate the benefits of the new law.

The Role of Nurse Triage and Call Centers in Helping Patients: People need easy and available healthcare support that allows them to ask healthcare questions and evaluate their condition. This is where call centers can come in.

We all look for experts to help us with the different tasks in our daily life. Healthcare is no different. Someone with a health condition can benefit by being able to speak to and be evaluated by a health expert. Many uninformed patients go to the emergency room because they don’t know where else to go for medical help and an expert opinion.

The development of telephone medicine and emerging communication channels has made it easier for people to receive healthcare guidance. Medical call centers provide an inexpensive and extremely effective solution for providing patients with the expert opinion needed to help them make healthcare decisions.

For example, in a previous article published in AnswerStat (“Patient Data Can Improve the Delivery of Care While Reducing Healthcare Costs”), we found that almost 70% of the patients who thought they needed to go to the emergency room were advised to stay home after discussing their symptoms with a telephone triage nurse. Not only does nurse triage help in preventing unnecessary emergency room visits, but it also helps improve patient health and prevent potential morbidity. In another AnswerStat article (“Case Study: Saving Lives with Telephone Triage”), we found that almost 10% of the patients who called and did not think that they had an emergency actually needed immediate care.

How Can Call Centers Better Prepare Themselves? Call centers will need to be involved in numerous aspects of patient care to encourage use of their services. For example, call centers should provide health-related protocols, make patient appointments, and help coordinate care between doctors and patients.

Current trends indicate that customers and patients are using online reviews, social media, and Internet searches to help determine where to do business. They want instant, 24-hour access to assistance and care, respect of their time, and multiple forms of communication including Websites, online chat, email, text messaging, and smartphone and mobile apps. Call centers that keep up with technology and customer needs will see the most increase in their involvement in patient health.

Conclusion: The goal of the new Affordable Care Act is to increase health availability and access to health services for Americans. The act has started giving access, but questions remain about the feasibility of the law because of the costs involved. Call centers can play a crucial role in helping coordinate health services and ensure the right patients get the right level of care at the right time.

Charu Raheja, PhD, has been the chair, CEO, and co-founder of TriageLogic since its start in 2005. She has a passion for using finance and economics to create business solutions that help people. For more information, call 855-832-6852.

[From the February/March 2014 issue of AnswerStat magazine]

Seven Deadly Contact Center Sins for Supporting Population Health Management

By Richard D. Stier, MBA

Healthcare call centers are profoundly relevant to today’s healthcare challenges, including managing population health. Call centers are assuming a critical role as communication hubs at the center of the healthcare continuum.

Why invite additional responsibility? Who needs all this pressure? Here’s a tongue-in-cheek guide to prevent your call center from becoming the nerve center at the heart of your organization. It details seven sins that will keep your contact center from being relevant in supporting population health management.

1) Don’t integrate first point of contact functions. Don’t consolidate first point of access functions into a central contact center communication hub. This will avoid assisting the newly insured, avoid supporting ACO and medical home physicians, and avoid creating economies of scale. Let duplication reign.

2) Don’t make post-discharge calls to reduce preventable readmissions. Don’t bother to schedule follow-up appointments with a patient’s primary care physician prior to discharge. Don’t make outbound calls to recently discharged patients to clarify follow-up care instructions, to make certain prescriptions have been filled, or to discuss dosage amounts and frequency. And, don’t bother to confirm follow-up physician appointments.

3) Don’t redeploy your contact center as a trust building resource for participating physicians. Don’t ask physicians how you can help them succeed in your network. Don’t ask them how the contact center can provide greater support for their practice. They might just tell you, and that could create unrealistic expectations.

Don’t provide navigation support by coordinating follow-up appointments, specialist referrals, or appropriate classes. Ignore patients of your emergency department (ED) who don’t have a primary care physician. Let the ED deal with them. Don’t facilitate physician consults for referring physicians with one-call access to specialists. These activities are time-consuming, and some have a learning curve. Chill out.

4) Don’t become the communication conduit to direct referrals for reference pricing. Okay, okay. Employers across the country are taking note of reference pricing, where employer groups are identifying the average price charged for a particular procedure in a given service area and agree to pay only that amount, with overages paid by the insured. Just because reference pricing will likely proliferate, it doesn’t mean your call center should be involved. Doing this requires data entry and record keeping. Who needs the headaches?

5) Don’t deploy clinical triage and advice to reduce ED utilization. In one study, nurse telephone triage reduced ED usage by 4.3 percent and produced an annual savings of $400,000. But, don’t believe every research study out there. So what if there are a few extra ED visits? That’s their problem.

6) Don’t shift your focus from transactions to transformative experiences. Yeah, yeah, the healthcare contact center is frequently a patient’s first experience with a hospital or health system. The first three seconds of that interaction is a strong indicator of patient preference and hospital selection. I get it.

But, if the future is really about transformative, memorable experiences, why do so many businesses manage transactions? What about that fleabag motel? All they care about is getting your money, and they’re still open. This patient experience stuff is overrated. Financial incentives or not, it might be nice if your competitors had to deal with the more challenging callers.

