The Contact Center’s Role in Reducing Readmission

Traci Haynes MSN, RN, BA, CEN

Reducing hospital readmissions has been a focus of the healthcare environment for many years. Steven Jencks MD, dubbed by many as the father of readmission research, along with Mark Williams MD and Eric Coleman MD, analyzed medical claims data from 2003-2004 to describe the patterns of rehospitalization and its relationship to demographic characteristics of hospitals.

They learned that almost one-fifth (19.6 percent) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within thirty days. They also found that 34 percent were hospitalized within ninety days; and that 67.1 percent of patients who had been discharged with medical conditions and 51.5 percent of those discharged after a surgical procedure were rehospitalized or died within the first year after discharge. Furthermore, of the 50.2 percent of patients rehospitalized within thirty days post medical discharge to the community, there was no bill for a visit to a physician’s office between the time of discharge and rehospitalization.

Additionally, the average length of stay (LOS) of rehospitalized patients was 0.6 days longer than that of patients in the same diagnosis related group (DRG) whose most recent hospitalization had been at least six months prior. The cost to Medicare for rehospitalizations in 2004 was 17.4 billion dollars (Jencks, S.F., Williams, M.V. & Coleman, E.A., 2011).

In 2007, the Medicare Payment Advisory Commission (MedPAC) reported to congress that 13 percent of patients rehospitalized within thirty days of discharge in 2005 were for reasons potentially preventable. These readmissions accounted for $12 billion in Medicare spending.

As a result, the Patient Protection and Affordable Care Act (PPACA) of 2010 mandated that the Centers for Medicare and Medicaid Services (CMS) implement a program in which hospitals with higher-than-expected readmission rates for certain designated conditions experience reductions (that is, penalties) in their Medicare payments.

Beginning in October 2012, the hospital readmission reduction program (HRRP) began adjusting hospital payments based on excess readmissions within thirty days of Medicare patients following myocardial infarction (MI), heart failure (HF), and pneumonia hospitalizations. The maximum penalty at that time was 1 percent of a hospital’s base Medicare reimbursement rate per discharged patient. 

Beginning October 2013, the penalty increased to 2 percent and then to 3 percent the following year (2014). The first year, more than 2,200 hospitals were penalized for failing to meet standards, with 8 percent incurring the maximum penalty. In addition to the MI, HF and pneumonia penalties, readmission penalties now include elective knee and hip replacements and chronic obstructive pulmonary disease (COPD).

The healthcare reform mandate required addressing a long-time quality issue. According to Bisognano and Boutwell, the primary reasons for readmission were no physician follow-up visit, medication discrepancies, and communication failure during transitions of care (Bisognano, M. & Boutwell, A., 2009). Eric Coleman MD and others identified poor information transfer, poor patient and caregiver preparation and limited empowerment to assert preferences as the primary reasons for readmission.

Contributing factors include nurses not having time to thoroughly address the needs of both the patients and caregivers upon discharge, the hospital setting not being conducive to education that will drive behavior change before discharge, and the care continuum breakdown between hospital discharge and the handoff to primary care (Coleman, E.A., Parry, C., Chalmers, S., & Sung-joon, M., 2006). [Tweet

The uneven impact of the penalties has been a significant concern for hospitals that care for a larger number of low-income patients. They claim it is more difficult for their patients to adhere to post-hospital instructions including payment for medications, dietary modifications, and transportation to follow-up appointments.

To address these challenges, some hospitals have implemented measures including discharging patients with medications, home visits, and follow-up calls. Other interventions include hiring specialty care coordinators and transition coaches to provide follow-up care for patients with multiple comorbidities, providing patients with extensive teach-back for multiple days prior to discharge so they’ll better know what to do once they are discharged. In addition, many include comprehensive medication reviews with a clinical pharmacist.

The contact center can be an integral team player in reducing avoidable readmissions by enhancing the quality of care in the hospital-to-home transition through the combined capabilities of technology and human interaction. While discharge planning should begin upon admission to the hospital and include arranging for durable medical equipment (DME), transfer to step-down as appropriate, home health care, transportation needs, communications with primary care providers (PCPs), and discussions with caregivers, the extended care team which includes the PCP, caregivers, pharmacist, and other members of the interdisciplinary team can be greatly improved by the services of the contact center in helping to comprehensively coordinate the patient’s care.

The patient and their caregivers will also benefit from the reinforcement of information provided, teach-back, appointment reminders, and coordination of services including transportation, as well as medication reconciliation and symptom assessment resulting in earlier interventions and improved outcomes. Extending the contacts beyond the 30-day penalty period will bring even greater benefits to patients/caregivers and may prolong readmissions indefinitely.

What readmission reduction activities are occurring within your organization? What is your contact center’s role in reducing readmissions? What level of service do you or can you offer?

Some contact centers make one post-discharge call to review the patient’s diagnosis, instructions, medications, and education materials and to ensure the patient has scheduled their follow-up appointment with positive results. Others make several outbound calls to the discharged patient including a call within the first 24 to 48 hours post-discharge.

In addition, the call center staff or care coordinator may reach out to the patient again after their first appointment, which ideally occurs within seven days post-discharge. This call typically reviews the follow-up appointment instructions, any changes in medications, assist in referrals and scheduling with additional providers or resources, and communicate to the interdisciplinary team as appropriate. During this contact, biometric monitoring may also be tracked through technology or as self-reported by patients or their caregivers.

Whatever level of service provided, it’s a win for the patients, their caregivers, and the organization. Utilizing the contact center to identify and implement communication strategies that effectively engage the patient and their caregivers adds value to the organization and the opportunity of better outcomes for their patients.

