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By Traci Haynes, MSN, RN, BA, CEN

During the last three decades, the prevalence of individuals being overweight or obese has increased significantly in both the United States and globally. In June 2013, the American Medical Association (AMA) officially recognized obesity as a disease. It was reported as a move to both encourage physicians to pay more attention to the condition and spur more insurers to pay for treatments. To date, obesity remains an epidemic in America and internationally as reported by the World Health Organization (WHO). Due to the rapid increase in obesity prevalence and the serious public health consequences, obesity is considered one of the most serious public health issues of the early twenty-first century (WHO, 2012).

The Trust for America’s Health, funded by grants and dedicated to saving lives by making disease prevention a national priority, conducted a study over a decade ago to determine the effectiveness of government action against obesity. The first edition of their report, F as in Fat: How Obesity Policies are Failing in America, was published in 2004. It stated, “Obesity had become an epidemic in America, and is poised to become the nation’s leading health problem and No. 1 killer” (Trust for America’s Health, 2004). It reported that nearly 119 million American adults, 65 percent of the population were overweight or obese, causing 400,000 deaths per year (or 45 per hour) and would soon overtake tobacco use as the leading cause of preventable death. It also reported that the percentage of overweight children had more than doubled and adolescents had tripled since 1980 and that these younger generations may be the first in American history to live sicker and shorter lives than their parents.

There has been an updated report published every year, and in 2007 the Robert Wood Johnson (RWJ) Foundation became involved, investing over $500 million to reverse the childhood obesity epidemic. In 2014 the report was renamed “The State of Obesity.” And in 2015 the numbers are still staggering. However, there is starting to be some improvement especially concerning building awareness, improving nutrition, and increasing activity in schools and in the communities.

The State of Obesity website provides “Fast Facts” on adult obesity and related disorders, obesity in children and teenagers, physical activity, healthy food, and racial and ethnic disparities. These Fast Facts report the ten states with the highest adult obesity rates are in the South and Midwest and most of the states with the lowest obesity rates are in the Northwest or West. The states with the highest adult obesity rates (over 35 percent) are Arkansas, West Virginia, and Mississippi. Colorado has the lowest obesity rate at 21.3 percent and the lowest rate of physical inactivity at 16.4 percent.

There are twenty-two states with an obesity rate above 30 percent, forty-five states are above 25 percent and every state is above 20 percent. Historically, in 1980 no state had an obesity rate above 15 percent; and in 1991, no state had a rate above 20 percent. Now, nationally more than 30 percent of adults, nearly 17 percent of two to nineteen year olds, and more than 8 percent of children ages two to five are obese. Nine of the ten states with the highest rates of type 2 diabetes are in the South and all twelve of the states with the highest rate of hypertension are in the South. For children and teenagers, seven of the ten states with the highest obesity rates for ages ten to seventeen are in the South, while seven of the ten states with the lowest obesity rate for the same age range are in the West. The four states with the highest obesity rate also have the most adults who don’t exercise (State of Obesity, 2015).

Not only is obesity a public health issue in the United States, which has the highest rate of obesity in the world, but it is also a worldwide problem. The WHO reports that worldwide obesity has more than doubled since 1980. In 2014 more than 1.9 billion adults ages 18 or older were overweight with over 600 million being obese. And most of the world’s population live in countries where overweight and obesity kill more people than being underweight.

Obesity was once considered a high-income country problem. However overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. More than 50 percent of the world’s obese population live in ten countries, which includes the US, China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan and Indonesia (WHO, 2015).

According to the National League of Cities, the estimated annual cost of obesity in the US is $190.2 billion. Obesity consumes nearly 21 percent of medical spending, and related job absenteeism equals $4.3 billion. Childhood obesity equates to $14 billion in direct medical costs (National League of Cities, 2015).

The Affordable Care Act of 2010 designated two recommended preventive services to be covered at no cost sharing to individuals. The first is dietary counseling for adults at higher risk for chronic disease; and the second is obesity screening and counseling for adults and children ages six and over. In November 2011, Medicare began covering intensive behavioral therapy for individuals with a BMI of 30 or more. Counseling may be covered if it is received in a primary care setting. It covers fifteen minutes of face-to-face individual behavioral therapy sessions or thirty minutes of face-to-group behavioral counseling sessions.

The food industry plays a significant role and could potentially be listed as a contributing factor to the obesity epidemic. Reducing the fat, sugar, and salt content of processed foods would help influence obesity, as would responsible marketing especially that aimed at children and teenagers. Ensuring healthy and nutritious food choices are available and affordable as well as supporting regular physical activity in the school and workplace is essential (WHO, 2015).

Obesity’s etiology is far more complex than simply an imbalance between energy intake and energy output, but this is how it is most commonly explained. In reality it is a complex disease with genetic, biological, economic, environmental, psychosocial, and behavioral determinants. Overeating relates to portion size, eating out, and eating fast food (less expensive), eating all day (a recent study reported many Americans eat fifteen hours per day and most of the calories are consumed after 6 p.m.), eating energy dense, or calorie rich foods, and eating disorders (bingeing, lack of satiety, food-seeking behavior, night-eating syndrome, etc.). Physical inactivity relates to a more sedentary lifestyle. Genetic syndromes such as Prader Willi and others, may affect hormones involved in fat regulation (e.g., a deficiency in leptin and the amount and areas of body fat storage).

