Tag Archives: outsourcing articles

Quality Contact Solutions named Top 10 Healthcare BPO for 2022

Quality Contact Solutions (QCS) shared that they have been recognized among the Top 10 Healthcare BPO Companies 2022 by Healthcare Business Review.

“We are excited to share that Quality Contact Solutions has been named a Top 10 Healthcare BPO for 2022 by Healthcare Business Review, a trusted source by healthcare leaders for information on managing healthcare business and operations,” said Julie Kramme, vice president of sales for QCS.

“With lower costs and increased efficiencies, business process outsourcing (BPO) is the perfect solution for healthcare organizations,” added Kramme. The QCS team can support the various needs of their clients in the nuanced healthcare industry.

Quality Contact Solutions is an industry leader in call center and telemarketing services solutions, including B2B and B2C programs. QCS offers many telemarketing services, including outsourced sales, upselling, cross-selling, surveys, lead generation, sales lead qualification, appointment setting, inside sales, and inbound customer service. 

From Efficiency to Experience: Three Major Benefits of a Medical Call Center Partnership

A medical call center partnership contributes to organizational efficiency

By Karen Brown

Organizational efficiency is defined as the ability to implement plans using the smallest possible expenditure of resources. It is an important factor in organizational effectiveness and vital to the healthcare industry which continues to experience increasing operating costs and smaller bottom lines.

Medicare expansion and the ACA have contributed to significant increases in patient populations that are expensive to treat and provide minimal financial return. This increase can strain an organization seeking to provide adequate post-discharge care, which can result in costly avoidable readmissions.

As patient loads and associated risks increase and reimbursement decreases, the ability to achieve organizational efficiency becomes more and more challenging. However, providing the highest possible quality patient care at the lowest possible operating expense can be possible with the assistance of a medical call center. By partnering with a call center’s team of registered nurses specially trained in telephone triage, organizations can save a significant amount of time and cost associated with adding staff while reducing the risk of unnecessary readmissions and inappropriate utilization of care.

Telehealth and Related Services Are a Large Part of a Bright Future

It is no secret that telehealth services and telemedicine are becoming increasingly popular due to the financial benefits they provide. Combined with federal policy changes (MACRA and MIPS) that address care planning and risk assessment—significantly effecting reimbursement in the process—telemedicine is poised to drive more revenue from virtual care directly to hospitals and healthcare organizations. And this is just the beginning. According to a recent report from Grand View Research, the telemedicine market is expected to top $113 billion by 2025.

While telehealth currently focuses on a range of primary care services, the rising occurrences of chronic conditions, as well as the increasing demand for self-care and remote monitoring, are significant factors driving telehealth growth. Healthcare organizations that add new primary care options will be able to reduce costs and create new services, while remotely offering existing ones to more of their patient populations.

Partnering with a medical call center provides a healthcare organization with access to established chronic care, self-care, and remote monitoring programs, eliminating significant labor costs. It is vital to find a call center with outbound service offerings that include a variety of chronic care and follow-up, as well as post-discharge call programs, including prescription/medicine reconciliation, self-care plan adherence, and follow-up appointment scheduling.

Patient (and Provider) Satisfaction Equal Quality of Care

In today’s world, people have a multitude of choices when it comes to their care. Because of this, it is vital for healthcare organizations and providers to get every aspect of the patient experience right. Providing the correct medical care is not the only factor contributing to a positive experience. From the initial appointment setting call to the final communication between a patient and provider/organization, every experience contributes to the overall satisfaction and quality of care a patient receives.

One of the largest factors contributing to patient satisfaction is access to care. We live in a 24/7 world, and having access to definitive medical care always is a standard patient expectation. Providing that level of access is challenging and often costly; not providing that level of access leaves patients feeling less empowered and engaged, which in turn can lead to poor experiences and even poorer satisfaction scores. A partnership with a medical call center gives patients access to definitive medical care 24/7/365 at much lower costs.

Another factor contributing to patient satisfaction is the quality of relationship with their caregivers. Patients expect to be engaged in decision involving their care. This includes open communication with nurses and providers involved in that care. If patients do not feel as though their concerns have been heard and taken seriously, they feel less confident in the care they receive, resulting in a negative experience—even if the outcome is positive.

It is not uncommon for providers to become overwhelmed with consistently increasing workloads in a 24/7 environment. This can lead to frustration and burnout, which is often evident in their interactions with patients. Utilizing a medical call center to cover all after-hours calls carves the 24/7 access out of the provider’s core responsibilities.

This is a powerful physician recruitment and retention game changer. In short, happy providers have more positive interactions with their patients, which result in higher patient engagement and satisfaction.

While no healthcare organization wants a patient to have a negative experience for any reason, there is a new factor regarding patient satisfaction that demands attention. Since the inception of value-based purchasing, the definition of a successful patient experience has been redefined. Now, 30 percent of the overall quality of care is attributed to patient satisfaction. This means patient satisfaction survey scores directly impact an organization’s bottom line.

The shift to pay-for-performance also means that reimbursements are tied to the quality of care that is delivered. Hospitals that provide a higher quality of care than their peers will receive reimbursement incentives, and hospitals that provide a lower quality of care will be penalized.