7) Don’t leverage personalized social and mobile media opportunities. I know, we must connect with patients where they are. We’re supposed to think of your contact center as an ongoing connection, a running dialogue with key stakeholders. I get that social media enables that continuous communication.

The truth is, if we weren’t so darned accessible, we might have fewer hassles. So, if we can avoid being too available on social media – and forget about mobile – we can save a lot of time and headaches. I say skip it.

Finally, don’t measure results. Who cares if management perceives your call center as an expense rather than an investment? Managing a call center is a lot of work. Your life would be easier if you didn’t have all this responsibility.

Richard D. Stier, MBA, serves as vice president of marketing for HealthLine Systems, Inc., a leading provider of contact center and credentialing software solutions and consulting services, serving over 1,000 leading healthcare organizations across North America.

[From the February/March 2014 issue of AnswerStat magazine]

Why Use Scripting for Managing Calls in a Healthcare Call Center?

By Matt Everly

Healthcare organizations can use scripting to enhance each customer’s call experience. A variety of call types, including patient information, physician referral, physician answering service, and code calls, can all be handled more efficiently, resulting in a reduction of errors using scripting for enhanced call flow navigation.

Scripting can be used to guide agents or switchboard operators through the flow of a patient customer conversation. A script enables the agent to drive the dialogue with the customer and ensures the agent is able to complete a customer interaction to the call center’s and the customer’s satisfaction. A script helps agents respond to a caller’s requirements and prompts the agent to ask, and obtain answers to, additional questions that will enable a call center to deliver a higher level of customer satisfaction.

A robust scripting application provides the ability to access all customer information appropriate to the call – sometimes acquiring that data from multiple databases, including electronic medical record (EMR) databases – and display it in a format that is easy for the agent to understand. It also provides the ability to update customer information and to collect new data that can help the call center provide superlative customer service.

Scripting in a medical or hospital call center provides a number of benefits:

Customer Relationship Management: Scripting helps maintain a consistent quality of customer interaction each time a customer makes contact, regardless of which agent handles the call. Scripting also provides an easy and efficient way to collect additional customer information that not only helps ensure the customer’s satisfaction with that call, but also enables the agent to enhance the overall relationship with the customer.

Increased Agent Productivity: Because all of the customer information that an agent needs is presented in a clear, concise format with no toggling through multiple data screens, agents can complete a customer transaction quickly. Scripting also provides talking points for agents so they know what to say and when to say it.

Reduced Agent Training Time: Many agents in a call center have multiple skill sets to handle different types of calls – appointments, calls for a doctor’s office, customer service, and so on. Each type of call typically needs to be handled somewhat differently, so scripts should be customized for each doctor and call type, ensuring agents get the needed information on every call.

The scripts then lead the agent through different types of caller transactions with minimal training because the script provides the correct data to handle the call and helps the agent navigate through the call flow. And, because a script can provide instructional information on handling a call, scripting can enable a call center to overflow calls to less skilled back-up agent groups more effectively during periods of peak calling.

Enhanced Agent Effectiveness: Customers want to have their needs met the first time they make contact – they don’t want to be told to call another number, be transferred to another department, or wait for a callback. Because a script can bring together information from a number of different databases, agents are provided with all of the information they need, when they need it, to handle the customer contact immediately.

Matt Everly is the marketing director for Amtelco’s 1Call healthcare division. Matt has worked at Amtelco for over 20 years and has held numerous positions, including Southeast regional sales manager, executive suite market development, and marketing manager.

[From the December 2013/January 2014 issue of AnswerStat magazine]

Minimizing Communications Downtime During Natural Disasters

Easy Office Phone, a provider of cloud-based business phone services, shares these tips for minimizing communications downtime during natural disasters. With hurricane season and many businesses preparing for potential weather events, it’s crucial for organizations to take steps to minimize communication disruptions. Their tips for minimizing communications downtime are:

Set a Protocol: Before the next disaster arrives, employees should know exactly what is expected of them if an event occurs. Develop a simple checklist for employees to follow and ensure every staff member has a copy. Do not allow for any confusion or uncertainty in the event of a disaster; you cannot afford it.

Assess the Current Business Continuity Plan: Determine which regular activities are mission-critical, and then apply worst-case infrastructure scenarios to see whether your plan holds up. For example, if your office loses power, how can your staff continue fielding phone calls?

Ensure Your Phone Service is Virtualized: For most healthcare organizations, phone continuity is mission-critical. Cloud-based phone service greatly increases the odds that your main phone number will remain reachable, and your callers will know you’re in business, even if a disaster takes your call center or office off the grid.

Obtain Backup Numbers from All Staff: Because you can never be too prepared, develop a comprehensive staff contact list, including cell phone numbers, home numbers, and personal email addresses. Some staff may not wish to receive cell phone calls outside of office hours, so your list should note which numbers are for emergencies only. Unless you have mass notification capabilities, implement a contact tree so all employees know who to expect an emergency call from, and if they, in turn, need to call someone else on the list.