Traci Haynes, MSN, RN, BA, CEN is the director of clinical services at LVM Systems, Inc.

References:

Is Your Contact Center Effective?


TriageLogic


Meeting the two essential elements of a contact is just the first step

By Peter L DeHaan, PhD

Peter DeHaan, Publisher and Editor of AnswerStatIt doesn’t matter if a call is answered in a modern contact center staffed with a team of trained professionals or by one weary person in a single-phone department. In both cases patients and callers evaluate their phone interactions in the same way, and they expect the same outcomes. Regardless of the circumstances, they compare each call with every other call and judge it accordingly. It matters not who took the call or the technology behind it.

Contact Essentials: At a basic level, patients look for two things when they contact you.

First, they want to accomplish their objective, the reason for their call. This may be to schedule an appointment, follow up on test results, or clarify discharge instructions. Or they might be calling because of a medical concern, hoping to talk to a triage nurse or find out if they should head to the ER. In short, they have a need, call you, and expect to accomplish their objective.

Second, though they may not realize it, they subconsciously want a positive feeling about the call. Do they perceive their need was met? Are they satisfied with the outcome? Do they sense they were treated with respect?

Together these two characteristics combine to result in effectiveness. An effective call is a phone interaction where the patient’s purpose is accomplished, and they hang up pleased with the interaction. However, too often contact centers meet callers’ objectives but leave them frustrated in the process.

Effective Call: Being effective means the caller’s reason for calling is addressed, and the customer is pleased. A rating of effective sets the minimum expectations for a contact center. This establishes the center’s service baseline.

Ineffective Call: Calls that aren’t effective are failures. This means the callers’ objectives weren’t accomplished, or they weren’t satisfied with the results. Too many organizations run contact centers that are not effective. Wrong information is given; errors are not corrected; callbacks don’t happen; and repeated calls occur, with no movement toward resolution.

Beyond Effective: However, other contact centers offer the other extreme. They start with effective and then offer more. Their staff is professional, accurate, and consistent. They excel at being empathetic with callers, and they aim for first call resolution.

Whether you have one phone or hundreds of agents, first ensure you are effective in handling calls. Then strive to become more than effective. Become everything your callers hope for when they contact you. Then everyone wins.

Peter L. DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat and a passionate wordsmith. Connect with him on his blog, social media, and newsletter, all at www.authorpeterdehaan.com.

Vendor Spotlight on 1Call, a Division of Amtelco: Over Forty Years of Innovation



Since 1976, Amtelco has provided innovative communication solutions to call centers around the world. In 1997, the 1Call Division was formed to offer enterprise-wide communication solutions designed specifically for healthcare organizations. 1Call is dedicated to serving the unique call center and communication needs of healthcare organizations, helping improve communications between patients, physicians, and staff by connecting people and information. Amtelco has been awarded twenty-eight patents, covering a wide range of communication processes.

Hospitals and healthcare organizations around the world turn to 1Call to solve their medical call center, answering service, on-call scheduling, call handling, secure messaging, voice processing, conference calling, and automated middleware notification needs. In an independent survey (by a Amtelco Satisfaction Research Study conducted by TMA+Peritus, February 2015) 100 percent of the respondents said they would highly recommend Amtelco and 1Call to another healthcare organization.

Five-Star Service and Support: Amtelco and 1Call are well known for continually developing comprehensive call center and communication solutions, all backed by superior five-star, after-the-sale service and support. Customer advocates and account managers are available to help customers and answer questions before, during, and after the sale.

1Call has a reputation for complete, professional system support, offering training, installation, and technical support staff on call on a twenty-four-hour basis. When customers need assistance for their call center solutions, 1Call’s customer support staff provides fast and reliable service.

1Call’s customer support staff includes trainers, installers, project managers, and technical support personnel. The customer support staff has an average tenure of over fifteen years, which is virtually unheard of in technology and IT businesses. All support staff members are in the United States. While most staff members work from the Midwest home office, there are several regional offices around the United States.

Help When Needed: When help is needed, it’s just a phone call away. 1Call customers can also email the support team or even access the online TechHelper tool for documentation, manuals, videos, and other training tools. TechHelper is available twenty-four hours a day, with unlimited access, and features a Google search engine. Emergency assistance for 1Call systems is available twenty-four hours a day, 365 days a year.

Software upgrades are included with support agreements, helping ensure 1Call customers always have access to the newest features.

In the Amtelco Satisfaction Research Study conducted by TMA+Peritus, 97 percent of the respondents said the Amtelco and 1Call service and support was excellent. 1Call looks forward to partnering with more healthcare organizations to provide this same level of service.

Solutions That Work: 1Call features a complete line of modular solutions specifically designed to streamline enterprise-wide communications, eliminate errors, and reduce training time for new operators. All the specialized 1Call solutions protect an organization’s limited resources, making each organization tremendously efficient and helping bring wellness to their members and their bottom line.

Each 1Call solution comes with the benefit of Amtelco’s years of experience in the field of call handling and messaging. Thousands of 1Call and Amtelco systems are in operation around the world, twenty-four hours each day.

Easily Customizable: 1Call understands every healthcare organization has unique needs and sometimes receives unusual requests from physicians and departments. That’s why 1Call offers powerful solutions that are easy to customize, by the customer. Customers have access to a wide variety of administrative functions, including the ability to customize scripts for any department, with individual scripts for every physician, if needed.

When additional help is required, 1Call has a Script Pro team available to assist customers with any specific requests.