This is perhaps the most beneficial aspect of partnering with a medical call center. Providing positive experiences for both patient and provider can drastically improve overall patient satisfaction and outcomes, leading to a higher overall quality of care and the related financial rewards.

Ultimately, the provision of appropriate, quality care to achieve positive outcomes is the goal of all healthcare organizations. Making that a possibility, while considering organizational needs, government regulations, and patient experience can be difficult and costly. Partnering with a medical call center provides access to high quality care at the lowest cost possible.

The TeamHealth Medical Call Center is the premier provider of medical call center solutions—including telephone nurse triage services. They provide services to more than 10,000 providers, health plans, home health, hospice organizations, employers, and universities across the United States. Karen Brown, RN, is the vice president of business development for the TeamHealth Medical Call Center. She has more than twenty-five years of senior management experience in healthcare.

A Day in the Life of an Offshore Medical Coder

By Dr. Liza Alcances, MD

The life of medical coders is completely different from the life of clinicians. Weekends are usually free, the shifts are fixed, and there are not a lot of different activities that fill their days. Coders may miss the exciting work of hospital duty, unique patient complaints, and endless rounds, but there is something to be said about an organized and sedate work life.

An Early Start: Most medical coders work days. A few companies require their coders to work nights, parallel to their US counterparts. Day shifts start as early as 7 a.m. This means that coders have to wake up early, allow for adequate travel time, and get to their offices on time. The dress code is usually business casual, so dressing for work depends on the coder’s fashion sense.

Life on the Production Floor: Each coder works on a computer, either a desktop or a laptop. Most will have the codes already in the software, removing the need for using hard copies of the manuals. Depending on the project, coders can be assigned cases directly from the system they’re using or assigned charts by their supervisor or team leaders. Quotas are set depending on the type of coding they do.

Generally, outpatient coders work on more patient charts, and inpatient coders work on a lesser number of charts. They are not allowed to pick the charts to work on, and so they gain experience working on a wide variety of cases. They must also finish the work assigned to them or meet the required quota, so the coders must stay focused and manage their time. Since they work on protected health information (PHI) and must meet US privacy standards, mobile phones are not allowed on the production floor.

Breaks and Lunch: Two short breaks are given, one in the morning and one in the afternoon. Coders may use the time to take snacks, smoke, have a power nap, or go to the break rooms or to the pantry. Many companies provide indoor entertainment devices, like game consoles, table tennis, foosball, and the like. Some have quiet rooms, meant for sleeping.

Lunch breaks are longer. Most would have their own canteen, and many companies are situated in areas near commercial establishments. Coders won’t go hungry, and usually have enough time to get some coffee or dessert after lunch.

Home Sweet Home: Since coders start their day early, they also end the workday early. Most are usually off by 4 p.m., leaving them ample time to spend with their family or indulge in other activities. Of course since they have to go back to work early the next day, they also go to sleep early.

Other Activities: Audits and team meetings are common occurrences. These are done with their superiors and sometimes with their US counterparts. The quality of their work must be top-notch, and companies require at least about 95 percent accuracy in their coding.

Companies usually hold town hall meetings quarterly. They also schedule team building sessions, family day, sports fests, and other activities that allow coders to release stress. Some companies sponsor seminars and appoint management trainees so that coders will have additional skills that they can use to better themselves and to help the company.

In Summary: The life of a medical coder isn’t something the entire healthcare community is aware of. Medical coding is a specialized occupation, requiring specific knowledge and high analytical skills. There are many challenges but also many opportunities. Some might think that the coder has a boring desk job, but as one of the occupations highly desired in the healthcare BPO, it can also get exciting.

Dr. Liza Alcances MD, RN, CPC, CPC-I, CIC, is the assistant manager, training—healthcare at TeleDevelopment Services.

Three Areas to Explore When Outsourcing Clinical Call Services

By Karen Brown

The Affordable Care Act’s focus on 24/7 patient access to care has created a need for established non-clinical call centers to consider adding these services. The cost and expertise required to develop a clinical call center make it worthwhile to look at an outsourced partnership.

Without intimate knowledge of these services, the discovery to find a partner that meets the organization’s needs can be a daunting task. However, exploration of three main areas can give a non-clinical call center much of the information required to determine the right partner.

Quality and Experience: Look for a clinical call center that has been URAC-certified for a number of years, preferably without recommendations for improvement. There should be at least one medical director who is board-certified in the appropriate clinical specialty and active in all clinical aspects. If pediatric triage is offered, a board-certified pediatric medical director should be in a program leadership role. There should also be a physician or master RN leading the clinical quality program. The medical director should be available to discuss his or her involvement with the program and be prepared to share actual service level and quality benchmarks, including complaint data and the complaint process.

A clinical call center should have a dedicated trainer, specific training programs, and a separate training area. A reputable outsourced call center with multiple clients and high clinical standards does not do “on-the-job” training. A quality clinical call center also uses preceptor ship and test for competency before employees are deemed competent to be on their own. Inquire about the ongoing training program and any specialized competency programs that are in place.

High-quality industry standard clinical decision tools and clinical information should be embedded in the clinical call center system. Ask to see samples of the guidelines used and information about the authors of these guidelines. Find out how the call center interfaces with providers on call.

