Why is Your Contact Center Essential to Your Organization?

Echo Access provider directoryBy Richard Stier

You are your health network’s senior leader for access with direct responsibility for the contact center. This morning your CEO asked you a question that has dominated your thoughts. “We’re taking a hard look at the budget,” she said. “The contact center represents a significant line item. Can you help me understand if, or why, the call center is vital to us? Why should it remain in our budget?”

How would you respond? Three key criteria provide the foundation for your effective reply.

Criteria 1: Structure the Framework: Align your contact center’s priorities with C-suite imperatives.

You have an ongoing conversation with your vice president about the organization’s driving priorities, and you’ve focused your contact center to support three of them:

  1. Reduce avoidable readmissions to eliminate a recent fine from CMS,
  2. Improve CAHPS scores for patient satisfaction to improve reimbursement, and
  3. Fill practices of newly employed physicians to accelerate the revenue cycle.

Because reducing preventable readmissions is an organization-wide priority, you’ve made it a contact center priority. At discharge, a contact center ambassador asks patients for permission to contact them and their caregivers when coordinating follow-up appointments. Your contact center receives discharge reports every morning from each member hospital. The ambassador calls, emails, or texts the discharged patient and the authorized caregivers to coordinate a day and time for the follow-up physician appointment.

After the scheduled day and time, a contact center ambassador calls the physician office to see if the patient kept the appointment. If the appointment was not kept, they reconnect with the patient or the patient’s approved caregiver to reschedule.

The results have been substantial. The readmission rate declined from 25 percent to 15 percent, and a fine from CMS was reduced by two million dollars over the past two years. Kept appointment rates for post-discharge physician visits have climbed to over 85 percent.

You’ve used tools in your contact center software to document and improve first experience satisfaction scores, and your overall CAHPS scores have been steadily rising. And, you have documented the stream of patients for whom the contact center has made appointments with newly employed physicians at eight practices.Your healthcare contact center is the virtual front door for personalized support and referrals. Click To Tweet

Criteria 2: Place the Rebar: Hardwire your contact center to strengthen your organization’s patient experience (PX) advantage.

You’ve shared with internal colleagues that healthcare currently has a 29 percent patient experience failure rate (per research by Hospital Compare). Only 71 percent of inpatient patients report they received the “best possible care.”

You’ve challenged your peers to ask, “In what universe is a 29 percent failure rate acceptable? Could we miss our revenue projections by 29 percent? Be over budget by 29 percent? Could we even conceive of missing our quality metrics by 29 percent—we only drop 29 percent of newborns, so we meet the standard?” Seriously.

You’ve communicated your belief that “best possible care” experiences begin before a patient receives care and continues after the patient returns home. You explained that your contact center is uniquely positioned to serve as the virtual front door for personalized support and referrals—whether on the website or on the phone—before using a clinical service and for individualized follow-up and coaching after discharge.

You’ve taken several actions to strengthen patient experience advantage:

  • You now include patient ratings and comments in your online provider directory. This key information for prospective patients increases the probability of a good match with one of your providers. Better alignment between patients and providers results in higher patient satisfaction.
  • Your contact center conducts pre-CAHPS patient satisfaction surveys to identify areas for improvement before the CAHPS surveys are conducted. The contact center leverages relationships with callers as a conduit of opportunity to improve CAHPS scores across the enterprise.
  • You place contact center ambassadors in your emergency department to capture patients without a primary care physician. This has resulted in less congestion in the ER, patients being re-directed to more appropriate sites or levels of care, and incremental patients being referred to in-network providers.
  • You have a pre-admission patient hotline where contact center ambassadors work with patients to keep them in-network, secure financial clearance, and arrange for a deposit prior to their visit. Ambassadors add value by providing patients with information about directions, location, and parking.
  • You shift your team culture to celebrate “phone hugs,” redirecting the focus from processing transactions to building relationships with patients through empathic conversations.
  • You launch digital patient experience journey mapping to document experiences from patients’ perspectives starting with the first online or phone contact to handoff of care to post-discharge connections.
  • You recognize the maturation of contact centers to require super agents whom you call “senior ambassadors.” They serve as indispensable personal coaches. They have a proven ability to calm difficult callers and help them with their most challenging situations. For example, they may coordinate pre-visit scheduling for multiple tests that need to be completed before the patient has their physician appointment.
  • You’ve integrated your contact center’s provider data into a single master provider database as a source of truth. The benefits include a comprehensive and more accurate database, reduced data errors, greater data security, increased provider satisfaction, and an improved caller experience.
  • You took two important steps to strengthen your organization’s patient experience advantage:
  1. You recognize your contact center’s role to deliver differentiating, memorable first experiences. In collaboration with your chief patient experience officer, you pulled together a team of first touchpoint and access leaders to multiply your impact.
  2. Your first touchpoint team understands the first three seconds of that initial interaction influences hospital selection and preference (SHSMD 2012). The team identified a shared metric for targeted improvement: first experience satisfaction score. You regularly monitor this and have ongoing first touchpoint team challenges across several departments to improve it. Your first experience satisfaction score has moved from 58 percent two years ago, when you implemented this initiative, to 84 percent last quarter. Future metrics considered by your first touchpoint team are: improved CAHPS scores and improved patient satisfaction with specific handoffs of care targeted for improvement.

Criteria 3: Pour the Concrete: Confirm your contact center as an investment, not an expense.

Expenses are cut. Investments are funded. You understand that if your contact center is perceived as an expense, you must be prepared for tough questions.

You’ve collaborated with your CFO to develop and publish a quarterly one-page contact center executive dashboard report for your leadership team. The metrics in this report are reviewed with your CFO annually and revised as needed.

Your contact center executive dashboard report includes three columns:

1. Executive Briefing on Strategic Priorities: The left column includes a bulleted list of metrics aligned to support Criteria 1 priorities.

In this case, you’ve provided a list of indicators under heading “Reduce avoidable readmissions.” Those indicators include: baseline, target, and current readmission rate; baseline, target, and current kept appointment rate; and baseline, target, and current percentage of PCPs with patient follow-up appointments within seven days of discharge.

The next indicator in the “Executive Briefing on Strategic Priorities” column is improve CAHPS scores. Your indicators are baseline, target, and current score for first contact satisfaction, and the number of pre-CAHPS patient satisfaction surveys completed by the contact center.

