Consolidating Call Center Activities in the ACA Environment

By Marlene Grasser

Healthcare call centers are again taking center stage due to recent changes in healthcare delivery. The Affordable Care Act (ACA) is creating an environment in which networking is necessary to provide the best possible care at the best available price as part of your population management strategies. Today’s consolidated call centers are in the best position to provide this service. Since their inception, healthcare call centers have connected community members to hospital services. Now, more than ever, it is important for a consolidated healthcare call center to connect an organization’s internal services to one another as well as to its affiliated member facilities.

Improve Access to Care: Operating from 9:00 a.m. to 5:00 p.m. no longer allows a healthcare call center to realize its full potential. Instead, to build a valuable brand that reflects the call center’s value as the hub of information, professional staff availability 24/7 is key. That way, when consumers encounter symptoms or have questions, they automatically know who to call for help. The call center triage nurse who takes symptom calls, especially after hours, has the ability to provide assessment and a recommendation of care, with both acuity level and time frame. Why is this so important?

Swedish Hospital in Seattle, Washington, answers this question by working with a community clinic run by Country Doctor near its busy emergency room to take evening and weekend patients who have lower acuity health needs. In a 2014 Kaiser Health News article, Carol M. Ostrom quotes Swedish Hospital administrative director Howard Springer as saying, “We are not all things to all people. We are illness-care providers, with a heavy emphasis on specialty care and inpatient care.”

Ostrom goes on to say, “The ACA, by bringing insurance to more, makes the deal affordable for Country Doctor. And by signaling that doctors’ and hospitals’ future livelihood will be linked to value, not volume, the ACA has led Swedish to seek such a partner.”

Due to federal regulations, patients cannot be redirected from the emergency room, but certainly they can be educated to know when to seek care in the clinic versus the emergency room. Healthcare call center triage nurses are the perfect fit for this role, ensuring efficient and cost-effective care at any time of day or night.

Maximize Efficiency of Healthcare Delivery: In addition to triage, nurses can also provide care management, post-discharge assessment with coaching, and critical lab calls. Staffing the healthcare call center with cross-trained individuals allows for additional services such as clinic scheduling, event registration, and even relatively new services like cost transparency.

Health2con.com notes, “There is increasing pressure for hospitals to be more transparent about their pricing. The Affordable Care Act now requires that all hospitals publish their prices for the most frequently performed services beginning in 2014.”

The same health coaches who help with scheduling and registration in the call center are positioned especially well to provide pricing information in a sensitive, professional, and accurate way.

There is also an opportunity for feedback via complaint, suggestion intake, and follow up. And since the call center is a centralized hub of information, ongoing and frequent updates to the health content can be made to assure the most accurate information delivery.

Set Bar High for Customer Service: Successful healthcare call centers have a reputation for providing excellent customer service. As the first point of contact for an organization, this is critical to gain and maintain consumer loyalty. Therefore, utilizing this framework to consolidate disparate “mini-call centers” located throughout the organization into a single, centralized center makes sense.

Other groups, like scheduling, have to split their attention between answering the phone and attending to the person physically in front of them. Consolidated call center staff members, unlike staff in other areas of the healthcare delivery system, are able to focus on the next phone call or Web hit, enabling them to provide the best possible front line for remote consumers.

Summary: With the consolidated healthcare call center’s unique ability to improve access to care, maximize efficiency of care provided, and set the bar high for customer service, the healthcare call center increasingly offers a significant benefit to a coordinated care delivery network.

Marlene Grasser is the regional vice president, sales at LVM Systems.

[From the June/July 2014 issue of AnswerStat magazine]