Quality and experience go hand in hand. The number of years in business and the annual call volume in the specific service line you plan to outsource are just two of the markers you will need to compare vendors. Also look closely at the tenure of the call center’s current clients.

Seamless Delivery: Your objectives and service delivery benchmarks should be mirrored in the service delivery of the outsourced provider. You want a clinical partner that can seamlessly provide the services you are offering. If you provide physician referral and class scheduling along with nurse triage, the clinical nurse triage component should be able to seamlessly transfer the caller to the non-clinical component. An outsourced clinical call center should understand and train their staff about the client’s culture so the caller feels the same quality of customer service from both organizations – yours and the outsourced provider.

The ability to customize processes and directives at different points of the call encounter is crucial to a seamless delivery. Ask for a software demonstration and review your customizable options.

Account Management: An account manager is your champion in the service partnership. The clinical call center should provide a dedicated and experienced individual to oversee all aspects of your outsourced relationship. This individual should be involved from the beginning with the implementation phase and should work with the clinical project manager to ensure that service requests, customizations, and reports are postured to meet your objectives. You should expect a schedule of ongoing regular communication and availability from your account manager.

Due diligence in these three service delivery areas will have you well on your way to choosing the right partnership for your organizations.

Karen Brown, RN, is the vice president of business development for TeamHealth Medical Call Center, a provider of telephone nurse triage services. She has twenty-five years of senior management experience in healthcare.

[From the June/July 2014 issue of AnswerStat magazine]

It’s Your Call: Outsource Calls for Leaner, More Effective Healthcare Delivery

By Steve Whitehurst

As I look out my window and watch one season steadily give way to the next, I’m reminded that healthcare is undergoing a seasonal change of its own. Reimbursements are drying up; consolidation is heating up. Patients are increasingly approaching healthcare with a consumer-oriented mindset, expecting – even demanding – a higher quality experience.

For most healthcare organizations, boosting revenue is no longer a matter of simply performing more procedures. Healthcare’s historically volume-based way of doing business is evolving into value-based models, placing higher priority on preventive care and overall patient wellness. Economic success in this environment requires not only providing the best services to those who are sick but also attracting healthier patients who bring better reimbursement opportunities.

To do this, organizations need to focus on the clinical and operational tasks that generate the highest return on investment (ROI). Clinically, this means identifying and leveraging treatments that deliver superlative outcomes, which in the future will largely be determined by the makeup of the patient population. As such, providers will need to allocate time and resources to effectively manage patients who are well, patients who are aging, patients who are critically ill, and so forth.

To do all of this efficiently, today’s healthcare organizations must optimize their operational processes. In many cases, this means taking a critical look at operational tasks and determining which processes should be outsourced to support enhanced patient satisfaction and retention as well as a better bottom line. Consequently, a strong case can be made for healthcare organizations to seek the guidance of a call center partner to optimize operations. In the midst of an increasingly challenging and competitive environment, many successful healthcare organizations – from smaller group practices to multi-hospital networks – are working with call centers to bolster administrative efficiencies, which enable them to do more with less and to keep their focus on delivering high-quality patient care.

Outsourced Call Centers: An Ideal Strategy: Fielding patient calls 24/7 can be a significant pain point for practices, hospitals, and health systems. While a few major healthcare organizations may have the infrastructure and financial wherewithal to control their own in-house call operations, this is not a core competency for most. To put it simply, building and maintaining such an operation is an expensive and labor-intensive proposition – one that often does not yield a high return on the dollars invested. Moreover, patients become frustrated when communication with their providers is not seamless, yet the growing patient demand for 24/7 accessibility is difficult for the majority of healthcare organizations to handle and staff internally. Finally, particularly in smaller practices, the staff members who take patient calls also manage a wide variety of other clinical and administrative tasks. As a result, typical call center duties can take their focus away from delivering high-quality patient care.

Most in-house call centers – and even many other freestanding services – are not set up to address the patient communication needs required across the full continuum of care. Consider, for instance, how call center operations can be used to help patients find a provider and help healthcare organizations acquire new patients, which directly affects an organization’s revenue. For example, if a patient calls a specialist’s general number listed online, the person who answers may not have the right information to offer the patient beyond just the name of one of its specialists who meets the patient’s desired criteria. In this scenario, the call will likely end before an appointment is made, making the healthcare organization’s chances at acquiring a new patient lower than if the organization had been using a call center.

By contrast, an outsourced call center with sophisticated technology and staff resources can turn a prospective patient call into a scheduled appointment – and a new patient into a regular patient. Call center operators with the right tools and training can suggest multiple provider options, book the appointment, remind the patient of the appointment, and follow up after the appointment to gather feedback about how the appointment went. What’s more, many outsourced call centers have the resources and technology available to capture, centralize, and measure call data against a healthcare organization’s goals – such as new patients per service line – which in turn can drive ongoing communication improvements.

Using this model, patients are engaged and managed throughout the entire continuum of care: from appointment scheduling and follow-up to education and retention. This is accomplished more efficiently and more cost-effectively than can be achieved by a healthcare organization’s limited internal resources. A robust call center partner can improve a healthcare organization’s patient access to care by moving more patients into the organization faster while simultaneously enhancing patient satisfaction by communicating with patients every step of the way.