Ensure Key Documents Are Virtualized: Ask your staff to develop a list of documents and files they regularly use and need to access easily. Implement a practice of backing up these key files to cloud-based storage on a regular basis. Remember, you may have only limited advance warning of an impending disaster, so preparing now saves staff from having to scramble to decide which files are critical, or worse, risk losing documents they saved locally.

Let Your Staff Work Remotely: Many employees will attempt to commute to the office even in extreme weather, unless you’ve told them otherwise. If employees cannot safely travel to the office or the office infrastructure is compromised, you need an alternative. Implementing a virtual private network (VPN) with cloud-based phone and email services will remove a great deal of pressure, enabling staff to access files and emails from home and make and receive calls from anywhere.

Set a Point Person: Although the above tips are crucial, implementing them involves work. As with most aspects of business, a clear leader is important. Designate one trusted staff member to work through the steps – and do it now, so you have a chance to review and test your system well before you truly need it.

For more information, visit www.easyofficephone.com. 

[From the October/November 2013 issue of AnswerStat magazine]

Preparedness Planning: Three Vital Steps

By Lucien Canton

The single biggest mistake organizations make in preparedness planning is to treat disasters as something outside normal business operations. There is a tendency to see disasters as a class by themselves, one that requires specialized plans and procedures. The truth is that disasters are part of a continuum that begins with day-to-day problems. The processes managers use to resolve these problems can be expanded and adapted for use in disasters.

Understand Your Risk: The first step in preparedness planning is to understand the risks your organization faces. We usually think about risk as a specific event, such as an earthquake or a flood, and focus our attention on the frequency and magnitude of the event. You really can’t do much about these two factors. The secret to successful preparedness planning is to understand that it is your vulnerability to the event that is important, and you can do something about this. We must consider the impacts, not the cause, of the emergency.

Risk is relative. What is a crisis for one organization can be a routine occurrence for another. The difference lies in the vulnerability of the organization to the event. We can change this vulnerability through mitigation. Mitigation reduces the potential impact of the event by reducing or eliminating the harm caused by it. For example, seismically retrofitting a facility in an earthquake zone increases the chance of it surviving an earthquake and thus reduces your vulnerability to earthquakes.

Know Your Organization: Once you understand the potential impacts facing your organization, you can consider what these impacts would do to your operation. If you are forced to do the unthinkable and close for a period of time, what will it cost you in terms of patient health and wellbeing, bad publicity, lost revenue, decreased respect in the community, and penalties or fines? In terms of continuity, we refer to this as a business impact analysis, and we use the results to perform a cost-benefit analysis on proposed preparedness costs. But it’s not rocket science – as a good businessperson, you should know what it costs you to have services impacted for a day.

There are other potential impacts that aren’t quite as quantifiable. Would a disaster result in a decreased demand for your services because your patients are affected, or will it result in an increase in demand because new patients need your services? How likely are your patients to remain in the area after a disaster? This is the type of market forecasting we do every day – we’re just looking at it in the context of a disaster.

Knowing your organization extends to knowing how your staff is likely to perform in a crisis. You already know which of your employees are reliable in crisis. Like most managers, you probably have a “brain trust” of key employees on whose judgment and advice you rely for daily operations. Consider these employees as the nucleus of your crisis management team. Remember that it’s not about job titles but about trust and expertise. By using the same team in varying levels of crisis, you train them and build a rapport that will pay dividends in a large crisis.

Think Systematically: It’s common to develop a disaster management plan that is distinct from all your daily plans and procedures with the expectation that this plan will only be used in a disaster. But disasters aren’t always big events, and plans must be scalable. Instead of focusing solely on big events, think systematically.

How do you approach a routine emergency? Your first thought is usually, “is everyone okay?” Your next thought is, “what do I need to do to fix this and get back to work?” You try to figure out what’s happened, you gather the people who can fix the problem, and you move forward.

While there are some differences, this is the same thing you do in a larger event. There are six basic steps you want to take:

  1. Take immediate life safety measures to protect your staff and limit damage. This might include evacuation, quarantine, increased triage, and so forth.
  2. Assemble your crisis management team.
  3. Assess the damage. In a large event, this includes information about what is happening within your community. One of the problems with area-wide disasters, as opposed to local emergencies, is that the resources you rely on daily may also be affected.
  4. Develop an action plan. Identify those things that need to be done immediately. There are short-term issues that must be addressed at once, but there are also long-term issues that may need to be decided upon and addressed as soon as possible.
  5. Plan for personnel support. Your employees will be anxious, some may be injured, and some may not be able to get home or return to work. You’ll need to make provisions for taking care of them.
  6. Implement a crisis communications plan. At minimum, you’ll want to communicate with your employees, but remember that your customers and patients will also be concerned. Keeping them in the loop may be the key to keeping their business.