The third indicator is “Fill practices of newly employed physicians.” Indicators are baseline, target, and current number of referrals and appointments made to employed physician practices and the baseline, target, and current number of referrals and appointments made to all participating physicians for this quarter.

2. Strengthen PX Advantage: The center column includes metrics aligned with Criteria 2 priorities. Your indicators include: number of click throughs on patient ratings and comments in the online provider directory; number of unattached ER patients referred to in-network PCPs; number of patients served this quarter with the pre-admission patient hotline; and baseline, target and current patient satisfaction with handoffs of care from the contact center to employed practices.

3. Contact Center Investment Summary: The right column metrics support the priorities in Criteria 3. Indicators include a bulleted list of metrics after contact center interactions and clinical triage such as inpatient admissions, outpatient visits, ER visits redirected, total physician referrals, total physician appointments, incremental gross revenue, estimated net contribution (supported with attached detail), and estimated ROI.

When you meet with the executive team, you have three additional categories of metrics available to discuss, in anticipation of questions.

  1. The first is priority service line measures with indicators for each clinical center of excellence such as referrals resulting in inpatient admissions and referrals resulting in outpatient visits.
  2. You have also identified metrics for integrated access centers such as number of switchboard calls, call length, total handle time, abandonment rate, caller satisfaction, appointments scheduled by clinical service and practice, number of transfer center transactions, number of physician-to-physician consults, and gross revenue from physician-to-physician consults.
  3. Finally, you are prepared to update the group on contact center operation indicators such as total website conversions, total appointments scheduled, kept appointment rate, average seconds to service, and call abandonment rate.

Your reply: As you mind concludes this mental review, you take a breath and hear yourself respond to your CEO’s question with confidence.

“I believe our contact center is essential to our ability to achieve our strategic imperatives. We intentionally support our priorities to reduce avoidable readmissions, improve our CAHPS scores, and fill the practices of employed physicians. Our contact center strengthens patient experiences as our competitive advantage, beginning at the important first point of contact—whether online or on the phone.

“Importantly, our contact center delivers a tangible return. Our Executive Dashboard Report documents an ROI of three to one. That is, we get three dollars returned for each dollar invested. In summary, our contact center delivers a solid ROI while improving patient satisfaction.”

As your organization’s leader for access, you made the shift from managing transactions to delivering transformative experiences. The contact center team you lead builds competitive advantage by ensuring extraordinary patient experiences at the critical first touchpoint and beyond. Your contact center is vital to your organization’s mission-critical priorities.

Echo, a Healthstream CompanyRichard D. Stier is vice president marketing at Echo, A HealthStream Company. He is a results-proven proponent of delivering transformative patient experiences. Echo, a HealthStream® Company, delivers enterprise-class, innovative solutions to optimize patient experience contact centers. Echo’s solution for hospital-based contact centers, EchoAccess, enables your organization to deliver intentionally memorable experiences that mitigate risk, solidify loyalty, and reduce unnecessary readmissions.

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Resurrection Health Care Tracks Revenue and Demonstrates Contact Center Value

By Patty Maynard

As hospital contact centers are tasked with being more accountable to their healthcare systems, measuring return on investment (ROI) becomes a necessity. A contact center with built-in accountability can show its worth to the organization through demonstrating its ability to generate revenue and increase market share.

For Resurrection Health Care in Chicago, change has come in the shape of hospitals bought and sold, staff realignments and reductions, and a merger with Provena Health in November 2011 that formed Illinois’ largest Catholic healthcare system. Throughout these changes, Resurrection Health Care has operated its contact center with RelayHealth products for marketing campaign management and triage since 1993. In 2007, Resurrection added RelayCare Revenue Tracker to help the contact center determine the effectiveness of these campaigns in generating revenue.

With Revenue Tracker, organizations can measure the revenue impact of direct and indirect services and calculate the financial impact of selected programs or the entire contact center. It also features intelligent technology that helps reduce the effort required to confirm partial matches and reduce the number of duplicate records.

Key Contributions and Compelling Numbers: Call Center Director Cheryl Dusenbery has worked at Resurrection for sixteen years. With Revenue Tracker, the center can follow a patient’s path from first contact to any financial service in the hospital and credit the revenue generated to the correct marketing campaign.

“If someone calls in looking for a doctor and gets a referral, for example, and nine months later they’re back in to deliver a baby, we’re able to match our call records with the hospital’s financial records and reconcile the revenue,” Dusenbery said. “Without RelayCare Revenue Tracker, it would be a totally manual process, and it would be nearly impossible.”

In fiscal year 2011, $32 million in incremental revenue at six hospitals could be correlated to contact center calls. This is an increase in revenue of approximately $330,000 per hospital when compared to the $35 million in revenue generated in fiscal year 2010 over seven hospitals.

“The average revenue per call for fiscal year 2011 was $925. That’s a nice thing to be able to say to a CEO, and it helps them understand the contact center’s value,” Dusenbery said. “They see the value in what we bring to the table. It brings credibility to the marketing team and the contact center.”

By using a file extract from an organization’s financial system to match revenue against contact center encounters, Revenue Tracker can assist contact center managers as they:

  • Generate reports showing gross and net contribution
  • Demonstrate financial value and impact resulting from contact center operations
  • Report against multiple time periods with criteria to account for multiple variables

“When I talk with other facilities, I stress how important it is to position the numbers as a correlation,” Dusenbery said. “If someone fills out a card to get a thermometer, or if you’re trying to track what you get from a physician’s lecture, that’s incremental revenue that demonstrates the effectiveness of a marketing campaign.”

Revenue Tracker has also helped with resource decisions in the contact center. Staff can be added during hours when call volumes or the average revenue per call are higher or reduced when they are lower.

“We can track callers by outcomes, by the number of calls taken by nurses or representatives, or by the percentage that generate revenue,” Dusenbery added. “We’re able to decide by looking at the results whether it’s more cost-effective to have nurses go out into the work force or to other call centers.”

Conclusion: Whether demonstrating or determining its worth to the organization, Resurrection Health Care’s contact center has received the help it needed from Revenue Tracker. Tremendous amounts of data have been processed during the time that RelayCare has been in use at Resurrection Health Care. In that time, it has also added and removed hospitals from its roster. Through it all, RelayHealth has been a partner in keeping the information flowing.

“Every time we added a hospital, we wondered, ‘What’s going to happen now?’” Dusenbery said. “Each one is a giant influx of data, and we worked hand-in-hand with RelayHealth to make sure we could handle it.”