ROI: Beyond Dollars and Cents: There is no question that delayed or unreturned messages – as well as a number of other communication gaps – can irritate patients, leading to the very real potential for revenue leakage as dissatisfied patients seek care from competing providers. As a result, this is why one Chicago-based health system looking to streamline operations and reduce costs recently decided to tap into the efficient infrastructure and professional expertise of a dedicated call center. By consolidating and standardizing its after-hours telephone services, which previously had been spread among multiple vendors with wide variations in service quality and reliability, the health system saved more than $1 million.

Along similar lines, a West Coast academic medical center with two hospitals and seven outpatient centers enlisted a call center partner to take over the appointment-scheduling services for its radiology department. Challenges for the department, which handles approximately 16,000 cases per month, traditionally included long wait times for patients on the phone, call abandonment rates exceeding 10 percent, and difficulty attracting new physician groups due to poor scheduling and patient accessibility.

The solution, which included a process redesign to streamline incoming calls and provide standardized metrics to measure improvements, resulted in call abandonment rates falling below 4 percent and the recovery of more than $7 million in annual revenue. In addition, the organization saved more than $700,000 per month in administrative costs simply by reducing the number of staff-answered calls.

Despite this, ROI from engaging a call center partner need not be measured exclusively in dollars and cents. For the West Coast radiology department, patient and physician satisfaction also has increased as access for patients has improved.

Additionally, a truly effective call center should generate data that can be used to enhance outcomes, as well as facilitate advances in patient acquisition and retention, management, and spending. Some call center partners offer detailed reports providing insight into essential business drivers like performance levels of service lines, effectiveness of community marketing campaigns generating revenue through classes and other public events, and increased levels of patient acquisition from preventive clinical services, such as breast-screening reminders.

What’s more, by providing comprehensive, data-enriched services, a call center partner can help healthcare organizations indirectly increase ROI by ensuring that in-house staff remain focused on their primary mission of delivering a high-quality patient experience. Ultimately, enhancing the patient experience is likely to lead to greater patient satisfaction and engagement, as well higher HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, which works full circle to attract more reimbursement and more patients.

Better ROI, Better Patient Care: Changing clinical and market dynamics demand that today’s health systems, hospitals, and practices leave behind volume-based models of care delivery for value-based models. This means they must focus on identifying those processes that generate the best clinical and financial outcomes, as well as increase ROI.

Against an increasingly challenging and competitive backdrop, high-quality call service operations can streamline operational efficiencies, enhance the patient experience, reinforce a positive brand image, and improve patient retention. They can help healthcare organizations of all types and sizes do more with less, allowing them to keep their focus on delivering the highest quality patient care.

Steve Whitehurst is vice president and general manager of Stericycle Communication Solutions.

[From the June/July 2014 issue of AnswerStat magazine]

Healthcare and Outsourcing

By Sandip Sen

Healthcare is not a field that can afford to broach any compromises on quality of customer care. As a healthcare provider, you need to take strategic business steps in the near-term to better manage your revenue streams and operating costs. Customer care does not need to suffer as a result of this strategy and can be turned over to experienced vendors.

Outsourcing is a strategic, cost-effective solution to manage costs while providing high levels of customer care. Deciding to outsource and choosing a business process outsourcing (BPO) vendor can be daunting tasks. Businesses are under pressure to find an outsourcer with extraordinarily high quality standards. While a vendor may cut on unnecessary costs, be wise to ensure your vendor doesn’t cut corners on the elements most important to you and your patients. Approach the relationship as a partnership rather than a vendor-client engagement. Here are a few critical attributes to look out for while choosing a responsible BPO partner:


The foot soldiers in customer care are the call center agents. They need to be surrounded by support such as training, quality assurance, and feedback. Start with training. Are your call center associates licensed to provide the right level of care? A good BPO partner should be able to hire call center agents with relevant skills and experience.

But how does it accomplish this quickly and efficiently? One solution is to hire professionally licensed associates with existing home-state licenses. One healthcare client reported that hiring licensed agents saved them $1,000 to $1,500 per person in billing time and training costs because agents did not have to be trained for the licensing examination. This procedure also keeps you out of the unpredictable and time-consuming licensing process.

Your BPO partner should look for highly qualified candidates with a background in the healthcare industry, experience in customer service, and a record of accomplishment in previous jobs. Once hired through a stringent selection process, experience shows that well-qualified agents usually exceed clients’ expectations. Licensed, well-trained, and high-caliber performers put your BPO partner in position to meet the key performance indicators you set.


Retaining associates is an essential task of outsourcing – ideally, the BPO partner would keep its employee retention rate high by using employee incentive programs and setting the right job expectations among employees. Successful BPO partners have run daily incentive programs based on performance metrics or attendance to boost employee retention.


Agents are on the front lines, so it is important for a responsive BPO partner to encourage feedback from agents, as well as their supervisors. Such feedback is important to detect customer issues at a grass roots level.

