By Richard D. Stier
Your call center is vital to your organization’s ability to harvest fees-for-service opportunities while concurrently supporting the emerging value-driven environment. As stated in Becker Hospital Review’s Annual CEO Roundtable: “One of the major challenges…is the transition from one economic system (fee-for-service) to the assumption of risk in a population-based economic model.”
Your call center has a timely opportunity to move from a siloed support function to a central communication hub. Healthcare strategist and thought leader Scott Regan believes that the move to value-based reimbursement with accountable care organizations (ACOs) represents a unique opportunity for healthcare contact centers. Call centers must move from a hospital ancillary support function to a critical role at the center of the care continuum, performing critical linkage functions as health coaches. In the developing environment, your call center will be a vital, central communication hub – or it will become irrelevant.
Leading healthcare organizations are already tapping their call centers to activate critical solutions, whether or not they deploy an official ACO. If you haven’t yet begun, you’re already behind. Have a meaningful conversation with your CEO about your organization’s driving priorities and how your call center can intentionally support them.
Five key solutions can make your call center an essential resource as your organization pilots the transition from fee-for-service to value-based care. In the process, these solutions can make a positive impact on the bottom line.
1) Streamline Access to Care:
Place post-discharge calls to reduce readmissions. Post-discharge calls can clarify discharge and follow-up care instructions, confirm medication and dosage accuracy to reduce medication errors, answer questions, and schedule follow-up appointments. The Studer Group documents that healthcare organizations making discharge follow-up calls achieve a 20 to 30 percent reduction in preventable readmissions. One study identified initial results of piloted post-discharge outbound calls with patient prioritization, including a 46 percent reduction in readmissions for congestive heart failure patients and a 21.6 percent reduction in readmissions for pneumonia patients.
Deploy evidence-based clinical triage to the most clinically appropriate and cost-effective care. Clinical triage using clinical guideline protocols directs the truly at-risk callers to immediate emergency care and redirects the inappropriate use of high acuity clinical services to primary care or home care. These evidence-based clinical guideline protocols address ACO requirements for evidence-based medicine, patient engagement, and coordination of care.
Identify and eliminate roadblocks to care by asking patients about their care experiences. Short of experiencing your organization’s care personally, there is no better way to understand what patients experience than to ask them. It is important to know what barriers need to be removed and what action to take. Call center survey functionality must be flexible enough to activate and track results of polls, questionnaires, and assessments, and it must support inbound, outbound, telephone, and Web components of your contact center.
Shorten appointment wait times. Leading healthcare organizations have adjusted their referral policy in an effort to reduce the time a caller has to wait for an appointment to see a participating physician. The goal is to minimize the likelihood of that patient choosing to go elsewhere to be seen sooner. Tools to enable this capability include referral algorithm optionsthatcan speed access to care by referring to participating physicians using physician-selected timeframes, such as physicians agreeing to see referred patients within 48 hours, 72 hours, or 5 days or more.
Provide one-call preregistration. An important opportunity to ease access to care is to make it easier to register for urgent care visits so patients are expected when they arrive, and their paperwork is already begun. Your contact center can be the call to action for urgent care and pre-register patients.
At the time of the patient call, document patient pre-registration information in your software and schedule automatic emails or faxes of this information to urgent care in advance of the next day’s patient visits. Your urgent care team can greet the patient with a smile, saying, “Welcome Mr. Smith, we’ve been expecting you.”
Reduce call-processing time to do more in the same amount of time. Software engineered for fewer clicks and faster call processing resulted in an average timesaving of 51 secondsper call for one organization. This meant 536 hours saved in year one.
Document kept appointments. Increasing your rate of kept appointments strengthens relationships with both patients and with participating physicians. It allows you to “close the sale” at the time of the initial patient conversation by conducting a three-way call to confirm an appointment with the physician of their choice. Getting more patients into a participating physician’s practice gives you a meaningful answer to a physician’s question, “So, what have you done for me lately?”
One healthcare organization increased their kept appointment rate from 56 to 71 percent. More patients who show up for physician appointments means more patients are likely to require subsequent services. The patient wins. The physician wins. The hospital wins.