Patty Maynard is the solution line leader for RelayCare.

[From the June/July 2012 issue of AnswerStat magazine]

The Recession’s Impact on Contact Center Technology Investments

By Donna Fluss

Three years ago, DMG Consulting predicted that the U.S. economy would enter a recession in 2009. While we did not anticipate the massive failure of financial institutions, we were expecting a significant economic correction. The current situation is expected to drive many economies around the world into a serious recession. Recessions generally have a dramatic impact on the level of technology spending. DMG Consulting expects the next eighteen months to be very challenging for many technology companies, including contact center vendors.

During recessionary or challenging economic times, most enterprises freeze all but essential technology investments; any investment that can be postponed generally is. Depending upon the severity of the economic crisis, even investments that have been approved may be postponed if the money allocated for those projects has not yet been spent. While the full effect of this economic downturn is not yet known, given its worldwide scope, it is expected to likely last well into 2010.

Here is how a recession is going to impact sales of the three top contact center applications: contact center infrastructure (automatic call distributor, or ACD), interactive voice response (IVR), and workforce optimization suites and modules.

Hosted Contact Center Infrastructure: If economic patterns from the prior two recessions hold, investments in premise-based contact center infrastructure (ACD), which require a large up-front capital investment, will slow significantly. However, sales of hosted contact center infrastructure seats for routing and queuing are expected to grow at a compounded annual growth rate of 28 percent over the three-year period from 2009 to 2011. We believe that the recession is going to be very kind to the hosted contact center infrastructure market. It will drive enterprises large and small to consider hosting as a viable alternative in order to conserve cash and avoid making long-term commitments.

Interactive Voice Response: DMG expects the current economic conditions to temporarily slow IVR growth, as companies of all sizes delay all but critical expenditures. However, once companies lift their investment freezes, there will be an increased emphasis on self-service applications as a means of reducing operating expenses. The IVR market will benefit from the need to replace outdated and expensive-to-maintain systems with newer technology. There will also be a positive impact from the need to standardize technology in newly merged companies, particularly in the IVR-intensive financial services industry.

Workforce Optimization Solutions: While the next couple of years are not expected to be particularly strong for workforce optimization solutions, this technology segment is likely to perform better than many other contact center and IT sectors. This is because most QM/Recording solutions are considered productivity tools. Just as importantly, some of the individual modules that are part of the WFO suites are in a high-growth phase and may continue to perform better than most other technology sectors. Speech analytics, which is just gaining mainstream acceptance, can enhance productivity, improve customer retention, and increase revenue generation. Workforce management solutions have recently been enhanced and are considered leading productivity tools in contact centers. In addition, surveying/enterprise feedback management products are being used to give companies insights into the customer experience.

QM/Recording solutions and all of the individual modules found within the suites are now being offered on a hosted or Software-as-a-Service (SaaS) basis. This is a departure from the traditional, premise-based licensed product delivery model. A hosted/SaaS arrangement allows companies to implement new solutions without large up-front investments in license fees and installation. This gives cash-strapped contact center managers acquisition alternatives that they did not have during other recent recessions. Many of the WFO vendors outperformed the market during the last recession because their solutions helped companies achieve goals that were essential during tough times. Now, with an alternative method for enterprises to acquire these products, they are again expected to outperform the IT sector and to continue to grow, albeit at a slower pace. These projections take the recession into account.

Final Thoughts: Projects that contribute directly to an enterprise’s bottom line have a good chance of being approved if they exceed investment approval thresholds for payback, internal rate of return, and net present value. Chief financial officers are looking for quantifiable benefits that fall into one of the following categories: cost savings from reductions in operating and staff expenses, reduced network charges and maintenance from displaced systems, incremental revenue, or reduction in customer churn. Contact centers should continue to make strategic investments in projects and tools that give them a differentiator, particularly in challenging times.

Donna Fluss is the founder and president of DMG Consulting LLC, the leading provider of contact center and analytics research, market analysis, and consulting. She is the author of The Real-Time Contact Center, the 2008 Contact Center Executive, Management Briefing, and many other leading industry reports on contact center hosting, IVR, speech analytics, performance management, workforce management, surveying and analytics, and quality management/liability recording. Contact Donna at donna.fluss@dmgconsult.com.

[From the April/May 2009 issue of AnswerStat magazine]

Medical Call Centers: Building Versus Outsourcing

By Ken Bleakley

Medical professionals and others who identify a need for health information services in their communities may be in an ideal position to build a thriving business. One of the biggest challenges faced by nurse triage call centers is building a large enough client base to support investment in infrastructure, operations, and accreditation for quality assurance. Modern communications technology and the Internet now make flexible, scalable solutions possible.

An organization with even a small potential client base can begin by branding services in its name and outsourcing them to an accredited 24/7 health information call center. As the business builds, the organization can recruit its own nurses and use a hosted health information system over the Internet to provide limited operations while continuing to outsource selective functions. If the business grows large enough, the organization can migrate to its own call center.

Approaches to Providing Health Information Services: Healthcare organizations have three basic choices regarding the provision of call center services. These choices are briefly summarized as follows:

1) Build a Medical Call Center: This is usually the first choice for large organizations because they view a proprietary facility as less costly than outsourcing, more easily customized to their particular needs, and more reliable because it is under their direct control. These assumptions are not always true, and some installed systems are now closing down. Problems include: an inadequate supply of nurses trained in call center operations; reliance on bundled technology or legacy operating systems; lack of understanding and flexibility regarding the multitude of applications and media available to access them; and a lack of knowledge and experience regarding how to install and operate a modern health information center. In general, a minimum of 6000-8000 triage calls per month are required to sustain a viable 24/7 medical call center.

Where such an approach makes the most sense, look for an industry leader in integrating the best technology available into a state-of-the-art health information center. An organization will need a health information operating system with pediatric and adult protocols, installation, training, and support at its site. It should also be possible to customize or add specialized protocols as needed. Specific things to look for include:

  • Reliable and easy to use software, designed by medical doctors and registered nurses with reliability and ease of use as their goals
  • Programming that allows for quick links to client databases, online scheduling applications, and community and national resources
  • Ready to integrate with EMR (electronic medical record) systems as they evolve
  • Fully-integrated, widely-respected office or after-hours medical protocols
  • Licensee’s system administrators should be able easily to customize the call flow and visible screen elements to make the triage process as efficient as possible for triagers
  • Licensee’s operations administrators should be able to customize client information by group and sub-group, allowing triage staff to provide personalized service to an infinite number of clients
  • It may be desirable for the software vendor to provide backup, overflow capacity, and specialized programs when needed.