Compliance and Certification

All BPO partners need to be compliant with the healthcare regulations that their clients follow. The outsourcing industry has certain certifications, and those possessing them tend to have more rigorous measures of performance quality. SAS70 (Statement on Auditing Standards (SAS) No. 70, Service Organizations), developed by the American Institute of Certified Public Accountants, is widely recognized because it represents that a service organization has conducted an in-depth audit of their control objectives and control activities, which often include controls over information technology and related processes. A responsible BPO partner should also have Payment Card Industry (PCI) and International Standards Organization (ISO) certifications, such as ISO 9001:2008.

Real-Time Adherence

BPO partners deploy real-time adherence technology that enables their clients to track differences between agent schedules and current agent activities in real-time. The automatic call distributor that supplies agents with calls also monitors their activities and enables supervisors to track the status of each agent. This technology has grown to become a client requirement because it affords visibility into the BPO partner’s operations process.

Emergency Support

Expect a BPO partner to keep their agent schedules flexible enough to provide emergency support during times of call-volume spikes, such as during open enrollment periods or in the wake of natural disasters. A good partner should be able to induce real-time changes to agent schedules to derive all the support it can out of the existing employee reservoir. Just as healthcare facilities staff up during peak periods, a BPO partner should also staff accordingly.


A BPO partner should proactively align its own schedule with the clients’, considering the seasonality and unpredictability of the healthcare business. As traffic ramps up for season peaks, the seasoned agents will return to the client campaign in time for the peak, reducing time spent in hiring and training employees.


A BPO partner’s capability amounts to the quality of its resources. As a member of the healthcare industry, search for an outsourcer that recruits agents quickly and effectively, providing the highest level of performance quality. The vendor should also be able to structure the schedules of their agents to meet client requirements. Make the relationship between a healthcare client and a BPO partner one of flexibility and understanding in order to provide the best experience for your patients.

Sandip Sen is president (Americas) and chief marketing officer with Aegis Global Communications.

[From the February/March 2011 issue of AnswerStat magazine]

Build Versus Buy: Considerations for Call Center Outsourcing

By Paul Spiegelman

Most of today’s forward-thinking hospitals already have some type of marketing call center in place. Whether it’s one or two people staffing phones in-house, a sophisticated outsource call center partner, or something in-between, hospitals have caught on to the inherent benefits of having a central location for community members to find physicians, register for classes and events, or simply get directions to the facility.

Historically, budget has been one of the key factors in determining the size and complexity of a call center. It has also, at times, been a significant driver in deciding whether or not to outsource this important function. To help you decide between operating a call center internally or selecting an outsourced partner, this article will look at important factors to consider.

Call Center Considerations

A call center should be an integral part of your customer outreach and marketing operations. As it is often the first point-of-contact for a new or potential patient, a call center is a prudent investment and, when used efficiently, can measure the return on investments for all of your marketing efforts. In fact, Solucient’s most recent call center survey revealed some imposing statistics that illustrate the importance of hospital call centers:

  • Forty percent of callers are new callers.
  • One in four callers will have an inpatient discharge or outpatient visit within 12 months of the initial call.
  • The retention rate (multiple visits to the hospital) of callers over three years is 70 percent, compared with 46 percent of non-callers.

Through our own work over the past two decades – and based on interactions with more than three million customers a year – we know that:

  • Consumers value accessibility, convenience, and customer service.
  • Around-the-clock availability can set one hospital apart from a competitor across town.
  • The burgeoning use of the Internet has compelled more call centers to integrate online communications with their existing telephone operations.
  • Consumers should be able to interact with you in the most comfortable and convenient method.
  • An investment in the hospital call center supports marketing efforts, increases patient loyalty, and attracts responsive patients; all of which help drive revenue.

In short, whether looking to implement a call center for the first time or reevaluating an existing arrangement, the impact that a call center can have on hospital revenue, profitability, and patient loyalty cannot be overstated.

Call Center Costs

In deciding whether to “build” or “buy” your call center, you first need to assess all costs associated with either option. Some of these costs may not be immediately apparent. The following six steps, however, can guide you through the process.

  1. Make some basic determinations. How many calls do you receive or are you anticipating each month?  Do these calls generate outgoing letters?  If so, how many each month?  Approximately how many minutes are spent on the phone each month?  If you have an internal call center now, how many call advisors do you currently have? How many supervisors/managers work in the call center?  How many IT staff support the call center?
  2. Look at the costs associated with setting up and maintaining an internal call center. Each call advisor needs furniture, a telephone with headset, routing system, computer, software with individual licenses, and a printer. An internal call center requires its own servers, adequate phone lines, and high-speed Internet access. The entire call center staff needs training (both initial and ongoing) and support. Don’t forget that someone will be needed to maintain all of the equipment.
  3. List the direct expenses associated with a call center. This includes salary and benefits for all of the staff needed to operate a call center, including supervisors, managers, and multi-lingual call advisors. Also include any support services, such as IT. Other call center costs include annual software license fees, office supplies, and postage for outgoing letters generated by the call center.
  4. Determine the indirect costs. These expenses include rent, utilities, real estate taxes, accounting, HR, facilities support, insurance, workers’ compensation, professional liability, and commercial and excess liability insurance.
  5. Add up all of the set-up, direct and indirect expenses to determine total call center cost.
  6. Divide total costs by call volume (actual or projected) to establish an average cost per call.