Why Choose 1Call? Hospitals continually recommend 1Call solutions, so more healthcare organizations continue to switch to 1Call. And it’s no wonder, with all the customizable hospital call center solutions available, the high levels of customer satisfaction, and quality support services.

What do customers have to say about switching to 1Call? Here’s one example: “It was a great decision switching to Infinity. The 1Call technology is innovative. It’s easy to learn, and it really seems to mold around what the particular needs of our hospital are. Everything runs so much more smoothly now. I think it’s also worth noting, the customer service—great. We couldn’t be happier.”

Strong Partner Relationships: 1Call forms solid partnerships with their customers. Each organization is encouraged to work closely with the 1Call team of consultants and engineers through each phase of system planning, configuration, and implementation. This helps ensure the 1Call systems are at their optimum performance levels to meet the communication needs of their organizations.

1Call also works closely with key technology partners to provide organizations with the solutions that best fit their communication and technology requirements. 1Call’s partners integrate at a high level with the call center, on-call scheduling, HIPAA secure messaging, alarms management, and emergency notification solutions to produce a comprehensive solution that satisfies the needs of each organization.

The 1Call technology partnerships include:

  • Apple iOS Developer Program
  • Avaya DevConnect Community
  • Black Box
  • Cisco Solution Partner Program
  • Cisco Developers Network
  • Copia OEM Partner
  • GENBAND Partner Program
  • Google Play Developer
  • Health Level 7 International (HL7)
  • HISCALL
  • Interactive Intelligence Global Alliance
  • Microsoft Developers Network
  • Mitel Solutions Alliance
  • NEC UNIVERGE Solutions Partner Program
  • SAP OEM Partnership Program
  • ShoreTel Innovation Network Alliance Partner
  • Spectralink Application Integration and Management Solvers Program
  • Unify (formerly Siemens) Technology Partners—Advanced Level Status
  • Vocera Solution Partner Program
  • Windows Development Center Member

One Company, One Solution: The development and customer support teams are in the Innovation Way hallway at the Amtelco and 1Call home office. These teams work together closely, and when a question arises, it’s a quick walk down the hallway to find the solution. One company, one solution: proudly located in the USA.

Recent Innovations: As customers have come to expect, Amtelco and 1Call continue creating innovative solutions. In addition to frequent enhancements to Intelligent Series, soft agent, and miSecureMessages, the newest innovations are MergeComm and Genesis.

The MergeComm Middleware Solution is designed to automate communications throughout an organization, speeding response times to help organizations provide better patient care. MergeComm takes an incoming message and uses a script to determine who needs to receive that information.

MergeComm can receive a message from a wide variety of sources, including alarms, alerts, HL7 messages, nurse call, severe weather alerts, TCP, WCTP, and web services. Notifications can be sent to an individual, an entire group, or the current on-call personnel. The notifications can be sent by email, miSecureMessages, IP phones, pagers, phones, smart devices, SMS, and Vocera badges.

The Genesis Software Switching Solution provides the Intelligent Series applications with advanced software-based telephony. Genesis builds on the features that made Infinity a leader in the industry. Genesis provides an all-inclusive call center solution with ACD, call management, reporting, and call center applications based on the Intelligent Series. A few of the many benefits of Genesis include reducing the need for hardware, virtualization of the switching platform, integrating with your SIP-enabled PBX, connecting remote agents, and automated overhead paging.

The Future: As technology continues to evolve and as customers have new communication challenges, 1Call and Amtelco will continue to develop new innovative solutions, as they have for over forty years.

1Call, a division of AmtelcoLearn more at www.1call.com.

Use a Customized Follow-Up Plan to Reduce Hospital Readmissions


TriageLogic


By Dr. Ravi Raheja

When patients get discharged after a hospital visit, it can be difficult for them to follow or remember discharge instructions. This can lead to higher readmission rates, longer recovery times, and overall lower quality of patient satisfaction.

Did you know?

  • Up to 20 percent of patients are readmitted within thirty days.
  • There is the potential to save 12 billion dollars on readmissions.
  • Hospitals could lose as much as 528 million dollars from Medicare cuts.

Why Hospital Readmissions Occur: A common cause for readmissions is poor follow-up by patients after the procedure. The stress and difficulty faced by patients during their hospital stay makes it common for them to forget or misunderstand the instructions given by providers during the patients’ hospital discharge. Often, patients go home confused about their medication orders, fail to follow the treatment plan, or neglect to follow up with a doctor visit in a reasonable time.

Family members may be able to help patients follow discharge instructions, but they are often distracted because of the hospitalization or not able to help with the patient discharge plan once they go home.

Offer patients customized continued care after patient discharge to:

  • Decrease ER readmission rates.
  • Ensure continuity of care.
  • Increase patient satisfaction.
  • Help patients avoid unnecessary ER visits.
  • Increase patient compliance with instructions.

Nurses trained specifically for post-op care can help a hospital reduce readmissions by creating a customized follow-up plan to keep patients on the correct path to recovery. A hospital staff member will fax the post discharge nurse the instructions from the hospital EMR for patients who have been discharged and are at risk for readmission. The nurses will make follow-up calls to confirm compliance with medications and screen for necessary follow up visits. If needed, nurses can also be available 24/7 for patients to call if a symptom arises. These calls can be customized to what doctors think will work best and can be adjusted at any time. 

The ideal program allows each specialty in the hospital to have its own custom profile, so that each specialty can include custom instructions for the nurses to follow related to the care for specific procedures and specialties. Advanced follow-up systems can even create custom protocols to allow nurses to ask specific and related screening questions. Some examples of these screening questions include:

Medication Compliance

  • Did you get medicines?
  • Do you know how to take them?
  • Are you taking them?
  • Do you have any concerns about taking the medicine?