2) Outsource: In many cases outsourcing may be a more effective approach, at least initially. The healthcare organization needs to be able to contract for the services required by each of its entities, experiment with different types of services, and analyze the costs and benefits of each — without a large capital outlay or commitment to particular technology and infrastructure.

The healthcare professionals and management operating the center should be recruited and trained for this specialized function to provide the peace of mind that clients are looking for.  Individual encounter and aggregated reports should be provided as an effective quality and cost control to the sponsoring organization. The service should also be transparent to the end-user in the event that clients are branding the service in their own names.

When shopping around for after-hours nurse triage, be sure to ask vendors these questions:

  • Is this service accredited by a recognized national or state agency?
  • Do they use unassailable medical protocols?
  • Is all triaging performed only by registered nurses with extensive experience?
  • Do they have a comprehensive orientation program and maintain a continuous quality improvement program?
  • Do they indemnify against their errors and omissions and carry adequate malpractice insurance?
  • Are calls recorded and individual encounter reports dispatched immediately upon call completion?
  • Does the service provide an authoritative point of contact and follow-up on all calls?
  • Is this an unsubsidized service without strings?
  • Is the service charge sustainable and all-inclusive (i.e. not a “teaser” rate)?
  • Can they provide multiple references from similar organizations?
  • Will their operating system facilitate practice-specific responses to callers?
  • Do they have 24/7 coverage?
  • Are nurses on standby for surges?

3) Hosted or Hybrid Systems: Organizations with 3000-8000 nurse triage calls per month might wish to consider hosted or managed systems that facilitate their qualified nurses logging onto a health information center operating system remotely. These are sometimes described as “software as a service” by access services providers. They have all the functionality of an installed system without the need for servers, systems administrators, and extensive infrastructure. The organization can operate its own facility but outsource certain functions, for example: coverage on slow shifts and overflow periods; foreign language service; and specialized programs.

Features to look for include:

  • The host provides all server hardware.
  • Licensee accesses the health information operating system via a standard Internet browser.
  • The host customizes the software for the licensee on both the developer and administrative levels.
  • The host can provide more extensive management functions and develop custom programs for the operating system if desired.
  • Users should be able to access the application from a call center environment or from their homes, substantially reducing overhead.

The Partnership for Success: Medical professionals and others who identify a need for health information services in their communities need to look closely at the specific opportunities in their target market. These may include services to employers, insurers, governments, and HMOs. Likewise, the service may be directed primarily at after-hours calls for physicians on a per-call basis.

After identifying their requirements, they should be able to ask in-depth questions such as those above of prospective providers. Their providers should be able to assist them in developing a realistic business model that identifies marketing strategies, potential call volume, costs, and return on investment. The best arrangements will be those in which the provider and the medical call center operator have a shared interest in the success of the venture and develop the close working relationship necessary to secure that success.

Ken Bleakley is the CEO of Fonemed — a URAC accredited company supplying installed and hosted medical call center systems and its own nurse advice line services. Contact them at info@fonemed.com or call 800-366-3633.

[From the February/March 2009 issue of AnswerStat magazine]

Charging for Telephone Care – An Initiative Whose Time Has Come!

By Peter Dehnel, MD

Imagine having a drive-up window at your clinic where patients can simply come at any time of the day or night, discuss their medical concerns, get your recommendations for care, get a prescription or some of their services coordinated with medical specialists, and then are sent on their way without charging a penny. Unthinkable, isn’t it? In this day of drive-up services, ease of credit card payments at fast food restaurants, and McDonald’s Big Macs, many products and services come with a definable price. As a result, people are more than willing to pay for them. So why should individualized medical advice be any different?

Consider the equivalent situation where, instead of a drive-up window, a nurse or doctor simply substitutes in-person care with care delivered over the telephone. A valuable service is provided, care recommendations are given, a prescription is called in, or assistance with coordinate care with specialists is arranged. Most medical providers will end up not charge anything. Most clinics don’t even have a process to recoup some of their telephone care costs, even when it is costing them several thousand dollars a year to give this care away free on the phone.

Telephone care and advice has been around, literally, for over a hundred years. Most patients consider it as part of their standard relationship with a clinic. This is especially true if they have a question they feel does not require a face-to-face interaction with a clinician. More significantly, most insurers consider it as a standard inclusion in their contracts with clinics and not as a separate “episode of care,” which is then a billable service.

There are an expanding number of reasons why it is important for all clinicians to rethink this paradigm and consider charging for medical care that is delivered in non-face-to-face settings. It is individualized patient care that you are providing to an established patient. Just as you would not charge an office visit if you have a casual hallway conversation in your office with a patient, you only charge for telephone calls that have some element of medical decision-making.

Telephone care, when it is considered as a part of total patient care, has a number of advantages to both the patient and the clinician. It is providing care to the patient that is more convenient and in a timeframe that meets their needs and availability. These care encounters will likely cost the patient less, since the cost for these visits will likely be less than the standard office visit. Since these have the additional advantage of not requiring the patient to come to an office, they do not have the indirect costs of missing work, driving to the clinician’s office, parking, and so forth.

For the clinic, telephone care will free up appointment times to see the patients that truly need to be seen in person. They will allow a broader number of options for follow-up care. Since these calls have to meet all of the documentation requirements of an office visit, the clinician will do a better job of documenting the telephone encounter. This will give a more complete picture in their medical record, will likely provide better coordination of care for patients with chronic conditions, and will reduce legal liability issues related to undocumented care and advice. Since a certain number of these calls will happen anyway, clinics will recoup some of the cost of delivering this care that has previously been missed.

The American Academy of Pediatrics has recently issued a policy statement supporting payment for telephone care (“Payment for Telephone Care.” Pediatrics 2006;118(4):1768-1773). This had been preceded by a 2003 policy statement by the American College of Physicians endorsing payment for telephone care. In addition, some insurers are now reimbursing for “e-visits” – non face-to-face care encounters delivered over the Internet.