Once you have determined the costs to operate an in-house call center, you now have a frame of comparison. Contact an outside call center provider – one whose reputation is one with which you feel comfortable – and ask them to provide you with their fees based on the same anticipated call volume and needs you used to calculate your in-house expenses. Also ask what additional “value added” benefits they bring should you choose them to be your outsourced partner. You’ll also need to make sure you do an apples-to-apples comparison. For example, if you are considering a 24/7 operation, you need to determine the internal costs in order to compare them to an outsourced provider.

Outsource Call Center Capabilities

A call center can and should be more than just a sum of its operating costs. A well-designed call center that has accountability built into its core can propel a hospital toward greater revenues and increased market share. Because outsourced call centers pride themselves in customer service and customer relationship management, they often can deliver value-added services that cannot be replicated in-house. An outsourced call center partner should be able to:

  • Expand your hours of operation.
  • Increase your service levels (make sure all calls are answered promptly).
  • Expand your service offerings through technology that may not be affordable otherwise.
  • Expand the languages you support.
  • Introduce you to like hospitals and share best practices.
  • Benchmark your organization against others in the industry.
  • Use your database as a real CRM (customer relationship management) platform.
  • Create revenue reconciliation reports that show a correlation between callers and patient visits.
  • Have the flexibility to grow with your changing needs.
  • Meet your customer service standards.

In addition to having it be financially sound and having the outsourced partner bring value-added benefits, another reason to consider outsourcing is that hospital resources can be freed up for other purposes. An external partner enables the hospital staff to focus on what they do best – provide top-quality medical care to their community.

Paul Spiegelman is founder and CEO of The Beryl Companies.

[From the August/September 2006 issue of AnswerStat magazine]

Critical Questions to Ask Before You Outsource

By Richard D. Stier, MBA

This article addresses the fundamental question, “How can you know if you should outsource your healthcare contact center?” It identifies five key questions you need to answer to make the best choice. Your decision to own or to outsource your contact center has a profound impact on your organization’s effectiveness and bottom line. Knowing the answers can help you avoid the loss of return on investment (ROI), of competitive advantage, and perhaps even your career options.

Question 1: What is the purpose of your contact center?

What is the core reason your organization has or desires a contact center?

Perhaps the purpose of the contact center in your organization is to provide a community resource. A community resource contact center provides physician referral, class and event registration, and information. Metrics include activity indicators such as the number of interactions, number of calls, number of referrals, the number of people served. The focus is a general connection, a community service with mostly inbound transactions, generally by telephone. It is most often marketing-centered. It is a generic service that reports activity, not outcomes. A community resource contact center is easily and appropriately outsourced.

Possibly the purpose of the contact center in your organization is to drive incremental revenue and market share.

Targeted growth contact centers create incremental volume for carefully selected services. Activities include referrals to primary care physician referrals, cross sells to carefully selected high-margin services, customer relationship management (CRM) initiatives, programs to attract newcomers, physician-to-physician referral, and an intentional interface with the website. Metrics include net contribution, share of market, productivity, conversion rates of calls to visits. Targeted growth contact centers measure outcomes, not mere activity.  The focus is on targeting increased utilization of specific high-margin services, on both inbound and outbound calls, and on creating access through both telephone and the website. Targeted growth contact centers require the partnership of marketing, finance, IT, operations, and clinical leadership. Targeted growth contact centers report net contribution. They can be outsourced with customization of scripts and cross sells tailored to the organization’s preferred clinical services.

Maybe the purpose of the contact center in your organization is to create competitive advantage through customer intimacy.

Service-Centric contact centers are the front door showcase for extraordinary service. They deliver on the promise of the co-created experience. Activities are relationship nurturing, data mining, extraordinary team training. Metrics include stakeholder satisfaction, loyalty, lifetime value share of wallet, repeat utilization. The focus is on lifelong relationships. Service-centric contact centers support leadership-championed organization wide cultural transformation. The contact center becomes a front door showcase of that transformation. Service-centric contact centers address all stakeholders; all access portals and are relationship-skill intensive. It is very difficult – some may even say it is not possible – to outsource the warmth and ethos of your organization’s unique culture.

Perhaps the purpose of the contact center in your organization is to integrate access portals across your enterprise. Preferred Access contact centers are the central hub for web, fax, voice, mail, and email. Activities are Web enablement, database integration, appointment scheduling, and the contact center as a clinical point of care including disease management. Metrics are cost per transaction, FTEs saved by integrating functions, the percentage of calls which respond to stakeholder need without transfer. The focus is the integration of data to simplify access for all stakeholders. It requires collaboration of the team at all level across the enterprise. It is improbable that a healthcare organization would choose to outsource a major portal of entry such as an emergency room or a preferred access contact center.

Question 2: Do you want to provide transactions or transformations?

Webster defines a transaction as “something transacted; especially: an exchange or transfer of goods, services, or funds.” A contact center conversation can be a transfer of information, services, or resources to the caller. Transactions can be easily outsourced.