Family history most often is attributed to the environment, but heredity can play a part in metabolic rate, spontaneous physical activity and thermic response to food. Age is another factor. As a person ages, there tends to be a loss of muscle mass. Also, physical activity often decreases, and since muscle burns (metabolizes) more calories there is a need for a decreased caloric intake. Foods specific to certain cultures and ethnic populations may be high in salt or fat.

Certain medications can also be a contributing factor, such as some anti-depressants, anticonvulsants, some diabetes medications, certain hormones like birth control pills, some antihypertensives, and most corticosteroids. Emotions influence eating habits, therefore psychological factors can also contribute. Environment plays a role in shaping habits and lifestyle. Driving instead of walking, increased technology for entertainment, and convenience foods have all had an impact on everyday life (Curry, K., Goldsmith, C., & Birn, C., 2015).

The two most commonly reported contributing factors to obesity is overeating and physical inactivity. Portion size today is two to eight times larger than the USDA or FDA standard. In 1955 a fast food restaurant introduced French fries with the original portion weighing 2.4 oz. and having 210 calories. Today, the large size of French fries is 7.1 oz. and has 610 calories. From 1982-2002 the average pizza size grew 70 percent. The average Caesar salad doubled in calories and the average chocolate chip cookie quadrupled in calories. Plate size has grown to hide the larger portions.

The surface area of the average dinner plate has expanded by 36 percent between 1960 and 2007 (Gunders, D., 2012). And the Cornell Food and Brand Lab reported that the serving sizes in the Joy of Cooking cookbook have increased 33.2 percent since 1996. A recipe that used to serve ten, now serves seven, or the ingredient amounts have been adjusted for the greater number of servings. Caloric density and a diet high in simple carbs and fats are also factors (Cornell University Food and Brand Lab, 2015).

Only about one-half of US adults meet the minimum guidelines for aerobic physical activity (150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise). Youth inactivity numbers are also accelerating, which results in increased health issues and cost. When school systems have to reduce expenses, physical education and sports are often cut back or eliminated. And research has shown inactive children don’t perform as well academically and that an inactive child will more than likely become an inactive adult. Video games and too much TV time is also socializing children to become inactive.

The most common complications and health risks associated with obesity include type 2 diabetes, hypertension, hypercholesterolemia, heart disease, stroke, gallbladder disease, gastroesophageal reflux disease (GERD), osteoarthritis, sleep apnea, and respiratory problems as well as some cancers (colon, endometrial, breast, lung, esophageal, and kidney). There are numerous other complications and comorbidities that would take pages to list, but would help one better understand the enormity of this disease.

The prevalence of obesity continues to grow in our country and worldwide. It affects everyone in some way but most profoundly affects those with the disease. Interventions are necessary to help control and reverse this epidemic. Supportive environments and collaborative efforts focused on reducing obesity and its comorbidities is essential, as is increasing efforts on prevention through massive public education in order to curb the medical and economic burden of this disease.

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

[Look for part 2 of this article in the June/July issue of AnswerStat.]

References

• Curry, K., Goldsmith, C., & Birn, C. (2015). Adult obesity in the United States: A growing epidemic.
• Gunders, D. (2012). Super-size, super waste: What whopping portions do to the planet.
• Kline, D.A., Goedkoop, S., & Bhimji, S. (2014) Regulation of body weight. com. 27(7), 42-47.
• National League of Cities. (2015). Economic costs of obesity.
• State of Obesity (2016). Fast Facts.
• The Cornell University Food and Brand Lab. (2015).
• Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants. The Lancet 387 (10026), 1377-1396.
• Trust for America’s Health. (2004). F as in fat: How obesity policies are failing in America.
• World Health Organization (WHO). (2012). Population-based approaches to childhood obesity. Geneva, Switzerland: Author.
• World Health Organization (WHO). (2015). Obesity and overweight fact sheet.

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By Charu Raheja, PhD

While there is no crystal ball we can look into to see how healthcare will be managed in the future, there are several clues that may provide a glimpse of the direction we should look and move.

In optimal circumstances, coordinated care is a well-accepted practice for providing quality healthcare. Unfortunately, conditions are not yet optimal, making truly coordinated health services a struggling endeavor. However, with proper planning and implementation, health call centers may be the unifying solution in the future.

Much has been written on the barriers to coordinated care and how a lack of communication, coupled with technological deterrents, remains at the top of the barrier list. In order to be effective, coordinated care requires convenient and timely communication between all parties, as well as the cost-effective and efficient access to a variety of technology channels. Fortunately, those channels are readily available and primed for effective use. All that is needed is a nucleus that organizes and shares pertinent patient information with all the members of the healthcare team.