However you approach preparedness planning, remember that to be effective, your plans must be an outgrowth of how you do business. You can’t just switch off your daily routine in a crisis. Instead, the trust and relationships you’ve built and the procedures you have in place before the crisis will ultimately determine how your organization performs during a crisis.

Lucien G. Canton, CEM, is a consultant specializing in preparing managers to lead better in crisis by understanding the human factors often overlooked in crisis planning. A popular speaker and lecturer, he is the author of the best-selling Emergency Management: Concepts and Strategies for Effective Programs. For more information, email info@luciencanton.com.

[From the October/November 2013 issue of AnswerStat magazine]

Leadership Accountability: A Circular Strategy

By Pat Heydlauff

Leadership accountability isn’t just evaluated by the marker of profitability. There are many components to accountability, but the most strikingly overlooked one is buried deep within the relationship of a leader and the workforce – the truth.

According to Sergeant Friday from the Dragnet television series, getting “just the facts, ma’am” doesn’t always tell the whole story. Accountability is based on truth, but what percentage of the truth are employees presenting to leadership – 100 percent, 65 percent, or just enough to get by?

Great leaders need to have factual and truthful information to make good decisions. In order to receive that type of information, they need to have good interpersonal relationships with their workforce – the kind that foster open-ended, confidential dialogue. It is only through this type of communicative interaction that the workforce will provide a leader the accurate information critical to making the right decisions.

Employees need to feel they can trust their leaders enough to tell them anything in complete confidence before they will expose themselves to possible blame, humiliation, ridicule, or undesirable consequences.

Apply the 80/20 Rule: It’s time to apply the 80/20 rule to employee relations and communication. The norm for most leaders is to spend 80 percent of their time behind their desks and 20 percent of their time among or communicating with the workforce. How can you possibly know what is really going on with your people if you do not spend time with them? And, how can you expect them to confide in you if they don’t know and trust you?

In order to create an engaged workforce that will gladly provide you the truthful information you need for long-term success, exchange the time you spend behind your desk with the time you spend with your workforce. No, you do not have to spend 80 percent of your time actually out in the workplace, but you do need to spend time physically out there daily and then add time together when in your office, common meeting rooms, their lunch room, or in their workspace. Obtaining truth-filled information is all about connecting, communicating, and being directly involved in their daily activities – you cannot do that sitting behind a desk.

Circular Communications are Key: Circular communications is the essential component to an accountability strategy. When everyone is accountable and engaged, productivity goes up, performance improves, and leadership’s ability to lead increases.

Get More Than Just the Facts: Start every day with a walk-through of the workplace whether it is a call center, manufacturing plant, or a retail store. Find the problems and issues that need to be addressed before the workforce begins its day. Ask questions and then listen. There is always a backstory. No matter what is happening, what went wrong, or why things didn’t work, there is always more to the story than just the surface facts. Spend time with team members and continue the dialogue until you feel you have the complete story. By showing interest in the person and the problem, he or she will learn to trust you, and you will be able to trust the information he or she imparts.

Is Anything Standing in the Way? Do your walk-through at different times of the day on different days of the week. This will provide you an array of information to connect with the workforce. When asking questions, it should never be “what happened here” or “why did this project derail?” Just as important is the question “Is anything standing in your way to prevent you from completing the task at hand?” You cannot remove something or prevent a problem standing in the way unless you know about it.

Get Anonymous Confidential Feedback on Your Performance: When seeking information and feedback, remember to get feedback on yourself. Sometimes, you might be what is standing in the way. Ensure private, uncompromised feedback from your peers and team about you. You cannot live in a vacuum or get to the truth if feedback essential to your leadership performance cannot be provided confidentially and received as constructive criticism. You also cannot stop with just getting the confidential feedback. You need to take appropriate action, or your leadership will suffer.

Leading a team or running a successful business given today’s uncertain economy, global implications, and marketplace competition is a difficult task for any leader or manager. It is all but impossible unless you have not only the facts, also but the back-story, to make wise decisions. Use the 80/20 circular accountability strategy to make decisions that result in improved workforce engagement, employee retention, and profitability.

Pat Heydlauff speaks from experience. She works with organizations that want to create an environment where employees are engaged, encouraged, and involved, and with people who want to be in control, anxiety-free, and confident. She is the author of the forthcoming book Engage, How to Lead with Power, Productivity and Promise. She can be reached at 561-799-3443 or engagetolead.com.

[From the April/May 2013 issue of AnswerStat magazine]

Three Reasons for Considering At-Home Agents

By Bob Webb

If you are looking for a winning strategy to streamline operations, provide improved customer service, decrease call center costs, and increase agent retention and job satisfaction, the at-home agent model could be your answer. The at-home agent paradigm is revolutionizing the call center industry. Three primary reasons for companies to implement remote agents are to lower costs, improve customer services, and enhance employee satisfaction and retention.

Lower Call Center Costs: Reducing call center operating costs results in bottom-line savings for companies. Operating costs associated with at-home agents include less need for brick-and-mortar facilities and support staff, increased labor pool with flexible scheduling options, and reduced training costs because of increased agent retention. Additional cost savings can be found with reduced benefit packages for part-time agents.