For those clinics and clinicians who want to venture into this new territory, preparation is the key to a successful outcome. You will need to develop a clinic process that includes fairly explicit descriptions of what type of calls will be included, the basis of charging for them, the documentation requirements and any supporting forms, how billing will be accomplished, and what to do with patient complaints and insurance denials. Your patients will have to be notified well in advance in a number of different ways, and options to come in for a real face-to-face visit may have to be available on a real-time basis. Finally, forewarning the insurers is always a good idea, and you will need to determine what appeal options for non-reimbursement are available to you.

Medical care over the phone is a great option for patients and clinicians. There is no reason why it should supplied free of charge in a haphazard way. It is time for clinicians to think about this type of care in a new way. This is especially true in light of the fact that the options for non face-to-face interactions are expanding much faster than we can currently accommodate.

Peter Dehnel, MD, is the Medical Director for Children’s Health Network and the Medical Director for Children’s Health Network Triage Service, Minneapolis, MN.

[From the August/September 2007 issue of AnswerStat magazine]

Untangling Wireless Expenses

By Al Subbloie

In the United States there are more than 175 million cell phone subscribers, over a third of whom are business users. Though a vital part of daily business operations, more and more corporations find they lack the control over their wireless costs that they enjoy in other telecom areas. Unlike traditional corporate IT or wired telecom services, wireless communication was not generally initiated or engineered by the corporation; it crept in the backdoor, so to speak, through employees – early adopters looking to enhance traditional methods of communication.

The speed with which cell phones and other devices were absorbed into the day-to-day operations of the enterprise was impressive. In 2001 U.S. corporations spent $37 million on wireless communication; by 2009, according to Cahners, business spending on wireless data will reach $11 billion. Naturally, as wireless usage continues to grow, management of those assets becomes more complex.

Surprisingly, very few companies actually know exactly how much they spend on wireless hardware and services each year. Take cell phones for instance. For years cell phones were considered the personal property of the employee and the corporation had nothing to do with choosing a phone, deciding on a plan, or paying the invoice. But as more workers began using these “personal” devices for business purposes, the corporation began to absorb more of the cost – usually via the expense report – an expedient (if terribly inefficient) method. In fact, one analyst (Meta) estimates that 30 to 40% of companies allow employees to expense their own cell phones and select appropriate plans. They know they’ll foot at least part of the bill eventually, but they’ve chosen to let their employee make the decisions. With some 12,000 constantly changing wireless carrier plans available, employee wireless contracts vary according to carrier, plan, cost per minute, roaming charges, monthly usage, and overage charges.

As a method of managing spending, the expense report is woefully inadequate – providing the least management control and the maximum usage costs; it fails to provide visibility into the company’s wireless usage and spending, offers few consistent budgeting capabilities, restricts corporate buying power, and limits inventory awareness. So it’s no wonder that so many corporations lack the control over wireless costs that they enjoy over traditional communications. They have little or no say over which carriers or plans their employees are choosing, have no real knowledge of their inventory, and no way to effectively audit what exists.

To a larger degree, organizations that are failing to manage their wireless costs are missing a large opportunity for savings. While analysts differ about the percentage of savings to be realized by implementing tighter management controls (the number ranges between 15 to 30%), what they do agree upon is that organizations need coordinated service procurement and management, as well as consistent documented policies, in order to minimize wireless costs and measure a return on investment.

Wireless Automation: The solution to the problem of unchecked wireless spending is to integrate wireless into the organization’s overall enterprise communication strategy. Wireless services do, after all, share common processes with traditional voice and data services, including contract and bill management, cost allocation, procurement, inventory management, analysis, and reporting. In the long run, failure to establish a unified voice, data, and wireless process will result in a deficient solution that will always be operating at less than optimum.

In addition, there are profound benefits to be had in integrating wireless into an overall telecom expense management plan:

  • Improved bill auditing and error detection capabilities
  • Increased accuracy of enterprise telecom expense allocations
  • Improved visibility and understanding of enterprise telecom costs
  • Consolidated enterprise-wide service inventory
  • Optimized carrier service rates
  • Right-sized inventory levels

One of the primary benefits to organizations that integrate wireless through effective use of resources, technology, and expertise is significant savings. But taking into consideration the intricacies of the technology, the volume of plans, a constantly evolving wireless infrastructure – issues that often affect global organizations on a country by country basis – the ability for an organization to single-handedly achieve a position of wireless self-sufficiency is, at best, limited. The sustained ability to manage wireless, voice, and data expenses is best achieved through a specialized provider of comprehensive, automated Telecom Expense Management (TEM) systems and services.

What Should You Do? If wireless telecommunications costs are “running wild” in your organization and there is no system in place by which to manage costs, then something must be done. But doing something, and doing the right thing, often have entirely different outcomes with remarkably varied results.

To ensure that wireless expense management activities are appropriately focused, organizations should take control of costs by adopting a wireless policy for usage and management, followed by negotiation for corporate-wide service contracts. Gartner Group estimates that enterprises can save 15 to 35% on their wireless costs by instituting consistent and documented policies, coordinated service adoption, and stringent management of wireless services.

In order to achieve this goal, corporations should enlist the aid of a knowledgeable TEM vendor that can address the multiple fundamental concepts that comprise telecom expense management. Although basic in nature, these concepts serve as guideposts for the organization and help ensure maximum bottom-line benefits to the organization.

ConsolidateConsolidating wireless operations should include administration and management areas, as well as procurement, billing, allocations, auditing, and negotiations. Consolidation will lead to simplified management, the standardization of adoption and usage policies, and will provide increased control and improved cost structure through the elimination or reduction of operational redundancies.

AggregateIt’s an arduous task, but in order to achieve a collective view of usage, organizations must gather information about their disparate wireless activities. An aggregated view of the wireless spending will aid in a significant realignment of corporate buying power; without this holistic view organizations cannot purchase or contract in bulk, bundle services, or negotiate the best prices.