Call Center Nucleus: By definition, a call center is “an office set up to handle a large volume of telephone calls, especially for taking orders and providing customer service.” Technology has changed the call center landscape whereby an increasing number of agents work from home rather than in a central office. But, the focus on customer service remains a primary characteristic. In fact, as customer expectations rise, call centers that emphasize agent training and performance are more likely to create better customer service experiences and become leaders in their field. Considering their position in numerous company processes, it’s not surprising that telephone agents can make or break an enterprise.

Call center agents play an integral part in every aspect of the business they represent. They are the primary channels between customers and the products or services they desire. They initiate orders and services, they are involved in quality control and customer satisfaction, and they share feedback and information between the company, suppliers, and customers. They are the hub on which all processes rely. As such, it is crucial that call centers stay up-to-date on business and consumer trends in order to be successful.

Trending Expectations: As the Internet provided consumers and patients with instant and easy access to a plethora of information, consumer expectations have risen dramatically. People now demand quality service from all sources. They are more likely than ever to quit doing business with a company that provides a poor customer experience. Trends indicate that customers and patients use online reviews, social media, and Internet searches to help determine where to do business. They want instant, 24-hour access to assistance and care, respect for their time, and multiple forms of communication, including Websites, online chat, email, text messaging, and mobile apps.

Coordinated care faces these same expectations from patients and their families, as well as the doctors, hospitals, and other professionals involved in patient care. The two main issues plaguing coordinated care have been the difficulties in 1) getting everyone involved to communicate and 2) developing cost-effective technology that can connect the myriad of electronic health information that exists across various platforms.

Solving these issues requires a standardized viaduct of information that can efficiently collect, analyze, distribute, and store patient data in a safe, convenient manner. While development of a software program that completes these functions is ideal, the numerous variables involved make it a daunting task. However, utilizing current resources and systems that are available and adaptable to business and consumer trends can help fill the gaps in coordinated care.

Coordinated Care Hub: Some triage call centers are already involved in numerous aspects of patient care and data sharing. They collect patient information, provide health-related protocols, inform physicians of patient issues, and assist in distributing appropriate information to approved members of the healthcare team. Those that are progressive focus on training their nurse representatives to provide quality customer service while following current trends in technology to reach patients and providers.

It would not be inconceivable to expand the role of health call centers so they serve as the communication conduit between all parties. Already, they provide a common language, can easily transmit information using numerous formats, and can store patient data received from healthcare providers and the patients themselves. This will require new data collection, updated procedures, additional training and staff time, and other adjustments. The potential benefits of expanding the role of call centers to serve as coordinated care intermediaries are definitely worth appraising in today’s dynamically evolving health care environment.

Future Care: It is important we recognize how the use of call centers has grown in the past decade and continues to expand. Additionally, the increasing need and demand for a coordinated process of patient care persists. If we recognize these developments as indicators of future trends, combining them to create a feasible solution to coordinated care issues may make for a healthier future.

Without a crystal ball, it is hard to say whether call centers will expand their role in coordinated care, but the “Magic 8 Ball” says “Outlook Good.”

Charu G. Raheja, PhD, is the CEO and chair of TriageLogic, a URAC accredited company offering web-based telephone triage software and nurse triage services. With a national footprint, TriageLogic has been providing affordable triage solutions for almost ten years for use in institutions and private practices.

[From the December 2013/January 2014 issue of AnswerStat magazine]

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By Richard D. Stier, MBA

At the recent SHSMD13 conference, Michelle von Dambrowski made the following comment about contact center solutions: “You guys are at the center of the whole shift to population health.” She gets it. The contact center can be vital to population health management (PHM) for your organization.

Healthcare call centers are now more relevant than ever. They are a pivotal tool in meeting the triple aim objectives of improving the experience of care, reducing costs, and managing the health of a population.

Call centers are moving from a siloed support function to a critical role as a communication hub at the center of the healthcare continuum. As stated in 2013 at the 25^th Annual Conference of Healthcare Call Centers, “The contact center is the nerve center at the heart of the new structure.”

A statement from the Society for Healthcare Strategy and Market Development (SHSMD) at their 2013 conference is likewise instructive: “The new role of marketing is personal health relationship management.” Notice the words relationship management. The call center is re-imagined as a central communication hub, the organization’s connection nerve center that assists the newly insured, supports ACO and medical home physicians, and creates economies of scale.

This communication hub is a vital tool for strengthening relationships with key stakeholders.

For Physicians: A key factor that pivots a CEO search away from an external candidate and toward an internal applicant is previously built physician relationships. “Having the trust of physicians is huge,” said Molly Gamble (“Notes from the Field: 7 Things to Know About Hospital CEO Searches” in Becker’s Hospital Review, October 11, 2013).

How can the contact center communication hub strengthen relationships with physicians?