Follow-up

  • When do you have an appointment scheduled?
  • Are you able to keep that appointment?

Symptom Review

  • Do you know what signs or symptoms to look out for?
  • Do you know what number to call if you have a medical concern?
  • Do you have any questions you would like me to pass on to your doctor?
  • Do you have any symptoms you are concerned about right now?

Following a holistic post-discharge protocol can reduce readmission rates, shorten recovery times, and improve patient satisfaction.

TriageLogicDr. Ravi Raheja, is the medical director at TriageLogic, which uses innovative technology to offer a comprehensive and customizable post-discharge system. In addition to the customizable post discharge plan above, TriageLogic nurses also remain available for patients 24/7 should any symptoms or questions arise. If your hospital is looking to reduce patient readmission rates, contact TriageLogic to get a quote on post discharge follow-up service.

Using Telehealth Data to Improve Patient Care

By David Thompson, MD

Understanding what drives patients to seek treatment can help you educate and prepare staff, which improves the patient experience. While you may have a gut instinct as to your patient’s chief complaints, have you ever crunched the numbers? Health Navigator has. We’ve explored approximately 20,000 medical call center patient interactions to identify the top reasons patients called, how urgent their symptoms were, and peak call times.

The analysis included information for patients from all age groups and found the top complaints included: fever, vomiting, stomach pain, cough, and head pain. Patients with the most urgent needs were babies or infants three to twenty-four months old (nearly 35 percent of calls), while the least urgent calls involved children (two to twelve years).

Understanding why and when people contact nurse advice centers allows telemedicine providers to manage staff expectations and prepare for common interactions. This can be accomplished by using a diagnostic telehealth platform that codes the chief complaints. This serves as a starting point to analyze the most common interactions at a hospital or health system.

If healthcare professionals and call center staff know what to expect in the average telehealth experience, they can:

  • Prepare a standardized call flow format and follow-up questions for their system’s top complaints.
  • Calmly and consistently handle patient calls and manage expectations.
  • Plan workflow and staffing needs, based on patient prioritization and time of day.

Diagnostic platforms can also provide data healthcare professionals can use to determine the suggested treatment protocol for common complaints and to enhance staff training, such as to:

  • Teach incoming staff the most common chief complaints.
  • Document follow-up protocol and questions to ask.
  • Prepare educational information about recommended treatments.

Consider the patient who contacts a medical call center about a persistent cough. The responding staff member recognizes this as a common chief complaint and asks follow-up questions suggested by the telehealth platform. This allows staff to consistently communicate the most common treatments for a cough and to provide care instructions for the patient. The telehealth platform can also provide easy access to printable aftercare instructions to share with patients.

This more efficient workflow can ultimately create a more effective environment for staff and contribute to patient satisfaction and retention efforts. The needs of a patient population may change over time, but data about common chief complaints can help understand these cycles and market services accordingly throughout the year.

David Thompson, MD, FACEP is CEO and chief medical officer at Health Navigator. A part-time faculty attending in the Northwestern Memorial Hospital Emergency Department, Dr. Thompson also works as an author and partner with Self Care Decisions, LLC and Schmitt-Thompson Clinical Content, LLC. In a collaboration with well-known pediatrician Dr. Barton Schmitt, Dr. Thompson has developed a comprehensive set of telephone triage protocols that are used in medical call centers and doctors’ offices in the United States and internationally. He can be reached at david.thompson@healthnavigator.com.

Using Mobile Apps to Engage Patients


TriageLogic


By Ravi Raheja, MD

Telehealth and mobile applications are changing the way healthcare is delivered. A recent Pew Research study found that about 77 percent of Americans own a smartphone. Smartphone users spend about 1.8 hours every day on their devices, and 89 percent of that mobile media time is on an app.

Anyone who owns a smartphone has come to rely on mobile applications to quickly access anything from their bank accounts to social media pages, even to that game they are addicted to. As the public relies more on technology, the telehealth field has grown and adapted to meet patients’ need to stay connected and in control of their health.

Mobile apps play a huge role in bridging access from the provider to the patient. However, as with all new technology, medical mobile apps face obstacles and the challenge of regulation. In recent years, there has been an explosion of patientcentered apps to aid in health and wellness.

Healthcare Mobile Apps Help Patients With:

  • Connecting to their physician’s office
  • Researching health insurance benefits or claims
  • Looking up reviews on providers
  • Finding nearby urgent care centers and ERs
  • Managing chronic disease
  • Lifestyle management
  • Smoking cessation
  • Diagnosis
  • On-demand doctors and telehealth

The Patient Behavior: A key issue for brickandmortar providers is to ensure their patients receive continuity of care with their health. However, with so many outside options available through mobile apps, doctors have to find ways to stay in touch with their patients and ensure patients come back to them for health issues. Solutions include providing patients with a service, such as a nurse triage on call, to ask questions about their symptoms when the office is closed. In addition, doctors can have their own mobile app to engage customers and improve access to the office for prescriptions and appointments.

Provider Driven Telehealth Apps: There are many times when a provider can use mobile technology on phones or tablets to assist in patient care. Mobile apps can send notifications or events directly to patients, such as reminders for appointments and tests or even reminders to help with antibiotic compliance.

Some mobile apps, such as My24/7HealthcareTM, allow patients to send messages to practices to request appointments and prescription refills. Additionally, some telehealth apps allow providers to virtually extend their hours, by allowing patients to conveniently access the practice and their nurse triage from their mobile app. A quality mobile app for a practice allows providers to increase engagement with patients, improve patient convenience accessing the office, and extend the hours when patients can get questions about their health symptoms answered.

