Opportunities Abound for Healthcare Call Centers

By Mark Dwyer, LVM Systems

Since our founding in 1988, LVM Systems has seen a great amount of growth in the healthcare call center industry. It would be easy to say that the changes in the industry have been exclusively technological. In the past 20 years, we have gone from huge, clunky, and painfully slow shared workstations to the ability to work from home on a laptop computer.

Yes, technology has come a long way. But if you really want to look at the biggest advancements in the healthcare call center industry, it’s the people. The level of skill and professionalism in the healthcare call center industry has never been higher. Healthcare call center managers are evolving into highly valued strategic partners within their respective organizations.

The future holds a great amount of opportunity for managers and their centers. We see a few trends emerging that we believe will further increase the stature and responsibility of healthcare call centers:

Healthcare Reform – Accountable Care Organizations: As various components of the Affordable Care Act are implemented, there are opportunities for healthcare call centers to play a critical role. One such area is within the concept of Accountable Care Organizations (ACOs).

According to an article by National Public Radio’s Jenny Gold, an Accountable Care Organization “is a network of doctors and hospitals that shares responsibility for providing care to patients. In the new law, an ACO would agree to manage all of the healthcare needs of a minimum of 5,000 Medicare beneficiaries for at least three years.”

Call centers that already provide services like physician referral, physician-to-physician referral, and hospital transfer know how to navigate disparate healthcare facilities. As ACOs begin to take shape, healthcare call centers are in a unique position to ensure the success of a burgeoning ACO. First, healthcare call center managers must understand their organization’s approach to ACOs. Once that is clear, you should make a case for participating in any strategic planning meetings. At those meetings, you can promote your expertise and put yourself in a position to be the hub of your facility’s ACO.

Medical Home: Medical home is similar in nature to ACOs. However, finding a single, universally accepted definition of medical home is difficult. The one characteristic most organizations have defined is the physician’s role. In a medical home care delivery system, there is a single primary care physician guiding the patient’s care.

The challenge for healthcare call centers in this scenario is that if physician offices take the lead role in coordinating patient care, they typically do not have a call center of any significance. In this scenario, a facility with a robust or growing call center can still provide this service but have data flow toward the patients’ primary physician.

Healthcare Reform – Readmission Reduction: Another element of the Affordable Care Act is the concept of readmission reduction. This is a punitive aspect of the Affordable Care Act that decreases Medicare payments to hospitals whose patients return to the hospital. This provision takes effect in 2013. This is another opportunity for healthcare call centers to take a lead. Call centers that are experienced with disease/case management should have an easier time transitioning into a readmission reduction environment.

In Conclusion: The future holds many exciting developments for healthcare call centers. Astute call centers managers will pursue these service opportunities, better addressing the healthcare needs of their community in the process.

Mark Dwyer is LVM Systems’ chief operations officer. He has more than a quarter century of experience in the healthcare call center industry.

[From the August/September 2011 issue of AnswerStat magazine]