• Ask physicians two key questions: “What can we do to help you succeed at our hospital?” and “How can our contact center better support for your practice?” Listen carefully to their answers.
• Provide navigation support by coordinating follow-up appointments and referrals to specialists and appropriate classes.
• Make referrals and appointments to primary care physicians for ED patients without a primary care provider.
• Facilitate physician consults for referring physicians with one call access to specialists.
• Schedule follow-up primary care appointments prior to hospital discharge.
• Conduct post-discharge follow-up calls to reduce avoidable readmissions, identify medication compliance problems, and determine durable medical equipment needs.
• Deploy evidence-based clinical triage and shorten appointment wait times by collaborating with physicians’ offices to hold a few priority slots for patients needing earlier appointments and document kept appointments.

For Payers: A key trend driven by payers is reference pricing. Reference pricing occurs when an employer or employer group identifies the average price charged for a particular procedure and agrees to pay that amount – and only that amount – with any overage paid by the insured. Now, there is a tangible financial incentive for the insured to find a provider who will accept the reference price. By October of 2013, only 8% of employers nationally were engaged in reference pricing, while 59% of employers across the country are planning to adopt it (Joe Flower, SHSMD13 keynote address, September 29, 2013).

For example, because of reference pricing, the average price for knee implants in California has fallen significantly. The California Public Employees’ Retirement System (CALPERS) identified that for their service areas, while the charge for knee implants ranged up to $36,000, the average price was $23,000. CALPERS set the reference price it would pay for knee implants at $23,000 and invited hospitals in its service area to participate. Initially, forty-eight hospitals signed on. Subsequently, six more hospitals signed up, deciding they would rather have $23,000 than nothing.

Employers across the country are taking note. Reference pricing is expected to proliferate across specialties. Here are ways the contact center communication hub can strengthen relationships with payers:

Become the communication conduit for reference pricing referrals:Research and understand reference pricing for each plan in your service area, and enter the participating hospitals into your contact center software. “Oh, yes, Mrs. Smith. I understand. You’re on CALPERS. St. ABC Hospital is a participating hospital for knee implant referrals. Would you like me to schedule an appointment for you with one of their affiliated physicians?”

Decrease ED utilization and related costs by providing telephone nurse triage to employer groups:For example, nurse-operated telephone triage programs that provide patients with prompt medical advice reduced ED utilization by 4.3 percent and produced annual net savings of nearly $400,000, (O’Connell JM, Johnson DA, Stallmayer J, et al., A satisfaction and return-on-investment of a nurse triage service, American Journal of Managed Care, 2001;7(2), pages 159-169).

In 2011, AtlantiCare provided clinical triage services through its access center to its own employees and their dependents. “As a result, just nineteen percent of those callers ended up in the emergency department; fifty-nine percent were treated at a lower level of care, primary or urgent,” (Society for Healthcare Strategy and Marketing Development SPECTRUM magazine, “From Silo to Hub: Not Your Father’s Call Center” May/June, 2013, page 10).

For Hospitals and Facilities: Integrate all first point of contact services such as scheduling, transfers, physician referral, class registration, physician-to-physician referral, nurse triage, and switchboard to reduce redundant costs. A key success factor is cross-training communication hub staff to provide all communication and navigation experiences.

Another opportunity to reduce redundant costs is to integrate multiple sources of physician information. We can no longer afford seventy-six sources of physician information. “A single source of truth is essential. Data exchange and HLS7 interfaces are a requisite part of the future,” said Joe Flower.

For the Community: The healthcare contact center is frequently a patient’s first interpersonal experience with a hospital or health system. The first three seconds of that interaction are critically important because that initial connection is a strong indicator of patient preference and subsequent hospital selection.

If your goal is to improve transactions, you’ve already lost. The future is about delivering transformative experiences at the first point of contact. Make the equivalent shift from coffee as a commodity to the experience at Starbucks or from shelter at a generic motel to the experience at Ritz Carlton. Role-play trust-building interactions before the first call and after every difficult call.

“PHM requires providers to connect with patients where they are,” said Joe Flower . Think of your contact center as an ongoing connection, a running dialogue with key stakeholders your organization needs you to influence.

SoLoMo: In addition to strengthening relationships with key stakeholders, the contact center communication hub must integrate with and personalize communications on social and mobile media. Social media, geo-location targeting, and mobile communications, or SoLoMo, enable contact center communication hubs to connect with key stakeholders where they already are.

Social

• Promote and register for upcoming classes and events
• Enable online physician referral
• Provide health information
• Post ER wait times with directions
• Support service recovery
• Recruit candidates
• Build an online community around the call center
• Monitor organization mentions or comments and respond as appropriate
• Engage with employees and key stakeholders

Geo-Location Targeting

• GPS directions to physician offices, urgent care, outpatient, and hospital locations
• QR code information on ER wait time and the ability to check-in

Mobile: Worldwide, by the end of 2013, there will be more mobile devices than people (Cisco’s Visual Networking Index Global Mobile Data Traffic Forecast Update). Additionally, there are currently more than 97,000 mobile apps available related to health and fitness (Research2guidance’s new report, Mobile Health Market Report 2013-2017: The Commercialization of mHealth Applications”).