In another use of mobile applications, patients can use telehealth mobile apps to replace in-office visits with their providers. This is most useful for rehabilitation or post-operative care patients and those with chronic conditions, who require regular follow-up care or monitoring. Many of these patients have transportation issues due to their health conditions. With the use of mobile applications, patients are able to chat or send images of their progress or setbacks, saving patients the time and money it would take to go to the physical office.

Finally, mobile health applications have proven especially beneficial to rural areas with limited access to physical medical facilities. Rural locations tend to have a shortage of specialists. Primary care providers can use mobile technology to access specialists from large institutions to virtually assist in the care of their patients. The primary care doctors themselves can save their patients time and effort to drive to their offices by conducting telehealth visits using the mobile application.

Regulation: As with any communication tool with patients, an important consideration is that all communication between patients and providers has to be HIPAA compliant. For example, text messages must be secure and coded to ensure that only the patient and the provider are able to access the information. In addition, when sharing a family account on a telehealth mobile app one must have a way for the patient to determine what is visible and to whom.

Though many states have passed telehealth coverage laws, there are still many issues with service reimbursement. Currently, there is some controversy over telehealth parity laws, which would require reimbursement by health plans for telehealth services at the same or equal rate as those services performed in person.

Since telehealth mobile apps are a relatively new tool, the medical community is still developing ways to regulate this industry in order to evaluate and prevent potential dangers. The US Food and Drug Administration (FDA) has weighed in on which apps require regulatory oversight and which do not.

Conclusion: Physicians need to acknowledge and embrace telehealth mobile apps or suffer losing patients to those who are able to integrate the needs of the patient. In this on-demand society, it is important for practices to adapt from the traditional model of healthcare.

Telehealth mobile apps have made it easier for the patient to take an active role in their healthcare, while making access to physicians and medical providers more convenient. While mobile technology has changed the way telehealth is practiced, there is still a lot of data that needs to be examined and adjustments made to the different models to figure out the best approach for the future of healthcare.

TriageLogicDr. Ravi Raheja is the medical director of TriageLogic, a URAC accredited, provider of quality triage solutions, serving over 9,000 physicians nationwide. TriageLogic provides software, mobile applications, and nurse triage services. Recently, TriageLogic expanded its offering to provide employee telehealth solutions through Continuwell. For more information contact Amy Smith at 888-TEAMTLC or visit www.triagelogic.com.

Healthcare Uncertainty and Optimism


LVM Systems

Whatever the future throws at us, the healthcare contact center industry will respond with excellence

By Peter L DeHaan, PhD

Peter DeHaan, Publisher and Editor of AnswerStatThe healthcare industry in the United States exists in uncertain times. What does the future hold?

  • Will the status quo prevail, along with its current problems, trending issues, and looming concerns?
  • Will we experience a mere tweak in our present situation? And if so, will the adjustments make healthcare provision easier or harder?
  • Will we witness a 180-degree turn? And if so, will we have a white-knuckle, breath-taking adventure or a controlled U-turn?

I don’t pretend to know the answer, but what I do know is that healthcare contact centers are the solution.

  • If it’s the status quo, we’re ready to elevate our game.
  • If it’s tweaking the current path, we’re ready and will adjust.
  • If it’s a great reversal, we’re poised to embrace what happens.

In any of these scenarios, I’m optimistic that healthcare contact centers are in a prime position to be part of the healthcare industry’s solution. As a group, we’ll improve the overall level of patient care, expand affordable solutions to more people, and be a key resource to all stakeholders.

Whether healthcare contacts occur via the phone, text messaging, webchat, email, mobile app, or video, healthcare contact centers have the experience, the staff, and the infrastructure to take innovation to a higher level. In addition we have the vision needed to capitalize on whatever may come.

How do I know this? It’s easy.

Just read the articles in this issue of AnswerStat. They make me giddy. And beyond this, our editorial advisory board has laid out a great vision for the rest of the year and into 2018. Already I’m hearing ideas from our insightful industry writers and I’ve already seen a couple articles for our next issue.

I can hardly wait.

Though we, in the healthcare industry, live in uncertain times, I’m full of optimism for our future and the future of healthcare.

Peter L. DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat and a passionate wordsmith. Connect with him on his blogs, social media, and newsletter, all accessible at www.authorpeterdehaan.com.

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Mobile Apps and Telehealth: Another Channel for Reaching Your Audience


LVM Systems

By Sue Altman-Riffel

Healthcare contact centers have acted as the communication and wayfinding hub between their sponsoring organizations and the audiences they serve. In the 1980s, when I started my first hospital call center, there was really just one channel for quick communication: the telephone. It was a landline.

We didn’t give much thought to our audiences’ preferred communication methods back then. The only option of note was whether someone wished to be contacted on his or her home phone or work phone. Later came car phones and cellular phones, more possible options to be considered when collecting callers’ phone numbers.

The typical contact center users: patients, parents, plan members, and prospective community members have not changed much through the years, but their communication options have expanded.

Internet availability brought about health organization websites. The primary advantages of the website are 24/7 availability and no waiting on hold, allowing its audience to quickly find information, download forms, browse physicians and facilities. and register for programs and services, whether a call center was available or not. Contact centers (note the change from call center to contact center) continue to add support to a variety of website functions behind the scenes, but a growing list of transactions can be concluded without human support.

Websites continue to be an extremely important digital platform for healthcare today. Studies show that the user’s viewing device (for websites) can change throughout the day: a smartphone in the morning and while the user is commuting or at lunch, desktop use picks up during the workday and tablet use increases in the evening. But for the last ten years, the communication medium that has outpaced all others is the smartphone.

