As you read the examples below, do any of these challenges sound familiar? Can you identify with the problem of high re-admission rates that risk fines from the Center for Medicare and Medicaid Services (CMS)? How about multiple points of access that confuse the newly insured? Have you experienced the awkwardness of trying to respond to a provider’s inquiry about key physician issues that have become lost in the system?
Yikes. It’s enough to give you a headache.
Today’s complex healthcare environment requires proven solutions. EchoAccess contact center software has earned client-validated results for over nearly three decades, delivering pain-reducing remedies. Take an EchoAccess, and call me in the morning. Here are three EchoAccess prescriptions that deliver the tools and technology for these specific headaches.
Headache #1: High re-admission rates risk fines from the CMS.
Prescription: Reduce avoidable re-admissions with these EchoAccess pain-relieving tools:
- Discharge follow-up call queuing, scheduling, and documentation system to automate and track the follow-up appointment process
- Comprehensive data capture, coding, and reporting
Imagine you are in a management meeting. Your CEO shares that your health system’s re-admission rate for the previous year is a whopping 25 percent. Worse, the CMS just issued your organization a fine of $2.5 million.
This occurred at St. John Providence Health System, a leading healthcare provider in southeast Michigan and a component of Ascension Health, the largest Catholic health system in the United States. As you can imagine, reducing preventable re-admissions became an immediate priority. (This example is shared with permission.)
The leader of the EchoAccess contact center suggested that the call center pilot a re-admission reduction program. EchoAccess functionality was a critical success factor, enabling six essential process steps:
- Capture critical data. EchoAccess enables both patient and physician records to be kept current, with all data in one database as a single source of truth. Key data elements for re-admission reduction include:
- When a follow-up appointment was made for a patient
- With which physician the appointment was scheduled
- Whether or not the patient kept the appointment
- Produce quality reports. Information regarding referrals provided, appointments made, and appointments kept is generated from EchoAccess and sent to the health system quality team each month.
- Attach the reason code. A special reason code in EchoAccess captures that this appointment is part of the re-admission reduction program.
- Email patient appointment time directly from EchoAccess.
- Email re-admission team the appointment time directly from EchoAccess.
- Generate monthly practice referral summary letters. A monthly referral letter is generated in EchoAccess that states patients’ names, addresses, and phone numbers along with their follow-up appointment dates and times; these letters are mailed or emailed to participating physicians.
What was the result?
- The re-admission rate decreased from 25 to 15 percent.
- The $2.5 million fine from the CMS was reduced by $1.9 million over two years.
- The kept appointment rate for post-discharge physician visits climbed to 83 percent.
- The percentage of primary care physicians whose patients scheduled follow-up appointments within seven days of discharge increased from 30 to 80 percent.
Headache #2: Multiple points of access that confuse the newly insured.
Prescription: Integrate first point of access functions with these EchoAccess pain-relieving tools:
- One single source of truth for provider data instead of multiple, redundant systems
- Integrated database for both phone and Web
- Evidence-based clinical content from Cleveland Clinic
- HL7-interface enables the triage nurse notes to populate electronic health records.
- Comprehensive reporting system
One solution to multiple points of access is to integrate the first point of contact services. For example, AtlantiCare consolidated scheduling, transfers, physician referral, class registration, physician-to-physician referral, nurse triage, and switchboard. A critical requirement of this solution is cross-training access center staff to deliver all communication and navigation services. (This example is shared with permission.)
AtlantiCare provides members and their dependents with navigation to the right level of care at the right time for the right cost. Triage nurses and navigators do this by offering three types of assistance to the center’s 140,000 callers every year:
1) Symptom-based triage
2) Health advice
3) Assistance with accessing programs and services
EchoAccess enables the AtlantiCare access center to:
- Schedule primary care appointments prior to discharge
- Place post-discharge calls to reduce re-admissions
- Identify medication-compliance problems and needs for durable medical equipment
- Provide evidence-based clinical triage with protocols from Cleveland Clinic
- Reduce call processing time
- Document kept appointments
- Bridge gaps and manage transitions of care from hospital to medical home
As featured in the May/June 2013 issue of Spectrum magazine, the AtlantiCare access center documents over $9.00 of reimbursed (not gross) downstream revenue for every $1.00 of cost. The 2014 updated ROI is $10.32 returned for each dollar invested.
[From the Dec 2014/Jan 2015 issue of AnswerStat magazine]