Contact centers can offer the following services:

• Class/event information and registration
• Physician finder
• Symptom-based triage
• Drug reference guides
• Directions
• ER wait times
• Monitor and respond to mobile communications and clinical data feeds
• Mobile, SMS, and text appointment reminders
• Back up or support for Website and mobile site visitors
• “Face Time” enables triage nurses to observe patient responses and visualize an injury
• Patient access to physician appointments
• Virtual healthcare visits

Six Opportunities: Yourcontact center can be essential to population health management for your organization. Here are six immediate opportunities:

1. Integrate first point of access functions into a contact center communication hub that assists the newly insured, supports ACO and medical home physicians, and creates economies of scale.
2. Redeploy your contact center to serve as a trust-building resource for participating physicians.
3. Become the communication conduit to provide referrals for reference pricing.
4. Provide telephone triage and advice to employer groups to reduce ED utilization.
5. Shift your call center’s focus from transactions to transformations by creating memorable experiences at the first point of contact for your health delivery network.
6. Build a plan to leverage personalized social and mobile media opportunities.

Rick Stier has a thirty-year record of results as a healthcare marketing executive and consultant. He is vice president of marketing at HealthLine Systems, Inc., a provider of software and consulting solutions to over one thousand healthcare organizations across North America.

[From the December 2013/January 2014 issue of AnswerStat magazine]

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By Tim Moynihan

The Affordable Care Act won’t directly touch most Americans until 2014. For healthcare and insurance companies, the ACA touched down in 2010 with the realization that they would have to bring 48.6 million uninsured Americans into the healthcare system.

Contact centers will be on the front lines of this massive effort. Consumers will need help from phone-based customer service reps and interactive voice systems to determine which plan best meets their unique needs. Corporate customers will also require ready answers to complex coverage questions.

In response, healthcare companies are investing heavily in contact center technology. Many are migrating from traditional PSTN-based (public switched telephone network) environments to flexible session initiation protocol (SIP) environments that scale more cost-effectively. Others are adding IVR ports, creating menu options, and updating routing solutions to provide faster access to increasingly diverse choices of information and agent services.

With the public uncertain about the changes the ACA brings, much is riding on these contact center upgrades. Insurers and healthcare providers realize they must build trust through contact center operations. People need to feel safe and confident when making such life-affecting choices – especially those who are enrolling in a health plan for the first time. Companies sponsoring employee health plans need to know they are properly administered.

Dropped or incorrectly transferred calls, dead-end IVR menus, and voice quality issues damage these important trust-building opportunities. Expanding and reconfiguring networks inevitably causes these kinds of mistakes. However, they don’t have to cause problems with customers. Adhering to best-practice technology deployment and management methodologies reduces the number and severity of implementation issues, yielding smooth processes that build credibility.

Assess Readiness: Every technology implementation has issues: programming bugs, vendor delays, knowledge gaps, and more. However, contact center projects are uniquely susceptible to problems. Voice and video services are resource intensive, which means that every system must be properly provisioned, sized, and integrated to ensure a great experience. A four-phase, pre-deployment testing program helps identify issues with contact center systems before they affect users.

• Phase 1, Network Assessment: To start, organizations need to validate foundational elements to ensure that the carrier connection and IP network functions properly as a whole. This assessment should include a test of security vulnerabilities and the session border controller (SBC) configurations. Once validated, these tests provide important baseline metrics for evaluating performance as additional applications are brought online.
• Phase 2, Evaluating Real-Time (Synchronous) Communications: Voice, chat, and video services are highly vulnerable to quality issues, such as delays and jitter. Companies need to assess the performance of contact center applications (IVR, CTI, and routing) from the caller’s perspective and collect quality of service (QoS) metrics for each application. This phase is critical for revealing interoperability issues.
• Phase 3, Evaluating Non Real-Time (Asynchronous) Systems: Once real-time services are working properly, companies should then test the data-driven applications the contact center must support (such as email messaging and agent desktop applications). This phase helps companies determine if the additional traffic will affect the quality of real-time communications and ensure that all services are properly provisioned.
• Phase 4, End-to-end Validation: The only way to ensure a great experience is to evaluate the entire system under expected call volumes and traffic conditions. For example, if a company expects 1,000 concurrent calls and 500 concurrent chat sessions, the test needs to be configured accordingly. It is also important to test voice quality from the customer to the agent and back to the customer to ensure a clear conversation for every call.

Unfortunately, many companies view pre-deployment testing as a luxury and do not adequately plan for it. In fact, a study conducted by the Customer Experience Foundation revealed that poor or no testing increases cost and results in delay in 79 percent of all projects. To keep projects on time and on budget, it is recommended that companies allocate five to ten percent of the total project cost for pre-deployment testing. Sadly, the “agent pizza party” approach – employees making manual calls into the center – is not as effective as an automated, repeatable testing solution for assuring today’s more complex environments.