A transformation is “an act, process, or instance of transforming or being transformed; the operation of changing (as by rotation or mapping) one configuration or expression into another.” In the book, The Future of Competition: Co-creating Unique Value with Customers, C.K. Prahalad and Venkat Ramaswamy state that “A well run call center can transform a consumer’s experience from negative to positive, not only by solving problems and answering questions but by offering entirely new ways to enjoy the product or service.”

A contact center provides both the personal connection and the data storehouse to shift customer relationships from generic to memorable. A contact center can provide competitive advantage by facilitating a visible shift from services to experiences, from transactions to transformations. Transformations are profoundly difficult to outsource.

Question 3: Do you choose to provide a commodity or an experience?

Is healthcare just a collection of raw materials like a mass of generic aspirin? Have HMOs forced prices downward to the point where healthcare has become a mere commodity?

Like coffee on the futures market, commodities are extracted. Like a one-pound package of coffee on the grocer’s shelf, goods are produced. Like the corner coffee shop pours a cup of java, services are delivered. Like Starbucks personalizes your brew in a friendly and nurturing haven, experiences are staged. Each shift, that from commodity to good, from good to service, and from service to experience commands greater competitive differentiation. Each shift earns larger margins.

Unless health providers choose to be postured for extinction, they are compelled to upgrade to the next level of economic value. The question isn’t if, but how to make the shift.

The contact center provides a uniquely powerful opportunity to create compelling, memorable interactions at the beginning of the health care experience. No other function, save bedside care, has a greater opportunity for direct, heart-felt interaction with patients and other stakeholders, as does the contact center. What would we do differently if we charged admission for the contact center experience? That experience may come to be an important competitive advantage for the organization.

Question 4: Is your contact center a cost center or a revenue center?

If your contact center is a cost center with a modest call volume, usually less than twenty-five thousand calls annually, a financial analysis will frequently reveal that the most cost-effective solution is to outsource. Higher call volumes usually result in a financial advantage to own the contact center.  The break-even point for your organization will depend on type of calls, mix of calls, length of calls, the ratio of inbound versus outbound calls, and other factors. When you’ve seen one contact center you’ve seen one contact center. It is important to identify the specific own/outsource breakeven volume for your organization.

Healthcare contact centers can be an intentional tool for increased revenue, an important facilitator of the revenue cycle. In addition to referring patients to participating physicians and to the emergency room, contact centers can benefit the bottom line by recovering revenue for services with high no-show rates by calling patients in advance to confirm or reschedule appointments – keeping the revenue funnel loaded. Leading healthcare contact centers document up to $6 to 1 for every dollar invested!

An industry panel sponsored by the Healthcare Financial Management Association and General Electric Company recommends against outsourcing revenue cycle functions.

“Before outsourcing any function, and the revenue cycle in particular, hospitals need to go beyond simply determining the labor and cost savings that may result. More importantly, they need to fully understand the cost to the organization of outsourcing a key opportunity for improving performance and enhancing revenue. Without a clear sense of this opportunity cost, hospitals may be needlessly sharing with outsourcing firms benefits they could retain and capitalize on internally.”

Outsourcing a key revenue driver such as your contact center requires sober evaluation. Would a hospital be well advised to outsource their open-heart surgery program?

Question 5: What’s the bottom line?

Does owning or outsourcing provide the greatest return on investment (ROI)? Return on investment for owning versus outsourcing your contact center should project ROI over each of three years. The option to outsource in some cases provides the best ROI in the initial year. Owning an in-house contact center in some cases provides a greater ROI in subsequent years. Based on a national study of 25 hospitals and 807,000 callers representing 1.9 million calls, the average ROI is $3 for every $1 invested in a healthcare contact center.

Sample estimated ROI per $1 invested in contact center


A partial list of factors to consider when projecting ROI includes the following.


  • Call volume by type of call
  • Inbound versus outbound versus on-line interactions
  • Start up fees
  • Monthly costs
  • Volume-related costs
  • Online credit card processing charges
  • Administrative fees
  • Opportunities for and costs of customer relationship management (CRM) database management for targeted mailings
  • Availability and cost of call scripting for inbound and/or outbound interactions, availability, and cost of scripting for intentional support of the organization’s branding
  • Costs for reports with metrics tailored to your organization’s outcome requirements


  • Call volume by type of call
  • Inbound versus outbound versus on-line interactions
  • CRM database administration for targeted mailings
  • Call scripting for inbound calls and/or outbound call campaigns
  • Scripting for intentional support for the organization’s branding
  • Whether or not an in-house contact center will be co-located with complimentary functions to facilitate cross training for backup during peak call times
  • Opportunity for collaboration with existing automated call programs, if any, to provide a live interaction to recover revenue for services with high no-show rates by calling patients in advance to confirm or reschedule appointments
  • Opportunity, if desired, to showcase the shift to staging experiences with specific coaching through role-plays and scripting
  • Opportunity to create executive report card with metrics tailored to outcome requirements


If the purpose of your contact center is to provide a generic community resource, then consider outsourcing. If your purpose is to accelerate revenue and market share growth in high priority clinical services, to showcase extraordinary service, or to integrate access, then carefully evaluate your own versus outsource decision.