2) Serve as Physician’s Marketing Partner:
Interview participating physicians. A key question to ask your participating physicians is “What can we do to help you be more successful at our hospital?” Your contact center survey tool should make it easy to collect information and summarize opportunities.
Refer unattached ER patients to your primary care physicians. One organization used their call center to support a part-time agent in the emergency department who scheduled 105 new primary care appointments in five months. Where would those patients have otherwise gone for care?
Provide practice navigation support. Coordinate referrals to specialists, follow-up appointments, and classes. Save physician time, improve patients’ care experiences, and reduce out-of network patient migration.
Deploy physician-to-physician consult. Activate physician-to-physician consults for one call physician access to specialists. One organization’s president remarked, “The referral center is my secret weapon!”
Provide tangible support for physicians with quality and patient safety. Track and trend patient safety events, including incidents, near misses, and unsafe conditions. Survey patients to provide physicians with valuable feedback for continuous improvement. Collaborate with physicians to assign post-discharge outbound calls to reduce readmissions.
3) Reduce Redundant Costs:
Integrate first-point-of-contact services. Consider co-locating scheduling, transfers, physician referral, class registration, physician-to-physician referral, nurse triage, and switchboard services. This is an opportunity to reduce or eliminate duplicative expenses, cross train your team, and provide one primary initial point-of-contact access portal.
Integrate call center with Website. It is important and cost-effective to have an integrated dataset for phone and Web components of your contact center, reporting call and Web transactions using the same database.
Eliminate duplicative provider data. Avoid redundant and conflicting physician data by integrating provider data from multiple sources and myriad systems into a single database.
Increase productivity to reduce cost. Automate letters, faxes, and email. This reduces or eliminates staff time required for printing, collating, and mailing. It also cuts supplies and postage costs.
4) Deliver Concierge Experiences:
Improve care experiences. Beginning in 2013, the Centers for Medicare and Medicaid will reduce payment for 3,500 acute care hospitals by approximately $850 million. The potential loss for one two hospital 950 bed system is about $2 million. Hospitals can earn that money back and more if their scores exceed those of their competitors.
Raise patient satisfaction scores with distinctively positive call experiences with the call center, which are frequently the first point of contact. Outline themes for consistent agent openings and closes, provide agent supportive messages of the day, and flag caller specific opportunities with silent selling points.
Document the value of repeat utilization. Record and report the financial benefit of repeat utilization following call center interactions. One organization documented a substantial total contribution margin for one year from new, dormant, returning, and existing patients.
5) Document the Call Center as an Investment. Validate the call center as an investment solution rather than as an expense problem:
Document non-compensated community benefit provided by the call center. According to an August 16, 2011, article in the Chicago Tribune online, the Illinois Department of Revenue has denied property tax exemptions to three hospitals and is reviewing applications from 15 others. The call center can document non-compensated community benefit, which is a tangible way to help maintain tax-exempt status.
Document increased utilization of priority clinical services. One healthcare organization’s example for a six-month period includes:
- Heart: 4 inpatient admissions, 157 outpatient visits, 13 physician visits
- Joint: 222 inpatient admissions, 625 outpatient visits, 43 physician visits
- Cancer: 3 inpatient admissions, 81 outpatient visits, 14 physician visits
- Bariatric: 465 inquiries, 18 surgeries, 16 physician visits
- Spirit of Women: 284 inquiries, 174 new members
Document results in an executive report card using new metrics. Recognizing a “dual” environment with both a fee-for-service focus and concurrently an emerging value-based system of care, compile a list of metrics which are no longer applicable or which can be phased out as new metrics are adopted.
Summary: Your call center should be a vital, central communication hub that measurably supports your organization’s driving priorities. The industry shift from fee-for-service to value-driven payment is underway. Whether or not you deploy an official ACO, these five solutions can enable your call center to be a vital resource for your organization as it navigates that transition.
Richard D. Stier, M.B.A., is vice-president of marketing at HealthLine Systems, Inc.
[From the April/May 2012 issue of AnswerStat magazine]