Provide Ongoing Assurance: In an ideal world, new technologies are released into product environments, and they work perfectly forever. In the real world, real-time communications and customer-facing solutions need to be closely monitored to maintain their performance. However, companies that only look at health statistics for their individual components do not get a complete picture. To understand customer experience, companies need a wider perspective with more meaningful metrics, such as:

• Call Blockage Rate: This measures how well customers can access services. When solutions are not working properly or the contact center cannot handle the volume of customer inquiries, calls are not answered. A high blockage rate has an immediate, negative effect on customer satisfaction.
• Call Abandonment Rate: High abandonment rates indicate application problems, incorrect routing latencies in back-end communications, or inefficient management of customer service resources. These conditions frustrate customers who are unable to get their problems fixed quickly and efficiently.
• Call Quality: Poor voice quality – low MOS (mean opinion scores) – reflects badly on any company. It also leads to an increase in call length when customers and agents cannot understand each other and are forced to repeat themselves. In extreme cases, customers will hang up and try again. Either way, these delays can be expensive to both customer loyalty and overall cost per call.
• Repeat Calls: This is a measurement of how many times a customer contacts the company before his or her issue is corrected. A variety of technical issues can lead to higher repeat call rates, improper routing, long queue lines, and dropped calls. This key performance indicator (KPI) also reflects how successfully agents are able to satisfy customers the first time.

The companies fully committed to quality take a proactive approach, using active monitoring to dial into the contact center and measure a wide range of customer experience oriented KPIs including response times, IVR availability, menu functionality, and voice quality. The results are compared to baseline performance measures. Any anomalies are automatically reported to the support staff for immediate investigation. Armed with intelligence on which test failed –and where – these companies can take corrective actions to minimize the negative impact on customers.

Prepare for Success: The variety and complexity of options makes it difficult for most individuals to choose the right health plan. In fact, a March 2013 poll conducted by the nonpartisan, nonprofit Kaiser Family Foundation found that 57 percent of Americans didn’t understand how they would be affected by the Affordable Care Act. Being able to have an informed, clear conversation with a knowledgeable service agent will go a long way towards giving people the confidence they need to make such an important decision.

These conversations will take place through contact centers and, by extension, contact center technology. Validating technology deployments through testing and monitoring is only one aspect of creating a reassuring experience, but it is one area that companies can control. Committing to best-practice quality assurance methodologies will pay off now and in the future as ACA regulations take effect and the estimated 48.6 million uninsured seek to comply.

Tim Moynihan is vice president of marketing at Empirix.

[From the August/September 2013 issue of AnswerStat magazine]

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By Mark Dwyer

One of the greatest fallacies of the Patient Protection and Accountable Care Act (PPACA) is thinking that assigning 32 million uninsured Americans to an independent or state run insurance plan will reduce the number of ED visits. This isn’t going to happen for a number of reasons.

First, these previously uninsured patients, despite now having insurance coverage, will find themselves in plans with insufficient primary care physicians (PCPs) willing to accept them due to full practices or an unwillingness to add patients with Medicaid’s reduced reimbursement rates. Unable to attain timely care, these patients will return to their comfort zone, the ED, in an attempt to receive treatment within hours instead of days, weeks, or months.

Further increasing the patient’s use of the ED is the current Emergency Medical Treatment and Active Labor Act (EMTALA) mandate that assures anyone who presents to the ED access to medical evaluation and emergent treatment, regardless of ability to pay. A recent National Ambulatory Medical Care Survey found that 4.5% of patients presenting at the ED were triaged as needing immediate evaluation, 11.3% emergent, 38.5% urgent, and 29% semi-urgent or non-urgent (defined as needing to be seen within 1-2 hours or later).

Does this provide an opportunity for the call center to play a role? Is it possible for the call center to safely triage select patients of this 29% semi- or non-urgent population to alternative, less-costly delivery locations? If so, it is estimated that avoiding hospitalizations for conditions treatable in ambulatory care settings could save the U.S. healthcare system $30.8 billion annually.

But, at what point must this redirection take place? According to the American College of Emergency Physician’s (ACEP’s) policy on medical screening of emergency department patients, the ACEP strongly opposes deferral of care for any patients presenting to the ED. The ACEP’s policy goes on to say that in cases where deferral is necessary, the hospital must have policies in place to ensure the patient has access to an alternative setting for timely, appropriate treatment.

A 2011 study of indigent patient care in the Philadelphia area conducted by Dr. Shreya Kangovi, PCP, at the University of Pennsylvania hospital, found that indigent patients were willing to wait for their condition to worsen, to the point of needing ambulance service to the ED, so they were assured access to care. A study in neighboring New Jersey by Dr. Jeffrey Brenner, director of the Camden Coalition of Healthcare Providers in New Jersey, identified additional perceived benefits of ED care. Patients indicated their preference for the ED due to the “one-stop-shopping” nature of the hospital. Ambulatory care requires travelling to multiple locations, and many indigent patients have limited or no access to reliable transportation.

Again, might telephone triage be used to avert these ED presentations altogether? But even if it could, Andis Robeznieks, reporter at Modern Healthcare, in an article posted July 8, 2013, pointed out that based on interviews with forty of the hospitalized low-income patients from Dr. Kangovi’s study, low-income patients have more trust in healthcare delivered in the hospital.”