The need for large call centers and accompanying support staff is reduced with at-home agents. The at-home agent pool is vast, and multiple configurations of scheduling options are possible. Remote agents with flexible schedules simplify staffing for special events, holidays, and vacations. Remote agents can also accommodate spikes in call volume on short notice.

Virtual training allows agents to live outside the geographical boundaries of the call center and receive the same training as on-site agents. E-learning technology enables ongoing training for remote agents to be deployed the same as for on-site personnel once initial training is completed.

Improve Customer Service: At-home agents have demonstrated their ability to create a better customer experience, resulting in increased customer loyalty. Customer loyalty due to improved service translates to increased revenue: First-call resolution is at 34 percent for United States-based centers. Remote agents are able to take customer service to the next level and increase customer loyalty.

Two factors contribute to call center success: excellent customer service and consistently reaching service-level objectives. Service levels are severely impacted when agents are out of adherence or underperforming. In-house agents encounter interruptions throughout the day that affect productivity. At-home agents are proven to be more productive than in-house agents, with a reported increased productivity of up to one hour daily. Working in an environment without disruptions allows agents to focus on meeting service-level objectives and provide excellent customer service.

In a disaster situation, an at-home model increases operational stability by having agents in multiple locations that can continue to work during an outage or natural disaster. Remote agents can also fill the gap when internal problems arise in on-site call centers by answering calls with no disruption of service.

Enhance Employee Satisfaction and Retention: Agent turnover is an inherent problem for call centers, and replacing agents is a major cost consideration. Employee satisfaction contributes to agent retention. Recruiting and training costs can significantly affect a company’s bottom-line profit margin. The retention rate for at-home agents is 80 percent versus 25 percent for in-house agents.

Agent morale is a key factor in retention. Remote agents have more control over their schedules, allowing for improved work/life balance. While software tools are available for helping increase agent control over schedules, the at-home model supersedes software solutions offered to on-site agents. Remote agents can create schedules unique to their availability, and schedules can be segmented throughout the day and vary on a daily basis.

At-home agents bring a level of professionalism to their job that enhances their quality of customer service. More than 80 percent of at-home agents have a college education and management experience, compared to 35 percent of on-site agents. At-home agents are more likely to value their employment and view it as a profession as opposed to “just a job.”

Conclusion: Many companies are implementing the at-home agent model for purposes of improving customer service and increasing customer loyalty, as well as increasing retention through improved agent satisfaction. The at-home agent model meets these objectives. Additionally, the current economy is driving the at-home agent model because of reduced operating expenses. Estimated annual savings per at-home agent is approximately $25,000, including reduced facility requirements, training, and supervisory demands.

The benefits of having a larger labor pool from which to choose is invaluable for meeting last-minute scheduling demands, filling peak call volume time slots, or continuing service during emergencies. Remote agents can be located anywhere and are available for hard-to-fill time slots, enabling contact centers to offer extended hours or accommodate non-traditional operating hours. The at-home agent model truly creates a win-win situation for both agents and call centers.

Bob Webb is VP of sales at Pipkins, Inc., a supplier of workforce management software and services to the call center industry. 

[From the February/March 2013 issue of AnswerStat magazine]

Minimize the Impact of Disaster

By Donna Fluss

Natural disasters, such as Hurricane Sandy last fall, remind us of the importance of disaster recovery (DR) and business continuity (BC) planning, something that too many contact centers neglect. Most business and organization leaders agree that disaster recovery and business continuity planning is critical, but often budget constraints prevent organizations from making the necessary plans. Unfortunately, hurricanes, tornadoes, snowstorms, floods, fires, and acts of terrorism remind us of how important it is to have strong DR and BC plans in place in the contact center.

Preparing for a Disaster: The primary goal when preparing for a disaster is to build a plan to keep your contact center operating during a crisis. The strategy you choose will depend on your technical capabilities and resiliency, the number of sites and their geographical dispersion, the percentage of work that can be deferred in the short term without major business ramifications and serious customer dissatisfaction, and how much you are willing to spend to keep your business going in the event of a disaster. Here are a number of ways to prepare your contact center and limit the negative impact and cost of disasters:

  • Have geographically dispersed locations, if possible. Set up business continuity routing plans to move interactions from an impacted site to its backup.
  • Invest in contact center infrastructure that is resilient and comes with full backup capabilities.
  • Invest in a cloud-based contact center infrastructure solution as your backup, but be sure it is based in a different location from your primary system.
  • Establish a business continuity plan with your carrier(s) that allows you to easily alter your routing scheme.
  • Be prepared to use self-service solutions as your primary customer interaction point for as long as half a day. This is not ideal, but if it becomes necessary, you should have an interactive voice response (IVR) application ready to be implemented. Build these environments, and hope you’ll never have to use them.
  • If your contact center technology supports work-at-home agents, assign 20 percent of agents to be DR staff. Implement the technology needed in their homes, train them to use it, and test it once a quarter to make sure they know how it works. (Make sure they have the necessary bandwidth to handle calls and other types of customer interactions.)
  • If work-at-home is not an option and you don’t have a second site in a different location, find an outsourcer in a different region that can provide backup agents and technology on short notice. The outsourcer’s agents must be trained and have availability to your systems and processes. To ensure they are ready, they should be tested every quarter.