We Love Our Smartphones: Since the smartphone was launched, we humans have fallen in love with its convenience and offerings. We each have our favorite apps. They entertain, keep us connected, act as a platform for sharing our views, provide us with answers, and support telephone and video communication.

In the US, the average adult spends eighty-seven hours per month on their mobile devices, mainly smartphones. We keep them nearby, often in a pocket or purse. Studies show that 75 percent of smartphone users take their phones to bed with them. (I want to smirk at this, but I remember using my white noise app to fall asleep last time I traveled.) Clearly, we’ve incorporated smartphones into nearly all aspects of our lives, including managing our (and our family members’) health.

Each year, more functionality is integrated into smartphones (effectively hand-held mini-computers). The list of functions will look familiar. At present, hospital apps support many do-it-yourself (DIY) services, such as:

  • Locate facilities, with mapping and directions
  • Find physicians: search based upon specialty, insurance, location, language
  • Check symptom acuity, with self-care advice and connection to care locations
  • Connect to a triage nurse or telemedicine provider
  • Browse health information libraries
  • Look-up dosages; track medications
  • Login to patient portals
  • Engage in social media
  • Pay bills
  • Sign up for a class or event
  • Get reminders, encouragement, and education via push notifications

One of the many advantages offered by mobile is one-tap connections to the next services needed. A symptom check is one tap away from calling one’s doctor, finding an open urgent care (with map), scheduling (online or agentassisted), or connecting to a triage nurse or telemedicine provider.

Have Mobile Apps Replaced Talking to a Real Person? No. Although mobile is becoming the organization’s digital front door, it is not the sole communication vehicle. The choice between mobile versus livevoice is influenced by your audience, the service required, and its complexity.

Audience and Age: First, audience adoption of apps differs by age group. Pew Research regularly studies the adoption of technology by population. In 2015, they found that 77 percent of the eighteen to twenty-nine age group has used their smartphone to seek information about a health condition, compared to slightly fewer (68 percent) of 30-49 year olds.

They also explored the shrinking segment of non-users (13 percent for websites; 20+ percent for smartphones). The shared characteristics are highlighted as age 65+, income below the poverty level, low education (high school or less), and rural. If this describes a portion of your audience, then telephone services will continue to be the main medium for supporting them.

General Movement Away From the Telephone: Recent Forrester research “Your Customers Don’t Want To Call You For Support” tells us adults in the US prefer using web or mobile self-service more than speaking with an agent over the phone. This use increased from 67 percent in 2012 to 81 percent in 2015 among US online adults.

Although calling customer service has steadily decreased over the past six years, it is still used for escalation. Customers prefer to resolve straightforward interactions using selfservice (web and mobile), but still reserve complex issues for a telephone call.

For 10 plus years, contact centers have seen the volume of inbound calls decline—especially in the age group of 18-35 years. Creating a mobile app to engage this audience is a way of keeping their loyalty by respecting their self-service preference. They will connect by telephone when their health needs escalate or exceed self-service.

Applying this to healthcare contact centers, communication preferences are situational. One example is symptom checking (described as self-triage). Young parents may use an app or website to check their child’s symptoms. It will help them understand what action is appropriate: ER, office visit ,or manage at home for now, and offer step-by-step advice for managing symptoms.

But what if the parent has additional questions? A great solution is offering the symptom-checker user an option (within the app) to connect to a triage nurse or request a call back. In many instances, self-service may satisfy users’ needs. But self-service can escalate to a nurse if the situation turns out to be more complex.

Scheduling: Not all desired services can be completed quickly via mobile. Appointment requests are still largely facilitated through voicetovoice communication. In many cases,

  1. the office (or hospital department) needs more information about the patient than can easily be completed using a web or mobile form, or
  2. the back and forth of choosing an appointment time that suits both schedules can be done faster via telephone.

There are exceptions. Many health systems are piloting self-scheduling for certain types of appointments through their patient portal or through apps such as ZocDoc. It appeals to the self-service enthusiasts and rates highly for fulfillment of instant-gettification.

Mobile apps can be a conduit for connecting the user to your organization for appointments. Placing a “request appointment” button (within the symptom checker or the physician finder) in logical areas can funnel new patients to your scheduling center.

Mobile is Another Channel: At its simplest, mobile represents another change. Since the first healthcare call centers, there have been cycles of invention and change:

  • pilot a service based upon a health system objective or unmet audience need
  • fine-tune the process to reduce variation
  • make it more efficient using software or automation
  • reinvest any time saved into growth or starting another service

Communication and wayfinding services will continue to be multi-channel: telephone, video, website, patient portal, and mobile applications. As the mobile experience is demanded by a growing audience, more services will be supported by it. It will interface with additional software and applications, putting more self-service at your audience’s fingertips.

Mobile may connect your organization with a new set of customers: the 18-29 age group who only use their smartphone to place a call as a last resort.

There is an opportunity to leverage mobile to off-load low challenge or low acuity calls. This creates the chance to take on additional business, improve service levels, or shift staff to support new opportunities. Mobile is just another cycle of (re)invention and change.

Sue Altman-Riffel worked as a manager and consultant in the telehealth industry for 28 years. She currently serves as the CEO for two digital companies: Self Care Decisions and AppCatalyst, which support more than 200 healthcare organizations with self-triage and mobile application design and development.

