Meeting Today’s HealthCare Challenges Through Contact Center Excellence

By Patty Maynard

Healthcare contact centers have been given an increasing amount of responsibility to help their organization meet critical goals related to health reform and patient engagement. With this added responsibility also comes an opportunity to shine – and play an even more valuable role in both your organization’s success and your community’s health. RelayHealth’s RelayCare™ provides the tools and technology to help contact centers achieve excellence in this expanded role.

The New and Expanding Role of the Contact Center: Last year, the Centers for Medicare and Medicaid Services (CMS) implemented its first round of reimbursement penalties for excessive readmissions, which led to more than 2,000 hospitals forfeiting about $280 million total in Medicare funds (Centers for Medicare and Medicaid Report, “Readmissions Reduction Program,” August 1, 2012).

As the penalties increase for excessive readmissions, contact centers can help solve this challenge. Leading healthcare organizations are taking positive steps to avoid CMS penalties and improve patient outcomes. Here’s one example.

Readmission Management Success Story: Wake Forest Baptist Health: Wake Forest Baptist Health, a nationally recognized academic medical center, had been making post-discharge calls to orthopedic patients for several years but saw the need for a more robust readmission management program. Beginning with general medicine and hospitalist patients, they later added cardiology and other patient groups.

The RelayCare Readmission Management protocol-driven workflows enable contact center staff to efficiently manage inbound and outbound readmission management calls, while giving patients a single access point for any questions or concerns. The surveys associated with each patient call are specific to his or her conditions, with an easy-to-follow interface that keeps users from having to scroll through questions that aren’t relevant. The workflow queues also include reminders for tasks, such as “Patient could not be reached; follow up again.”

Post-discharge patient outreach has added about 100,000 outbound calls to the contact center’s annual call volume. The thirty-nine full-time employees handle about 400,000 total calls. Overall, RelayCare facilitates easier, more consistent documentation across multiple touch points. Its reports track discharged patients through the readmission program and cross-references them against readmissions, enabling contact center staff and clinical leadership to view the program’s successes and identify areas for improvement.

The Emerging Importance of Care Management: While hospitals have a powerful incentive to reduce readmissions, a care management program is also important. Nearly 133 million Americans, or half the population, suffer from chronic diseases or conditions (Wu, Shen-Yi, et al, “Projection of Chronic Illness Prevalence and Cost Inflation,” RAND Corporation, 2000). Plus, their ongoing care management represents 85% of healthcare spending (Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2004). An outbound communication program managed by the contact center can yield many benefits:

  • Promote self-care and a more proactive role among chronically ill patients
  • Facilitate better care coordination
  • Support a patient engagement strategy
  • Reduce inpatient treatment when possible (to optimize utilization of hospital clinicians) by avoiding admission or readmission
  • Provide care management resources for patients, caregivers, and the community at large

Top healthcare organizations use care management software to engage with patients and help them better manage their health. In addition to improving patient outcomes, they are realizing cost savings through reduced readmissions and ED visits.

To read more customer success stories, visit the case study section in the resource library at www.relayhealth.com or learn more by contacting a RelayHealth solutions advisor at 888-743-8735.

[From the June/July 2013 issue of AnswerStat magazine]