The Expanding Markets for Health Call Centers

By Monica Corbett

A new era for healthcare began October 1, 2012 with the implementation of the provisions of the Affordable Care Act seeking to reduce readmissions for congestive heart failure, pneumonia, and heart attacks. The combination of rewards and penalties for those who are tasked with reducing costs and improving outcomes for patients is emerging as a principal driver of resource decisions by the spectrum of stakeholders.

Full-service health call centers, with their longstanding emphasis on appropriate care for particular symptoms and conditions, are ideally suited to support the use of remote resources as an integral part of health solutions in this new age. While there are multiple stakeholders interested in complying with the new world of healthcare, common issues are on the forefront and begging for innovative solutions.

What is the Market Seeking from Healthcare Call Centers?

Providers Seek to:

  • Reduce costs by allowing case managers to handle more cases
  • Reduce over-utilization of ER by redirecting to appropriate care
  • Be more competitive and expand customer base by demonstrating better outcomes through patient-centered care
  • Reduce hospital readmission rates
  • Comply with Medicare accessibility requirements
  • Achieve overflow and staffing gap coverage
  • Offer concierge services
  • Realize a good night’s sleep for physicians
  • Provide community outreach
  • Compile a matrix of data demonstrating results to increase funding opportunities
  • Comply with Healthcare information exchanges and meaningful use standards

Payers Seek to:

  • Reduce cost, including administrative costs
  • Assess and monitor risk
  • Deploy turnkey systems for the continuum of care
  • Access matrices of data on conditions and outcomes
  • Integrate operating systems for remote monitoring with core databases
  • Increase productivity through behavioral and physical health
  • Mitigate on-site injury and exposure solutions
  • Reduce medical costs

End-Users Seek:

  • 24/7 triage and health advice
  • Convenience and access
  • Concierge service and one-stop shopping
  • Assistance with preparing personal health records
  • Second opinions
  • Referrals
  • Health system navigation
  • Behavioral health hotline
  • Guidance for occupational exposures
  • Remote healthcare to prisoners and others with restricted access

Use of Telehealth to Support Market Requirements: Heavy investment in monitoring devices by technology companies, growth forecasts by the major research companies, and successful pilot programs by the public and private institutions all indicate a major role for telehealth in meeting the above requirements. A prominent example is the Whole System Demonstrator program, demonstrating the capabilities of telehealth and telecare, set up by the British Department of Health in 2008. It is one of the most complex trials ever undertaken by the Department of Health.

The program provides a clear evidence base to support important investment decisions and show how the technology supports people in order to live independently, take control, and be responsible for their own health and care. Results from over 6,000 patients demonstrate that, if used correctly, telehealth can deliver a 15% reduction in routine visits, a 20% reduction in emergency admissions, a 14% reduction in elective admissions, a 14% reduction in bed days, and an 8% reduction in tariff costs. More strikingly, they also demonstrate a 45% reduction in mortality rates.

However, as George Tilley pointed out in the Aug/Sept 2012  issue of AnswerStat, “Impact of Telehealth and Remote Patient Monitoring,” specific protocols for selecting, specifying alerts, using appropriate medical guidelines, and documenting outcomes for remote monitoring of patients who are already quite ill have been lacking. For some providers of remote services, as many as 41% of readings result in alerts, of which 90% call for an ER disposition. Tilley’s article outlined the efforts underway to develop and deploy appropriate protocols for remote patient monitoring to supplement existing triage guidelines as part of an integrated solution to the healthcare challenges outlined above.

In addition to deploying specialized protocols for remote monitoring and disease management, health call centers that are up to the challenge for an expanded role in the new medical age will need:

  • Access to nurses, therapists, and doctors with specialties and licenses able to interact remotely with the beneficiaries of the organizations they serve
  • Supervisors and senior level management experienced in remote care
  • Advanced Web-based operating systems and triage guidelines accessible over the cloud by the remote clinicians
  • Redundant Web-based and hard-wired communications networks

Health call centers that are prepared to meet the above challenges will become the nerve centers and personnel resource for telehealth.

Monica Corbett is the director of development for Fonemed Health Solutions.

[From the December 2012/January 2013 issue of AnswerStat magazine]