Vendor Spotlight: TriageLogic Expands Telehealth’s Reach to Help Your Employees


TriageLogic


TriageLogic® believes no one should delay care because physicians are unavailable or the ER is too expensive. That is why earlier this year, TriageLogic launched a new product, Continuwell®, to provide telehealth services to a wider market. With Continuwell, TriageLogic tackled the big question that many organizations face: How do they keep healthcare costs down and employees healthy?

This new telehealth product was created to help businesses and organizations decrease employee healthcare expenses and reduce employee absenteeism by providing free, 24/7 access to a qualified, objective registered nurse. It also allows companies to engage employees by placing all services in one platform and send push notifications and messages.

A recent Pew Research study found that 77 percent of Americans own a smartphone. TriageLogic realizes the connection people have with their phones and their desire to be better connected with more aspects of their life.

The American Hospital Association found that:

  • 74 percent of U.S. consumers would use telehealth services.
  • 76 percent of patients prioritize access to care over the need for human interactions with their healthcare providers.
  • 70 percent of patients are comfortable communicating with their healthcare providers via text, email, or video, in lieu of seeing them in person.
  • 30 percent of patients already use computers or mobile devices to check for medical or diagnostic information.

Continuwell is a telephone healthcare service with a network of experienced registered nurses. Continuwell provides nurses on demand to evaluate employees and their family members to determine the appropriate care for their symptoms. Continuwell differentiates itself with its nurse-first model, where nurses use doctorwritten protocols to evaluate callers and determine the care to resolve their symptoms.

Continuwell nurses provide the necessary care without the need of a doctor in three out of four cases, saving the cost of a telehealth doctor visit and making the system affordable for employers and employees.

The Service

Step 1: A member enters their symptoms using a mobile application (app) or website portal.

Step 2: A registered nurse calls back within minutes.

Step 3: The nurse evaluates their symptoms and helps them with the next steps.

The team at TriageLogic has spent years developing a mobile app that would be user friendly, to increase utilization, as well as customizable, to allow employers or brokers to modify content to fit their specific needs. They recognized the challenge of getting employees to download, register, and then remember the benefits available to them through their employer.

The Continuwell platform allows organizations to select the services they want to include and creates a custom mobile app for their employees, where they get access to all of their services in one place. The app even has single sign-on capability to make it even more convenient. The platform is flexible enough that services can be added or removed on demand.

You take care of your patients, but who takes care of your staff? Why not extend a confidential and independent triage service for your staff by making Continuwell part of your employee benefits package? Continuwell is always available to help your staff get back on their feet, no matter the symptom.

Benefits

  • Easy to use, easy to access.
  • Customized with your logo and your own buttons.
  • Single sign-on ability means your employees can seamlessly navigate through all of your services.
  • Announcements and events calendar make it easy to keep information coordinated with all your employees, through push notifications.

Continuwell can place all wellness and health options in one, easy-to-access spot. With so many options available to employees, it is easy for a company’s benefits and programs to get lost. The customizable mobile application places the company’s benefits in employees’ hands, making it easy for them to find the resources they need, when they need them.

The Continuwell mobile app extends the reach of telehealth service to more people and puts them in control of their health. As telemedicine becomes more prevalent, TriageLogic is committed to providing hospitals and practices with the technological tools to meet the needs of their patients and staff. TriageLogic is also committed to helping its clients ensure high-quality care, while decreasing costs and improving patient satisfaction.

TriageLogicFounded in 2006, TriageLogic is a URAC accredited, physician-led provider of high-quality services and software for telehealth. TriageLogic is a leading provider of top-quality triage technology, mobile applications, and call center solutions. The TriageLogic group serves over 9,000 physicians and covers over 18 million lives nationwide. Visit www.triagelogic.com for more information

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Do Mobile Apps Belong in Telephone Triage?


LVM Systems


By Mark Dwyer

Being a “digital immigrant,” whose knowledge and comfort with mobile apps is admittedly deficient, over the past thirty years I have championed the value of a traditional, phone-based nurse triage call center. If I need clinical help (or vendor assistance, for that matter), I still prefer a phone call to interact with a person.

To me, texting, emailing, tweeting, or communicating by any other non-voice-to-voice method, not only can be cold, impersonal, and incomplete, it is often intimidating. Despite claims to the contrary, the developers of many mobile apps have compromised ease-of-use for faster programming and meeting product release deadlines.

That said, I do see a number of scenarios where having access to a mobile app or other software-based solution offers a real benefit to the consumer and a natural tie-in to today’s nurse triage call center. Let’s begin by looking at a few functions commonly used today in telephone triage call centers to which mobile apps are being interfaced.

The Triage Nurse Callback Queue: The follow-up call queue is of weighty value especially when new patients call and all of the call center nurses are busy speaking with other patients. Here, assuming the call is of a non-critical, low-acuity nature, a non-clinical staff member could advise the patient that no nurse is currently available and he or she would gladly add the patient to the nurses’ callback queue once some initial information is gathered.

Web or Mobile App Requests for a Nurse Follow-up Call: For some, enabling the patient to send a summary of their conditions via a smartphone app would be the logical starting place for a phone app interface. Many hospital call centers have begun accepting this kind of communication.

Using the triage nurse callback queue for outbound calls to the patient enables the nurse to review the text sent via the mobile app. Once reviewed, the nurse calls the patient back to engage in a more in-depth conversation regarding the details of the patient’s symptoms.

As always, if the patient is experiencing critical symptoms, they should always be instructed to hang-up and dial 9-1-1 or proceed to the nearest emergency department.