AutomateOrganizations should deploy automation tools with functionality tightly integrated between wireless processes. For instance, creating an inventory of enterprise-wide equipment and services may yield positive benefits in the contract negotiation phase. However, without the ability to link inventory to contracts, billing, auditing, procurement, reporting, and allocations, inventories that were once accurate – and the resultant benefits – become outdated. The process areas requiring tight integration include, but are not limited to:

  • Contracts – Automated contract management lets companies manage all aspects of their carrier/vendor agreements by capturing all applicable details including service and product descriptions, rates, discounts, commitment levels, and contract terms. A consolidated view of contracts allows organizations to achieve optimal terms, rates, and conditions by examining agreements, eliminating overlaps, and conducting timely, well-informed agreement negotiations. Automated contract management capabilities also serve as a foundation for automated rate tests, usage threshold comparisons, and inventory discoveries.
  • Inventory – Manually creating and maintaining an accurate wireless equipment and services inventory would be pointless given the average number of services and inventory items to manage within an organization, not to mention the frequent changes resulting from employee hirings, dismissals, transfers, and moves. Automated inventory capabilities that enable an accurate and up-to-date inventory, give organizations the ability to capture, analyze, and allocate monthly spending and utilization activity at the line item and employee level.
  • Provisioning – Provisioning enables requests and orders for services and equipment to be handled on an enterprise-wide level. With a centralized provisioning ability, companies can centrally manage moves, adds, changes, and disconnects for a wide array of products and services. Automated provisioning is a vital component in establishing a closed loop “procure to pay” process and should not be overlooked when considering an automated solution.
  • Billing – Automated billing should include of all aspects of invoice processing including the receipt, loading, audit, allocation, approval, payment, and tracking of carrier billing. Billing automation simplifies the processing of invoices by providing a standard, consolidated view of all telecommunications expenditures, not just wireless. With the ability to handle automated billing feeds, an automated telecommunications expense management system can eliminate paper bills, reducing turnaround cycles and late fees.
  • Auditing – With accurate inventory and contract data, organizations can regularly and frequently audit contact rate and terms, billing, service inventory accuracy, employee spending, market factors, trend and spending variances, utilization, and configuration services. Through automated auditing, enterprises can identify discrepancies and errors, allowing telecommunications staff to focus on best revenue generating/expense management practices rather than on administrative data manipulation and comparison.
  • Reporting and Analysis By using a consolidated data structure, an automated TEM process will provide the ability to “slice and dice” information across multiple functional areas. With standard reports writing and analysis capabilities users can develop customized reports on everything from usage and allocation to billing and inventory – all of which enables greater understanding for improved manageability. In addition, “what-if” analyses functionality helps organizations identify and target opportunities for reducing and controlling costs.

OptimizationOrganizations must be able to interpret what is going on within their organization in order to make reactive and proactive changes. With automation comes the ability to optimize infrastructure and implement the process, policy, and staff-related changes necessary to leverage wireless investments and resources in a strategic manner.

If the organization doesn’t recognize the processes of change and adaptation as critical components of managing wireless expenses, it will ultimately subject itself to unnecessary frustration and less than optimal benefits and savings. Centralization allows companies to report and manage their operations with a higher degree of understanding and responsiveness. Therefore, organizations should carefully consider the ability of their automated solutions and processes to adapt to the growing needs of their organization and their market.

Al Subbloie is an Internet pioneer, and the President and CEO of Tangoe, Inc.

[From the June/July 2006 issue of AnswerStat magazine]

Improving the Financial Impact of Your Call Center

By Rebekah Temple and Giustina Parisi

As medical call centers become contact centers, organizations can capitalize on the mutually beneficial relationship by transforming relationships with callers from one-dimensional, transactional exchanges to transformational interactions that offer meaningful information and initiate ongoing dialogues. Hospitals struck oil (though some still may not know it) with the call center. From a business standpoint, what they created was a direct line to the right customers and a repository of valuable information.

Call centers increasingly are becoming the crossroads for all communication touch points. While they house more information than ever, many are unsure how to wield it. By merging contact center data with data from across the enterprise and market, contact centers can use Customer Relationship Management (CRM) to invest in key relationships by improving the customer experience.

Nearly two out of every three U.S. hospitals operate a contact center, together triaging thousands of calls each day. CRM leverages these connections, enabling contact centers to relate and transform their behavior. One study found that up to 40 percent of callers and Web visitors are new to systems. The same research also revealed that 25 percent of individuals who contacted a center came in for a visit within 12 months. Since contact is often a precursor to clinical activity, how the interaction is managed is just as important as the connection itself, if not more so.

Anticipating Individual Needs: Catalogue companies are masters at up-selling and cross-selling products and services. Websites swiftly seized up-selling and cross-selling, taking it to an entirely new level. The case example is Amazon.com. Purchase one book and the site skillfully prompts a buyer to consider others in the same genre. In 2004, just its seventh year as a publicly-held company, Amazon.com boasted net sales of $6.92 billion, an increase of 31 percent over 2003 sales.

Because information is the enabler, the same concept easily is applied to medical contact centers. CRM anticipates a caller’s needs. For example, a caller inquiring about obstetric services is informed about upcoming pregnancy and baby-care classes. Another caller seeking a physician is asked if anyone else in her family needs a physician. Predicting health needs is more complex than selling retail goods. CRM uses what is known as predictive modeling to boost knowledge.

Predictive modeling uses internal data and combines it with market statistics and projections to foretell a person’s likelihood of using as well as needing certain medical services as defined by the major diagnostic categories (MDC), specific diseases within the ICD-9 (International Classification of Diseases, Ninth Revision), and diagnostic related groups (DRG). The more data used, the stronger the prediction. Modeling run on patient information, therefore, will yield stronger results than on non-patients.

This information, for the contact center, provides instant insight into a person’s needs, providing the opportunity to enhance the call. It also engages callers with their health needs and bonds them with the organization. Ideally, the interaction results in the caller scheduling an appointment or enrolling in a class. Even if that’s not the outcome, with CRM the foundation for ongoing dialogue is set.

Becoming a Two-Way Conduit: Customer interaction does not stop when a call is completed, but instead initiates post-call follow-up opportunities. CRM allows contact centers to place outbound calls to continue conversations with callers, as well as to deliver and capture vital information.

Contact centers can make calls to previous callers with pertinent, high-value information. Continued communication might involve providing callers with relevant educational opportunities, new service and physician announcements, as well as recommended screenings and immunizations. With CRM technology, contact centers not only know when patients are due for immunizations and screenings, such as a mammography or colorectal, but also who should be screened because their health history indicates they’re susceptible to disease.

A South Central United States hospital’s contact center realized the value of outbound calling when a physician abruptly resigned. The contact center quickly used a telemarketing campaign to prevent patient loss. By pulling patient information from the CRM database, the contact center gave patients alternative physician recommendations. The contact center contacted 1,400 households and the effort resulted in a 100 percent conversion.

Applying HIPAA: How does the Health Insurance Portability and Accountability Act (HIPAA) apply to contact centers using CRM to enhance patient care? Contact centers that are part of a health care entity’s operations, such as a hospital’s internal call center, are governed by HIPAA. However, outsourced contact centers are considered business associates of health care providers under HIPAA and must have a business associate contract that assures the center’s activities adhere to the law.