Testing Is Key: In a worldwide benchmark study on contact center disaster recovery, DMG found that only 36.7 percent of companies were confident that they could operate during a disaster without a serious impact on service quality and the customer experience. This percentage is actually low, because a majority of contact centers either do not have DR and BC plans or are not keeping them up-to-date.

This same study revealed that only 4.7 percent of companies test their DR and BC plans on a monthly basis. This leaves 95.3 percent of contact centers at risk of a major meltdown in an emergency, which is not a position anyone wants to be in. The best plans won’t help if your staff does not know what to do, and the technology does not work. So, it’s essential to run a full business continuity test once a year and test various aspects of the plan on a quarterly basis.

Final Thoughts: Nobody likes to think about disasters, but whether they are weather-related, such as a hurricane, or man-made, such as a terrorist attack, they do happen. Not every company will be hit by unexpected events, but all contact centers should be prepared so they can mitigate the impact on their customers and bottom line without putting their employees at risk.

Donna Fluss is the founder and president of DMG Consulting LLC, a provider of contact center and analytics research, market analysis, and consulting.

[From the February/March 2013 issue of AnswerStat magazine]

Do More with Less: 15 Opportunities, Two Mistakes, and One Performance Ceiling

By Richard D. Stier, MBA

“Now more than ever, healthcare providers must begin to test innovative healthcare delivery and payment models such as accountable care organizations, bundled payments, clinical integration, and the patient-centered medical home,” states John Redding, MD, MBA. “Ultimately, providers will need to learn how to do more with less.”

At the 24th Annual Conference of Healthcare Call Centers held June 20 to 22 in Philadelphia, this writer facilitated a roundtable of senior healthcare contact center leaders from across the United States. The key question was, “What is your number one challenge moving forward?”

Responses included “How can I achieve my goals with inadequate space?” and “I’m losing touch with my team because we’ve eliminated management positions.” As these leaders shared their ideas, a consensus emerged, “Our number one challenge is doing more with less.”

This chorus has had frequent replays over the past three decades of healthcare’s evolution. How can call center leaders lift the performance ceiling? The discussion uncovered fifteen opportunities:

1) Offload non-clinical functions to free-up clinical staff. Time every activity performed by clinical team members. Which tasks can be reassigned to non-clinical team members? For example, could non-clinical staff front-end the calls? Should they make non-urgent physician appointments following clinical triage?

2) Replace one agent with two less expensive operations specialists who are cross-trained for multiple non-clinical roles, both of whom develop intentional areas of specialization, such as data analysis and reporting or outbound calling.

3) Replace one full-time role with two part-time or split shift positions to allow greater scheduling flexibility and improved coverage.

4) Require appropriate FTE support when asked to be responsible for additional call center functions from other areas of the organization.

5) Charge participating physicians on a per call basis for after hours first call support. Depending on the organization, this may be a fee calculated to cover direct expenses rather than to generate a margin on services provided to partnered physicians.

6) Increase productivity to reduce cost per transaction. Where possible, automate letters, faxes, and e-mail; replace direct mail with email; and use text messaging for appointment reminders. Reduce or eliminate staff time required for printing, collating, and mailing. Cut expenses for supplies and postage.

7) Use volunteers in non-clinical and non-technical support roles where possible, such as for items requiring printing, collating, and mailing.

8) Hire students. Students want to learn and can add inexpensive value for part-time or split shifts in non-clinical roles.

9) Consider modifying agent compensation. Instead of paying agents by the hour, pay a flat fee per call to agents who maintain or exceed a predefined quality standard. Some participants suggested that this may be more feasible for non-clinical roles.

10) Leverage technology such as voice recognition systems and call monitoring systems. Integrate the provider database with a single source of truth for physician information.

11) Cross-train nurses, with each nurse having specialized expertise in specific clinical areas that align in support of the organization’s clinical centers of excellence.

12) Refer unattached ER patients to in-network primary care physicians. Place a call center representative in the emergency department. This approach can reduce the use of ER for primary care and align patients who might have gone elsewhere with in-network PCPs.

13) Co-locate first point-of-contact services. This might include scheduling, transfers, physician referral, class registration, physician-to-physician referral, nurse triage, and switchboard, which can reduce or eliminate duplicative expenses and provide a central first point of contact.

14) Integrate the call center with the Website to increase transaction volume without a corresponding increase in FTEs. Activate live chat to add value to Web users and potentially moderate call volume. Report both call and Web transactions using the same database.

15) Redefine call center metrics. Make a list of legacy metricsto be phased out. Select new metrics, such as documenting the value of reimbursement recovery from reduced avoidable readmissions.

