Three Areas to Explore When Outsourcing Clinical Call Services

By Karen Brown

The Affordable Care Act’s focus on 24/7 patient access to care has created a need for established non-clinical call centers to consider adding these services. The cost and expertise required to develop a clinical call center make it worthwhile to look at an outsourced partnership.

Without intimate knowledge of these services, the discovery to find a partner that meets the organization’s needs can be a daunting task. However, exploration of three main areas can give a non-clinical call center much of the information required to determine the right partner.

Quality and Experience: Look for a clinical call center that has been URAC-certified for a number of years, preferably without recommendations for improvement. There should be at least one medical director who is board-certified in the appropriate clinical specialty and active in all clinical aspects. If pediatric triage is offered, a board-certified pediatric medical director should be in a program leadership role. There should also be a physician or master RN leading the clinical quality program. The medical director should be available to discuss his or her involvement with the program and be prepared to share actual service level and quality benchmarks, including complaint data and the complaint process.

A clinical call center should have a dedicated trainer, specific training programs, and a separate training area. A reputable outsourced call center with multiple clients and high clinical standards does not do “on-the-job” training. A quality clinical call center also uses preceptor ship and test for competency before employees are deemed competent to be on their own. Inquire about the ongoing training program and any specialized competency programs that are in place.

High-quality industry standard clinical decision tools and clinical information should be embedded in the clinical call center system. Ask to see samples of the guidelines used and information about the authors of these guidelines. Find out how the call center interfaces with providers on call.

Quality and experience go hand in hand. The number of years in business and the annual call volume in the specific service line you plan to outsource are just two of the markers you will need to compare vendors. Also look closely at the tenure of the call center’s current clients.

Seamless Delivery: Your objectives and service delivery benchmarks should be mirrored in the service delivery of the outsourced provider. You want a clinical partner that can seamlessly provide the services you are offering. If you provide physician referral and class scheduling along with nurse triage, the clinical nurse triage component should be able to seamlessly transfer the caller to the non-clinical component. An outsourced clinical call center should understand and train their staff about the client’s culture so the caller feels the same quality of customer service from both organizations – yours and the outsourced provider.

The ability to customize processes and directives at different points of the call encounter is crucial to a seamless delivery. Ask for a software demonstration and review your customizable options.

Account Management: An account manager is your champion in the service partnership. The clinical call center should provide a dedicated and experienced individual to oversee all aspects of your outsourced relationship. This individual should be involved from the beginning with the implementation phase and should work with the clinical project manager to ensure that service requests, customizations, and reports are postured to meet your objectives. You should expect a schedule of ongoing regular communication and availability from your account manager.

Due diligence in these three service delivery areas will have you well on your way to choosing the right partnership for your organizations.

Karen Brown, RN, is the vice president of business development for TeamHealth Medical Call Center, a provider of telephone nurse triage services. She has twenty-five years of senior management experience in healthcare.

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