Under HIPAA, marketing is defined as making “a communication about a product or service that encourages recipients of the communication to purchase or use the product or service.” A covered entity, under HIPAA, is not engaging in marketing when it communicates to individuals about:

  • Participating providers in a network and the services they offer,
  • The individual’s treatment, or
  • Case management or care coordination, such as directions or recommendations for alternative treatments, therapies, health care providers, or settings of care.

Since the HIPAA requirements protect core health care functions, contact centers, which prove their value, will continue to play an indispensable and valuable role in health care operations.

Proving Return on Investment: During a time of increased health care expenses and tighter budgets, today’s contact centers are under increased scrutiny. Yet, research shows that few use information captured during a call and even fewer use it to prove return on investment (ROI). However, for centers that are integrated with a CRM database, it is tough to argue against the contact center’s role in converting prospects to patients. By simply tracking inbound and outbound calls, a contact center can go from a cost center to a profit center.

To track contact center ROI, health care organizations can analyze database activity.  This includes the number of annual calls, type of calls (physician referral, general information, calls from specific campaigns), and number of service encounters linked to calls and the financial impact of those encounters.

When a Midwestern health system’s contact center was under scrutiny, it used its CRM system to prove the center’s value. The health system demonstrated that after one year the call center increased inbound calls by 10.8 percent, earned $1,395,856 in revenue from 817 new patients, and $22,363,800 in revenue from 4,160 existing patients for a total of $23,759,665 in revenue for the year.

Health care organizations that use contact centers to connect and relate with callers, anticipate individuals’ needs, and capitalize on post-call opportunities will improve patients’ satisfaction and increase call center revenue. With a CRM system to measure inbound and outbound activity, they also have the tools to prove it.

Rebekah Temple is a PR/Marketing Communications Manager. Giustina Parisi is a Marketing Database Manager. Both are located at Middleton, Wisconsin-based CPM Marketing Group. They may be reached at marketing@cpm.com or 800-332-2631 x221.

[From the June/July 2005 issue of AnswerStat magazine]

Healthcare Call Centers Make Sense

By Mark Dwyer

Long hidden in back offices or basements, the healthcare call center is recognized today as an integral component of an organization’s success. It is now valued as a cost-effective tool to increase customer loyalty and boost patient revenue.

The value of healthcare call centers: Bill Woodson, director of marketing products for Solucient comments, “Hospitals need to realize that the contact center can be a huge and powerful way to interact with the community and to bring patients in the door. It is a primary touch point for a hospital.”  Solucient conducted a four-year, 25-hospital study in which it measured the value of the medical call center and found four primary results. Call centers were able to:

  • Drive revenue and profitability
  • Build patient loyalty
  • Support Customer Relationship Management (CRM) initiatives
  • Attract customers from the hospital’s target markets

In fact, the Solucient study found that call centers deliver a 3:1 return on investment when used strategically throughout the organization. This is significant.

The framework of a well-structured call center: A successful call center is one that leverages its capabilities across multiple hospital departments and the organization’s website. As the call center staff members come to learn the nuances of each department, they become increasingly more valuable to the organization. The fact that the weight management director has also overcome obesity, that the Lamaze instructor delivered twins last year, and that the director of your senior program has just celebrated her 70th birthday are all examples of personalized information that can be used to make a meaningful connection and successfully position the hospital in the eyes of the caller.

What’s more, the successful call center takes full advantage of each caller interaction. Up selling and cross-referral are among the benefits best managed by in-house call centers. Used for years in other industries, the practice of cross-referring callers to additional programs and services is only now becoming common in healthcare call centers. This can significantly increase patient loyalty and boost revenues.

For example, when the pregnant mom calls to see an obstetrician, the call center can cross-refer her to Lamaze classes, pre-natal exercise classes, and sibling programs, as appropriate, as well as pre-registering her for delivery. By performing this cross-referral process, each interaction with the caller is maximized, yielding greater return for the organization. “By the time the patient sees the doctor, the relationship is accelerated and the patient is more willing to give the ‘other services’ a try,” says Russell Coile, senior strategist at Health Solutions & Strategies Inc.

In addition, the best call centers today also exploit the capabilities of the Internet. Through use of the hospital’s website, the call center can develop relationships with callers, helping them to research health concerns, look for physicians, and enroll in classes. “Every web page should have a button that says ‘I would like to talk to a person about this problem’,” says Coile. “And that button should be linked to the contact center.”

Added benefits of an in-house call center: Call center staff that can offer local callers directions around town, within the caller’s “comfort zone,” greatly enhance the call experience. Knowing that the closest available facility to the caller may be beyond a perceived boundary such as a river or heavily traveled railroad tracks, allows the in-house call center staff to refer callers to facilities better situated to meet their needs. Doing so enhances the personalized relationship with the caller.

It is also important that the call center have the ability to make last minute corrections to information in the database. If a class is moved from the hospital to an off-site location, the customer-focused call center staff should place outbound calls to all registrants advising them of the location change. This seemingly minor task pays significant dividends in strengthening patient/hospital relationships.

What about ongoing updates to the physician profiles? Physician profiles must be updated regularly to enable callers to be referred to physicians best able to meet their needs. Referring callers to physicians who no longer accept their insurance plans not only frustrates the caller, it also creates unnecessary calls for the busy physician office staff.

Finally, truly valuable call center software can be customized to better meet both the organization’s needs and the needs of its callers. It can be modified to capture unique data elements of interest. This includes the development of custom reports and letters all done quickly and free-of-charge.

Options in staffing your call center: With the inclusion of remote communication functionality in most good call center software today, the once centralized call center can now establish remote users enabling staff to work from home. By running the call center in-house, it provides a career option for clinical staff no longer capable of, or interested in, doing hospital shift work. In this way, the organization is often able to retain individuals with great stores of knowledge regarding the hospital and surrounding community.

The bottom line: The benefits of a call center do not end when the calls are finished. Rather, how the organization makes long-term use of the data gathered impacts its level of success. The information gained through processing calls enables the call center staff to proactively reach out to its market to refer people to appropriate programs throughout their lifetimes.

The true bottom line of any call center is its ability to demonstrate ROI. With a good system that enables the call center to develop custom tracking reports, generating meaningful ROI data becomes a central component of the call center’s monthly activity.