These call center leaders also identified two mistakes to avoid:

1) Do not assign team members to roles that require skill sets they don’t currently possess. For example, it should not be assumed that because a nurse has excellent clinical triage skills that she or he has an equal ability to communicate over the phone in a way that nurtures trust.

2) Don’t press well-intended team members to perform beyond their capacity. Encourage and reward excellence while being sensitive to the boundaries of each individual’s capabilities.

Lastly, there is a performance ceiling. Two filters determine a contact center’s performance ceiling. They are either a limiter, which constrains what is possible, or an accelerator, which empowers it. These filters are capacity and attitude.

Capacityaddresses fundamental intellectual horsepower and skill-based ability. Capacity begins with training and is seasoned by experience. Learning strategist Jay Cross indicates that 80 percent of training dollars are typically spent on structured, formal learning in the classroom or, perhaps, with e-learning. However, 80 percent of what people actually learn is informal or social through on-the-job discovery or through collaboration with co-workers who serve as mentors.

Attitudeis a choice. Whether a team member’s attitude is one of positive anticipation or negative expectation, behavior will follow attitude. The single largest limiter or enabler of contact center performance is attitude.

Raising a contact center’s performance ceiling to meaningfully do more with less requires two intentional actions: continuously expanding capacity and hiring for attitude. In the words of Dr. John C. Maxwell, “Motivation determines what you do. Ability determines what you’re capable of doing. Attitude determines how well you do it.”

Opportunities to do more with less require contact center managers to lift the lid on what is possible. Mistakes and missteps tighten that lid.

Richard D. Stier, M.B.A., is vice-president of marketing at HealthLine Systems, Inc.

[From the October/November 2012 issue of AnswerStat magazine]

Reinvent Your Call Center’s Role: Five Solutions to Activate Now

By Richard D. Stier

Your call center is vital to your organization’s ability to harvest fees-for-service opportunities while concurrently supporting the emerging value-driven environment. As stated in Becker Hospital Review’s Annual CEO Roundtable: “One of the major challenges…is the transition from one economic system (fee-for-service) to the assumption of risk in a population-based economic model.”

Your call center has a timely opportunity to move from a siloed support function to a central communication hub. Healthcare strategist and thought leader Scott Regan believes that the move to value-based reimbursement with accountable care organizations (ACOs) represents a unique opportunity for healthcare contact centers. Call centers must move from a hospital ancillary support function to a critical role at the center of the care continuum, performing critical linkage functions as health coaches. In the developing environment, your call center will be a vital, central communication hub – or it will become irrelevant.

Leading healthcare organizations are already tapping their call centers to activate critical solutions, whether or not they deploy an official ACO. If you haven’t yet begun, you’re already behind. Have a meaningful conversation with your CEO about your organization’s driving priorities and how your call center can intentionally support them.

Five key solutions can make your call center an essential resource as your organization pilots the transition from fee-for-service to value-based care. In the process, these solutions can make a positive impact on the bottom line.

1) Streamline Access to Care:

Place post-discharge calls to reduce readmissions. Post-discharge calls can clarify discharge and follow-up care instructions, confirm medication and dosage accuracy to reduce medication errors, answer questions, and schedule follow-up appointments. The Studer Group documents that healthcare organizations making discharge follow-up calls achieve a 20 to 30 percent reduction in preventable readmissions. One study identified initial results of piloted post-discharge outbound calls with patient prioritization, including a 46 percent reduction in readmissions for congestive heart failure patients and a 21.6 percent reduction in readmissions for pneumonia patients.

Deploy evidence-based clinical triage to the most clinically appropriate and cost-effective care. Clinical triage using clinical guideline protocols directs the truly at-risk callers to immediate emergency care and redirects the inappropriate use of high acuity clinical services to primary care or home care. These evidence-based clinical guideline protocols address ACO requirements for evidence-based medicine, patient engagement, and coordination of care.

Identify and eliminate roadblocks to care by asking patients about their care experiences. Short of experiencing your organization’s care personally, there is no better way to understand what patients experience than to ask them. It is important to know what barriers need to be removed and what action to take. Call center survey functionality must be flexible enough to activate and track results of polls, questionnaires, and assessments, and it must support inbound, outbound, telephone, and Web components of your contact center.

Shorten appointment wait times. Leading healthcare organizations have adjusted their referral policy in an effort to reduce the time a caller has to wait for an appointment to see a participating physician. The goal is to minimize the likelihood of that patient choosing to go elsewhere to be seen sooner. Tools to enable this capability include referral algorithm optionsthatcan speed access to care by referring to participating physicians using physician-selected timeframes, such as physicians agreeing to see referred patients within 48 hours, 72 hours, or 5 days or more.

Provide one-call preregistration. An important opportunity to ease access to care is to make it easier to register for urgent care visits so patients are expected when they arrive, and their paperwork is already begun. Your contact center can be the call to action for urgent care and pre-register patients.