So, what’s the answer? Can the call center work across the healthcare delivery system to team not only with area hospitals and PCPs but also emergent and urgent care centers, wellness and preventive care facilities, and other services often attained by Medicaid patients in the ED? If so, by creating a network of healthcare providers willing to accept and treat patients with lower paying insurance plans within reasonable timeframes, call centers can build trust in patients so they are confident in the information and resources provided and will act on it. Otherwise, it is estimated that the ACA, by increasing insurance coverage to individuals who in the past had none, will exacerbate the problem of ED overcrowding by an additional 134 million publically insured patients.

Mark Dwyer has 27 years of experience in the healthcare call center industry. He joined LVM in 2003 and serves as the company’s COO. Prior to that, he held senior positions in the areas of training, product management, and product marketing.

[From the August/September 2013 issue of AnswerStat magazine]

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By Kate Bolseth

Telephones have evolved dramatically since their development in the nineteenth century, and so has the telephone support role provided by operators. No longer manually plugging calls on a switchboard, today’s operators perform a more specialized role, especially within a healthcare setting.

The healthcare call center remains a public voice of the facility – the primary contact many patients, prospective patients, and visitors have with the hospital. Being the first interaction, there is a big responsibility to provide exemplary service and set the tone for an overall positive impression.

Pressure from the Healthcare Reform Act to reduce costs throughout hospitals is helping fuel new communication efficiencies that save time and improve patient care. With technology advances in the contact center have also come the added duties of managing code calls, emergency dispatch, and a general shift to assisting hospital staff streamline overall communications. More recently, call centers are gaining attention as potential revenue generators with opportunities to perform after hours answering services to other care providers.

Mobile Is the New Desktop: The widespread adoption of smartphones has dramatically altered the communication landscape. People can search a directory and locate a desired number themselves, no matter where they are.

Employees within healthcare facilities are a mobile bunch, and we are seeing many hospitals in the midst of transition, moving towards providing or supporting smartphone usage among their staff. Clinicians, an especially mobile group, expect to quickly and easily reach anyone they need to communicate with. Smartphones allow them access to staff directories and on call scheduling to facilitate the fast, easy messaging they want and need. The availability of information, effectively at the caller’s fingertips, means a significant increase in direct peer-to-peer communicating. This self-service model increases provider productivity, satisfaction, and efficiency; it also reduces internal traffic through the call center.

The reduction in caller traffic is important because it gives hospital operators the flexibility to spend more time on customer service and provide support for code calls and other messaging. Of course, the operator role as backup, with ability to step in and direct critical communications if other methods fail, remains tantamount to patient care and safety.

Clinical Initiatives and Emergency Response: Call centers in clinical settings are involved in multiple applications, and the operator role has expanded well beyond answering and directing phone inquiries. Call center staff are expected to have advanced skills in customer service, emergency dispatch, and messaging to support these other functions.

Acting as the nucleus of the hospital’s communications, contact centers announce code calls for everything from fires to infant abductions. Providing fast, accurate announcements is crucial to patient and campus safety, and they are not just for the intercom anymore. Code calls are more sophisticated and include instant messaging options – pre-programmed for notifying large groups of employees or specific groups, such as rapid response teams or code STEMI responders – on their mobile devices. These pre-written messages and notification trees save critical time in emergencies where seconds count.

Customer Service: Technology is certainly allowing call centers to do more with less. In addition to decreased call volume due to smartphones and staff access to internal directories, call centers are also receiving fewer internal calls because of speech recognition software. Speech recognition is able to direct many people to specific departments or care providers, leaving operators available to handle special requests and provide support for alternate services.

Call recording is another feature changing the landscape of contact centers. Call recording enables centers to document proof of correct handling for code calls and emergency responses. It categorizes calls to enhance new operator training, particularly in complex areas, such as emergency dispatch. Recording also helps identify opportunities for call handling improvement and for future automation to further facilitate call center specialization.

The ability to offer call center specialization and excellent customer service is becoming more important as hospitals and health systems compete with one another for customers. Beyond merely encouraging patients to select the facility for delivering care, call centers are increasingly looking to external primary care providers (PCPs) and other health professionals to supply additional revenue by contracting with the call center for after hours answering services.

Financial pressure on hospitals is giving rise to these creative revenue-generating solutions. Advanced operator consoles and Web directories mean call centers can process answering service calls from multiple locations and even provide individualized greetings for each incoming request (for example, answering with the name of the office the call is being directed from). An after hours answering service keeps operators engaged during low volume times and generates revenue for the department.

Virtualization: Technology has advanced to not only allow individuals mobile freedom and flexibility, but operators themselves are more mobile and no longer bound to a single, on-site facility. The trend among hospitals is to consolidate into health systems, and these mergers create opportunities to combine resources.

Geographical freedom allows multiple call centers to consolidate into a single hub, reducing overhead operating costs and space requirements. The technological advancements that permit consolidation are also enabling operators to perform their jobs from alternate locations, such as a home office or satellite centers, in the event of a disaster or other emergency.