By providing personalized service to each caller, the call center is able to boost patient referrals, increase program attendance, and expand the hospital’s reputation within the community. “If a call center can do all of these things, there is no question as to whether or not it will pay for itself,” says Coile.

Mark Dwyer is the VP of Business Development at LVM Systems, Inc. He can be reached at mark@lvmsystems.com or 480-633-8200, x275.

[From the June/July 2005 issue of AnswerStat magazine]

Meeting with Your CFO

By Joanne Cawley

Call centers are a familiar part of many U.S. hospitals. Some have been delivering community based services for decades, while others are still in their infancy. For both, funding is a tremendous strategic issue. Between employing qualified clinical and non-clinical staff and using the latest technology, call centers are often viewed as “cost centers” that make little or no contribution to the financial security of the organization. Those working within a call center know the kind of value that it adds to patients and the entire organization. However, in today’s economic climate, you should expect that your call center will be asked to prove its value to the CFO in real numbers. So, how can you demonstrate the value of your call center, the revenue it generates, and prove the worth of all of your efforts?

The Buck Stops There: One of the responsibilities of a CFO is to establish an overall strategy to reduce spending while increasing revenue. Although many people feel intimidated by the title “Chief Financial Officer,” this person can assist you in the definition of your call center business goals and help you determine the type (direct or indirect) and amount (percentage) of revenue you can claim for your existing call center services. The CFO should also be included in the planning process for new services so you can establish from the beginning both support for the program and agreement on the amount of revenue the call center may claim.

Keep in mind that every organization’s financial philosophy may be different when it comes to the call center. For example, it may be acceptable to one CFO to have the call center simply able to cover its costs or break even. Another may want the call center to show positive net revenue contribution. In some cases, it may even be acceptable to be an expense, as long as the call center is contributing to the overall mission or goal of the organization. But you will probably not get a clear picture of what that philosophy is until you meet with your own CFO.

After you meet with the CFO and understand what his or her philosophy is for the organization, you can begin tailoring programs within your center that bring in either direct or indirect revenue. Direct revenue are dollars that are paid directly from the buyer to the service provider and may be obtained from programs like class registration or after hours triage support for physicians who pay a set dollar amount per call. Indirect revenue refers to dollars generated or saved for other entities; it can be obtained by providing services for other departments to help them better manage costs and increase productivity. By working with your CFO, you can determine together a revenue recognition plan that will be credible and build the security and stability of your call center.

And the Winner Is…You! Using a revenue-tracking program can help you collect appropriate data and track revenue generated through services and programs. Working with your CFO to show how your call center has financially contributed to the overall organization will add credibility to the importance of your programs and services. It could even extend the life of your call center!

Joanne M. Cawley is the Marketing Communications Specialist for McKesson Health Solutions. One of their products is CareEnhanceTM Revenue Tracker (CERT).

[From the February/March 2005 issue of AnswerStat magazine]

Coping With Budget Cuts During Tough Times

By Joanne M. Cawley

In today’s economy, everyone is pinching pennies and watching costs. From large corporate CEOs to small business owners, regardless of the industry, people are nervous about budgets and bottom-lines. It is hard to predict how much longer this downswing will last, but until the markets start rising again, it seems everyone is holding their breath.

In the healthcare industry, many call centers are faced with a common problem: offering free advice to patients who do not need to seek immediate medical treatment. Although it is a “nice thing to do,” healthcare executives see potential income going down the drain. So what can you do to avoid budget cuts in your call center? More than you may think!

Plan Ahead! The services your call center provides are extremely helpful to the public. Without a consistent revenue flow, it may be hard for your management or hospital administration to justify spending money without a solid plan for earning it back. Prior to adjusting your current call center programs, review all aspects first and decide what you want to achieve with the call center. It is helpful to develop a plan that aligns the services of your call center with your organization’s overall objectives.

Once you have determined on which services you need to focus, begin communicating with your organization’s marketing, IT, and finance departments. Make them aware of your budgets, equipment, and staffing. Determine what you need from them in terms of support and resources. Make sure you can communicate a value proposition to them about what they will gain by supporting you. Plan ahead before meeting with these departments and carefully do your homework. Use the following checklist to help you prepare:

  • Call center evaluation report including budget, equipment, and staffing
  • Description of triage and marketing functions currently offered
  • Listing of staff reporting responsibilities
  • Current job descriptions and pay grades
  • Detailed explanation of formal guidelines and procedures

It is better to take this proactive approach than to be left out of senior management decisions. If you wait, you may find your budget significantly cut with no explanations.

Additional Tools: If you use a revenue reconciliation program, be sure to discuss exactly what types of financial reporting are considered useful prior to running reports. “Revenue trackers can really help, but you must have buy-in from the executive teams in advance to make sure the formulas used to calculate return are accurate and accepted,” says Kathy Divis, President, Greystone.Net, Inc. As with any reporting software, be sure to understand how the results are calculated should you be called upon to explain the outcome.

Can You Please All the People All the Time? Some healthcare administrations reduce costs by reducing or eliminating call center services like triage. Many call centers are changing the focus of their services from triage to marketing programs and services to bring in revenue. With call centers under a watchful eye, many are counting on programs such as disease management, class registration, and health screenings to bring in new patients while retaining existing patients.

On the other hand, if your call center is offering triage services, you are undoubtedly providing an extremely useful service to the population you serve – a service upon which many people depend. Proving the value of a triage service by demonstrating its ability to affect both soft ROI (return on investment) like loyalty and satisfaction, and direct financial ROI is important. Be prepared with revenue reports that link your services to the organization bottom line.

Although you may not be able to control the final decision, you can offer suggestions to keep triage part of your call center. Consider a compromise such as offering triage services after-hours only on a trial basis or look for alternative funding and revenue sources. See if there are ways to offset costs by bringing in revenue producing contracts. Be open to other ideas and alternatives. You may even try recruiting your staff for a brainstorming session.

Bottom Line: It should not be a surprise when programs and budgets are cut during tough economic times. Eliminating costly items saves the organization money, thereby improving financial stability. Although being handed down a reduced budget may feel personal, don’t view it as such; it’s business. Your best protection is to be prepared to prove how your call center adds value and contributes to your organization. Be flexible and think creatively!

Joanne M. Cawley is the Marketing Communications Specialist for McKesson Health Solutions.

[From the Summer 2004 issue of AnswerStat magazine]