Prioritizing Calls in the Callback Queue by Acuity: The best way to verify that each call added into the nurse callback queue has been assigned an appropriate acuity level would be to have all calls reviewed, assessed and, if needed, adjusted by acuity. To facilitate this, many sites have a charge nurse responsible for managing the queue throughout the day, making sure the highest acuity requests remain listed at the top of the “requests received for nurse call-back” queue.

But this is an article on mobile apps. Isn’t there a way to review and assign an appropriate acuity level with a technological solution instead of needing to manually review each request using a process that requires the addition of more staff?

Natural Language Processing: A more technologically advanced option would be to utilize one of the industry’s natural language processing (NLP) mobile apps. An NLP system can read, at the time of the initial call, the notes captured by the non-clinical, front-end intake person or directly by a call center nurse. The NLP can then interpret the notes into their clinical equivalents, assess the acuity of the call, and send the call to the follow-up queue or make it available to the nurse, in both cases with the appropriate acuity level.

There are systems that can automatically assign an acuity ranking to each call before adding it to the nurse callback queue. If the call is being handled directly by the call center nurse, this same information can be provided directly to the triage call center nurse to help direct her guideline selection. Doing so substantially reduces the time needed to manage the queue. Instead, the charge nurse could be used to provide greater value to patients by handling additional live triage calls.

Again, if needed, these calls could be assigned a higher or lower acuity level by the charge nurse monitoring the queue. When functioning correctly, the auto-feed, queue-sorting algorithm should take into consideration newly added calls every two to three minutes. Generally, callbacks should be made within thirty to forty minutes of receipt of the initial request.

Live Chat Technology: Another option traditional nurse triage call centers are beginning to embrace is utilizing live chat technology to enable the patient to directly interact with a triage nurse within just a couple of minutes of the initial inquiry. Here, via the chat function on most computers and smartphones, the patient can simply enter a brief description of his or her symptoms and send it to the call center. A triage nurse opens the chat, reads the patient’s notes, and then enters an educational or directive note back to the patient again in the chat window.

The nurse’s reply, along with the patient’s initial message, is returned to the patient for further review. If the patient is satisfied with the nurse’s response, he or she simply closes the open chat link. Otherwise, the chat can continue. Once the final message is sent, click to close the chat window. Be sure to follow organizational HIPAA privacy rules.

Using the chat function can be a great productivity benefit because a single nurse can manage multiple chats simultaneously. Just be sure, if chat is implemented in the call center, clearly segment each caller’s or patient’s data from all others to avoid inappropriately sharing personnel health information (PHI) with the wrong individual.

Self-Assessment via Guided Questions: Another mobile app gaining popularity in the telephone triage world is often referred to as a symptom checker. This app provides patients with the ability to self-assess their symptoms using a web or phone-based app. These programs typically begin by providing instructions for using the app and the site’s privacy rules.

When the patient is ready to begin, two diagrams appear, one male and one female, with several body regions defined (such as upper right leg, lower left leg, neck, etc.). The patient can rotate the body to indicate the concern has something to do with an area on the back. Once the body region is identified, the patient clicks on it to display a list of symptoms from which to choose (for example, muscle ache, sunburn, laceration, etc.).

Typically, these programs present a user-friendly interface with self-triage guidelines or some other healthcare information pertaining to the issue the patient is having. If the patient prefers to speak with a nurse, some of the more advanced symptom checker apps will enable the patient to request a follow-up call from a call center nurse.

The patient’s request is added to the nurses’ follow-up call queue. The process continues from there, processing the request much like the steps for chat follow-up interactions, except that the subsequent contacts take the form of phone calls instead of chat texts.

Photo of Wound: This is a surprisingly simple, yet significant feature of many remote apps tied to triage call centers. One of the greatest challenges of performing remote patient triage is the inability to see the patient’s symptoms or problem visually. By adding the ability to share a photo with the call center nurse, the patient can greatly enhance the nurse’s ability to successfully triage the issue.

It is true. A picture is worth a thousand words. These photos are typically shared as jpg files and are stored as part of the patient’s overall triage encounter record.

Video of Patient Behavior: Another visual tool available from some vendors is the ability to send and store a video of the patient’s behavior. Describing lethargic or manic behavior or the uncontrollable crying or hysterics of a toddler is often difficult for a highly stressed parent. Enabling the nurse to watch a brief video of the patient’s current activities can greatly improve the nurses’ ability to correctly assess the patient’s health issues.

Video-Based Doctor Visits: The last application is a rapidly growing phenomenon that spawned an entire new industry to address what many believe to be one of the greatest challenges of Obamacare: providing insurance coverage to twenty million Americans, while struggling with a major shortage of primary care physicians throughout much of the country.

Through governmental action such as the ACA, millions more Americans were provided government subsidized healthcare. Unfortunately, the vast majority of individuals who initially enrolled in the new programs were those of greatest ill health and costliest conditions. These individuals were also largely without a primary care provider. Consequently, the over-crowded, already backed up emergency departments across the country became even more congested with individuals who had nowhere else to go to receive the healthcare they needed to stay alive. Video-based doctor visits provided a partial solution.

The sharpest players in the healthcare triage call center niche will be those who devise a strategy to integrate with these video-based physician practices, performing both pre and post-visit calls and doing follow-up case management calls to these individuals.

The future is here. Either embrace it or miss this current wave—or might it be a tsunami?

LVM SystemsMark Dwyer is a 30-year veteran of the healthcare call center industry. Mark is in his sixteenth year at LVM Systems where he serves as COO. LVM Systems provides healthcare call center software. For more information or a demonstration of LVM’s call center solutions contact Carol Zeek, regional VP, sales, at 480-633-8200 x279 or Leann Delaney, regional VP, sales at 480-633-8200 x286

 

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