By Gina Tabone
Changes to the United States of America political scene are upon us and most certainly will have an impact on the provision of healthcare. Regardless of party affiliation, several healthcare reform objectives need to remain in the forefront by future government leaders. Examples include enhancing quality of care, improving interdisciplinary coordination and collaboration, and better utilization of available resources.
Focusing on these concepts will contribute to the goal of improved outcomes for both individuals and the patient populations we serve. The benefits achieved from the implementation of the triple aim must continue, regardless of who is leading the country. Nurse triage, as a component of an integrated medical call center (MCC), is a pivotal—and no longer optional—intervention.
The world of medical call centers has finally gained the recognition and credibility in the healthcare marketplace that many of us have been trying to expound for two decades. Centralized medical call centers are rapidly emerging as the backbone of health systems because they are integral in achieving better patient outcomes.
The new administration has wisely sought healthcare advice from the most innovative physician leaders in the United States. For example, Toby Cosgrove, of Cleveland Clinic, and John Noteworthy, of the Mayo Clinic, were invited to meet with President Trump to share their thoughts on the Affordable Care Act (ACA) and offer ideas to plot out the best plans for the future.
Concerns were expressed that the current model needs to focus more on patient health and wellness and less on the avalanche of paperwork. This has negatively impacted the day-to-day responsibilities of clinicians who are held accountable for reporting on hundreds of quality indicators. These points of contention are agreed upon by most caregivers. Cleveland Clinic and Mayo Clinic have improved patient access, outcomes, and satisfaction by integrating state-of-the-art integrated call centers with clinical access across their multi-state enterprises.
Hopefully, their example will resonate and continue to motivate other organizations to rapidly integrate outsourced or optimized in-house MCCs as a proven solution for reaching the three goals of the triple aim: improving the patient experience of care, improving population health, and reducing the per capita cost of healthcare.
Improving patient experience of care requires open access channels. Access means that patients can receive the most appropriate level of care needed, in a timeframe best determined by specially trained nurses guided by evidence-based tools. The patient learns to expect reliable advice that takes their current health state into account and is consistently available day or night. Gaps in care are eliminated, and delays are avoided, leading to favorable patient outcomes and higher reimbursements in a fee-for-value model. When patients’ wellbeing is enhanced, everyone gains—especially patients. MCCs can stake a claim for making this happen.
The year 2017 will have many organizations taking a close look at their operations and making tough choices about what functions are best accomplished internally and which ones can be entrusted to an outside partner. IT departments are now being outsourced by some of the largest hospital systems in the country. IBM is, by far, the vendor of choice. Patient Financial Services is another service with options for outsourcing where the benefits to an organization outweighs the cost incurred. Incentives for meeting targets are common. Last, there is a surge by strategic decision makers to explore nurse triage services being performed by an outside call center partner.
The common denominator in all three areas where outsourcing is increasing is the fact that there is a reliance on human capital and all the contingency costs that goes along with being an employer. High labor costs often consume up to 70 percent of many call centers’ operating budgets. Outside partners can assume the responsibilities with greater efficiency, better outcomes, and lower costs.
There is also the possibility that many vendors are willing to assume some of the risks associated with the successful attainment of goals. The choice to retain, outsource, or develop a hybrid of both is a multi-faceted decision that is reserved for leaders at a higher level than the call center. Organizations must evaluate which option best aligns with their mission, vision for the future, and strategic plans.
Medical call centers are branching out and taking on a variety of responsibilities that are well suited to be conducted remotely and reliant on state-of-the-art technology and a dedicated workforce. Once the technological infrastructure is created, the MCC can be enhanced to take on additional functions.
The task of appointment scheduling is the most common function of many MCCs and often happens in tandem with the strategy of centralization. Electronic Medical Records (EMR) products have customized templates embedded with providers’ schedules that are used for office visits, imaging, or procedural appointments. Outbound calling campaigns are often conducted in conjunction with scheduling for appointment reminders.
Centralizing all medication refill requests is emerging as a successful addition to many MCCs. Call center technology such as CRM allows for requests to be tracked, acted upon, and measured, ensuring that established targets are being met in a timely manner. Without measurement, there is little possibility for improvement.
Patients can expect a standard process for medication needs and defined timeframes for responses or resolution. Medication management and compliance is critical for optimal outcomes, so implementing a process that fosters it is a good idea. Patients stratified as high-risk garner the most advantages, which contribute to maximum reimbursements for medical treatments.
MCCs have taken on the significant task of not only caring for the acute needs of primary care patients, but also the chronic needs of vulnerable high-risk patients. The successful coordination and transition of care is central to every health system’s strategy for sustainability today and growth tomorrow.
Nurses are the clinicians assigned to figure out how to morph from case management to transitional care coordinators. Regular communication between patient and caregiver is vital and is often done via telephone, text, or email. Training the newly created transitional care nurses in the fundamentals of remote patient care is imperative and is based on the standards of care for telephone triage nurses. The practice of triaging acute symptoms has branched out and will serve as the starting point for nurses involved in coordinating care.
It is up to those of us established in the medical call center world to continue to proclaim the unlimited value of a MCC to the healthcare industry. In many healthcare organizations, more than 10 percent of employees spend most of their day doing their job on the telephone. The benefits of centralizing and consolidating the work they do are undeniable.
C-suite leaders must accept the fact that medical call centers are no longer considered an expense but an investment with impactful ROI.
Initially there were call centers; then access centers came along, followed by contact centers. In 2017, we are now called engagement centers. The task at hand is to capture the limited attention of decision makers and educate them on the role MCCs play in a fee-for-value system and the distinct results that are possible. The future may be uncertain, but there remains a need for products, services, and expertise that bring the call center to the forefront of patient care.
Gina Tabone, MSN, RNC-TNP, is the vice president of strategic clinical solutions at TeamHealth Medical Call Center. Prior to joining TeamHealth, she served as the administrator of Cleveland Clinic’s Nurse on Call 24/7 nurse triage program.