At the time of the patient call, document patient pre-registration information in your software and schedule automatic emails or faxes of this information to urgent care in advance of the next day’s patient visits. Your urgent care team can greet the patient with a smile, saying, “Welcome Mr. Smith, we’ve been expecting you.”

Reduce call-processing time to do more in the same amount of time. Software engineered for fewer clicks and faster call processing resulted in an average timesaving of 51 secondsper call for one organization. This meant 536 hours saved in year one.

Document kept appointments. Increasing your rate of kept appointments strengthens relationships with both patients and with participating physicians. It allows you to “close the sale” at the time of the initial patient conversation by conducting a three-way call to confirm an appointment with the physician of their choice. Getting more patients into a participating physician’s practice gives you a meaningful answer to a physician’s question, “So, what have you done for me lately?”

One healthcare organization increased their kept appointment rate from 56 to 71 percent. More patients who show up for physician appointments means more patients are likely to require subsequent services. The patient wins. The physician wins. The hospital wins.

2) Serve as Physician’s Marketing Partner:

Interview participating physicians. A key question to ask your participating physicians is “What can we do to help you be more successful at our hospital?” Your contact center survey tool should make it easy to collect information and summarize opportunities.

Refer unattached ER patients to your primary care physicians. One organization used their call center to support a part-time agent in the emergency department who scheduled 105 new primary care appointments in five months. Where would those patients have otherwise gone for care?

Provide practice navigation support. Coordinate referrals to specialists, follow-up appointments, and classes. Save physician time, improve patients’ care experiences, and reduce out-of network patient migration.

Deploy physician-to-physician consult. Activate physician-to-physician consults for one call physician access to specialists. One organization’s president remarked, “The referral center is my secret weapon!”

Provide tangible support for physicians with quality and patient safety. Track and trend patient safety events, including incidents, near misses, and unsafe conditions. Survey patients to provide physicians with valuable feedback for continuous improvement. Collaborate with physicians to assign post-discharge outbound calls to reduce readmissions.

3) Reduce Redundant Costs:

Integrate first-point-of-contact services. Consider co-locating scheduling, transfers, physician referral, class registration, physician-to-physician referral, nurse triage, and switchboard services. This is an opportunity to reduce or eliminate duplicative expenses, cross train your team, and provide one primary initial point-of-contact access portal.

Integrate call center with Website. It is important and cost-effective to have an integrated dataset for phone and Web components of your contact center, reporting call and Web transactions using the same database.

Eliminate duplicative provider data. Avoid redundant and conflicting physician data by integrating provider data from multiple sources and myriad systems into a single database.

Increase productivity to reduce cost. Automate letters, faxes, and email. This reduces or eliminates staff time required for printing, collating, and mailing. It also cuts supplies and postage costs.

4) Deliver Concierge Experiences:

Improve care experiences. Beginning in 2013, the Centers for Medicare and Medicaid will reduce payment for 3,500 acute care hospitals by approximately $850 million. The potential loss for one two hospital 950 bed system is about $2 million. Hospitals can earn that money back and more if their scores exceed those of their competitors.

Raise patient satisfaction scores with distinctively positive call experiences with the call center, which are frequently the first point of contact. Outline themes for consistent agent openings and closes, provide agent supportive messages of the day, and flag caller specific opportunities with silent selling points.

Document the value of repeat utilization. Record and report the financial benefit of repeat utilization following call center interactions. One organization documented a substantial total contribution margin for one year from new, dormant, returning, and existing patients.

5) Document the Call Center as an Investment. Validate the call center as an investment solution rather than as an expense problem:

Document non-compensated community benefit provided by the call center. According to an August 16, 2011, article in the Chicago Tribune online, the Illinois Department of Revenue has denied property tax exemptions to three hospitals and is reviewing applications from 15 others. The call center can document non-compensated community benefit, which is a tangible way to help maintain tax-exempt status.

Document increased utilization of priority clinical services. One healthcare organization’s example for a six-month period includes:

  • Heart: 4 inpatient admissions, 157 outpatient visits, 13 physician visits
  • Joint: 222 inpatient admissions, 625 outpatient visits, 43 physician visits
  • Cancer: 3 inpatient admissions, 81 outpatient visits, 14 physician visits
  • Bariatric: 465 inquiries, 18 surgeries, 16 physician visits
  • Spirit of Women: 284 inquiries, 174 new members

Document results in an executive report card using new metrics. Recognizing a “dual” environment with both a fee-for-service focus and concurrently an emerging value-based system of care, compile a list of metrics which are no longer applicable or which can be phased out as new metrics are adopted.

Summary: Your call center should be a vital, central communication hub that measurably supports your organization’s driving priorities. The industry shift from fee-for-service to value-driven payment is underway. Whether or not you deploy an official ACO, these five solutions can enable your call center to be a vital resource for your organization as it navigates that transition.

Richard D. Stier, M.B.A., is vice-president of marketing at HealthLine Systems, Inc.

[From the April/May 2012 issue of AnswerStat magazine]