Tomorrow: The role of the hospital in patient care is changing. Procedures that used to require hospitalization are now performed in outpatient clinics. Standard lengths of stay have been shortened, and patients are transferred home or to rehabilitation facilities sooner. Primary care providers, visiting nurses, and even insurance companies are delivering more continuing care management to monitor patients with chronic diseases and prevent the need for emergency room visits. In short, care delivery is moving to a broader continuum, of which the hospital is becoming a smaller piece.

These changes in the care delivery model will push healthcare operators further into areas of specialization, and call centers will offer nurse triage services, patient transfer handling, and appointment scheduling and reminders. Operators, like physicians, are likely to specialize in specific roles and many may have the flexibility to work from anywhere that they can connect to the web of information. The quest for additional revenue will continue and entirely new functions may soon be added to the extensive list of call center skills. The call center will change, but as the backbone of critical communications, it will remain an integral part of the healthcare environment.

Kate Bolseth is COO of Amcom and oversees Amcom’s operations across professional services, technical support, information technology, and human resources, reporting to the CEO and president of Amcom’s parent company, USA Mobility.

[From the February/March 2013 issue of AnswerStat magazine]

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By Monica Corbett

A new era for healthcare began October 1, 2012 with the implementation of the provisions of the Affordable Care Act seeking to reduce readmissions for congestive heart failure, pneumonia, and heart attacks.

The combination of rewards and penalties for those who are tasked with reducing costs and improving outcomes for patients is emerging as a principal driver of resource decisions by the spectrum of stakeholders.

Full-service health call centers, with their longstanding emphasis on appropriate care for particular symptoms and conditions, are ideally suited to support the use of remote resources as an integral part of health solutions in this new age. While there are multiple stakeholders interested in complying with the new world of healthcare, common issues are on the forefront and begging for innovative solutions.

What is the Market Seeking from Healthcare Call Centers?

Providers Seek to:

• Reduce costs by allowing case managers to handle more cases
• Reduce over-utilization of ER by redirecting to appropriate care
• Be more competitive and expand customer base by demonstrating better outcomes through patient-centered care
• Reduce hospital readmission rates
• Comply with Medicare accessibility requirements
• Achieve overflow and staffing gap coverage
• Offer concierge services
• Realize a good night’s sleep for physicians
• Provide community outreach
• Compile a matrix of data demonstrating results to increase funding opportunities
• Comply with Healthcare information exchanges and meaningful use standards

Payers Seek to:

• Reduce cost, including administrative costs
• Assess and monitor risk
• Deploy turnkey systems for the continuum of care
• Access matrices of data on conditions and outcomes
• Integrate operating systems for remote monitoring with core databases
• Increase productivity through behavioral and physical health
• Mitigate on-site injury and exposure solutions
• Reduce medical costs

End-Users Seek:

• 24/7 triage and health advice
• Convenience and access
• Concierge service and one-stop shopping
• Assistance with preparing personal health records
• Second opinions
• Referrals
• Health system navigation
• Behavioral health hotline
• Guidance for occupational exposures
• Remote healthcare to prisoners and others with restricted access

Use of Telehealth to Support Market Requirements

Heavy investment in monitoring devices by technology companies, growth forecasts by the major research companies, and successful pilot programs by the public and private institutions all indicate a major role for telehealth in meeting the above requirements.

A prominent example is the Whole System Demonstrator program, demonstrating the capabilities of telehealth and telecare, set up by the British Department of Health in 2008. It is one of the most complex trials ever undertaken by the Department of Health.

The program provides a clear evidence base to support important investment decisions and show how the technology supports people in order to live independently, take control, and be responsible for their own health and care.

Results from over 6,000 patients demonstrate that, if used correctly, telehealth can deliver a 15% reduction in routine visits, a 20% reduction in emergency admissions, a 14% reduction in elective admissions, a 14% reduction in bed days, and an 8% reduction in tariff costs. More strikingly, they also demonstrate a 45% reduction in mortality rates.

However, as George Tilley pointed out in the Aug/Sept 2012  issue of AnswerStat, “Impact of Telehealth and Remote Patient Monitoring,” specific protocols for selecting, specifying alerts, using appropriate medical guidelines, and documenting outcomes for remote monitoring of patients who are already quite ill have been lacking.

For some providers of remote services, as many as 41% of readings result in alerts, of which 90% call for an ER disposition. Tilley’s article outlined the efforts underway to develop and deploy appropriate protocols for remote patient monitoring to supplement existing triage guidelines as part of an integrated solution to the healthcare challenges outlined above.

In addition to deploying specialized protocols for remote monitoring and disease management, health call centers that are up to the challenge for an expanded role in the new medical age will need:

• Access to nurses, therapists, and doctors with specialties and licenses able to interact remotely with the beneficiaries of the organizations they serve
• Supervisors and senior level management experienced in remote care
• Advanced Web-based operating systems and triage guidelines accessible over the cloud by the remote clinicians
• Redundant Web-based and hard-wired communications networks

Conclusion

Health call centers that are prepared to meet the above challenges will become the nerve centers and personnel resource for telehealth.

Monica Corbett is the director of development for Fonemed Health Solutions.

[From the December 2012/January 2013 issue of AnswerStat magazine]