Do you want to document a maximum number of transactions, or stage transformations? Do you want to deliver a commoditized service, or will you intentionally mature your organization’s healthcare solutions from commodity to experience? The contact center can play a key role in that maturation. Is your organization’s objective to minimize costs for a low volume of calls? If so, consider outsourcing.

Which option provides the greatest return on investment over time? Carefully evaluate the factors that determine the bottom-line benefit for your organization, and whether owning or outsourcing generates the maximum return. Your decision to own or to outsource your contact center can profoundly benefit or negatively impact your organization’s effectiveness and bottom line.

Take action!  Schedule a meeting with your key decision-makers. Thoughtfully evaluate these questions. Bring the ROI analysis. Lead the discussion. Make a decision that is informed and intentional; make the decision that is right for your organization.

Richard D. Stier, MBA is Vice President of Echo, A HealthStream Company. He can be reached at 800-733-08737 x7265 or rick.stier@healthstream.com.

[From the October/November 2005 issue of AnswerStat magazine]

To Outsource or Not to Outsource

By William McKinney, Theresa Enebo, and Michael Ringman

Outsourcing and offshoring are two words that have become staples in household conversations across the United States and are part of daily life for more than 350,000 people who are employed in U.S. contact centers today. According to the National Association of Software and Services Companies, the outsourcing industry is responsible for nearly $5.1 billion in annual revenues in the United States. According the research and analyst firm Gartner, the industry will exceed $12.2 billion by 2007. With so much discussion and conjecture about contact center outsourcing, how do you cut through the clutter and determine if outsourcing is right for your company?

There are considerable benefits to outsourcing your contact center services, including increased cost efficiency, access to cutting-edge technology, improved customer satisfaction, and greater functionality. There are also some crucial factors to consider when making the decision to outsource, such as internal transition challenges, the potential for lost jobs, and cultural differences in some offshore contact centers.

When making the decision to outsource or keep contact center operations in-house, it is imperative that you take a realistic look at your organization, its current operations, and where it’s headed. As you decide what the right choice is for your company, consider the following list of dos and don’ts for successful outsourcing. They might be the difference between just hiring an outsource supplier or gaining a trusted, comprehensive outsource partner who makes your business more productive and profitable.

Doing it Right: The Rules for Successful Outsourcing: To ensure success with your company’s outsourced contact center services, consider the following:

Do Consider the Big Picture: Most companies interested in outsourcing their contact center services look to decrease the costs associated with labor and technology, but outsourcing helps your company do more than just cut costs. Enlisting the help of an outsource partner can give your company access to the latest contact center technology without incurring the costs of purchasing, maintaining or upgrading expensive equipment. Technologies such as Voice-over-IP (VoIP), computer telephony integration (CTI), and interactive voice response (IVR) may not be affordable for in-house contact centers, but they add great value in the customer relationship management chain. Outsourcers can offer this technology at a favorable cost because of their scale, allowing for greater functionality and efficiency in the contact centers.

Also, most companies who outsource have core competencies that are distinctively different from customer care and contact center technology, ranging from manufacturing and retail to financial services. When they partner with an outsourcer, they gain the freedom to focus on their core competencies.

Finally, the decision to outsource can mean lost jobs within your company as you cut staff to avoid job duplication; however, outsourcing doesn’t always have to translate into inevitable layoffs. Companies might choose to outsource only the technology component, keeping their current staff intact. Also, when companies outsource their contact center services, they have the ability to more accurately predict their staffing needs so they can avoid overstaffing or duplicating job functions.

Do Look for the Latest and Greatest: One of the key benefits of outsourcing is deferring the costs of expensive, state-of-the-art contact center technology to your outsource partner. Make sure to find a partner who employs the latest technology. Companies can see substantial cost savings when their outsource partner has the latest and most powerful technology.

Do Ensure Company-Wide Support: Before outsourcing your contact center services, ensure that you have as much internal acceptance and support for the change as possible. The number one factor in determining how well the transition to outsourced operations goes is the way the change is communicated and supported internally. Here are some tips:

  • Communicate openly with all employees, from executives to contact center and technology staff, about the transition and how it will help better serve customers, improve the company’s performance, and make their jobs easier.
  • Establish clear and realistic objectives, goals, and expectations for the transition. Depending on the number of call types and complexity of services, a gradual, phased approach will help ensure success.
  • Build a partner relationship with your outsourcer, as opposed to a supplier relationship. The relationship will be most successful if you openly share all information, policies and tools to thoroughly train new agents, familiarize them with your company, and better serve customers.
  • Know that you will face some challenges during the transition process, but, with the proper framework in place, internal support, and a trusted outsourcing partner, the benefits of outsourcing will certainly outweigh the challenges.

The Don’ts: Maximizing Your Outsource Partnership

Now that you know what you should consider when making the decision to outsource, here are a few equally important things to avoid:

Don’t Consider Only Cost: As with any other product or service, cost is a critical factor. However, in the outsourcing business, the old adage, “You get what you pay for,” rings true. Though most companies are looking to reduce contact center costs, companies should also look for an outsource partner who can help identify and open additional revenue opportunities, provide technology that improves efficiency and lends more insight into your business processes, and help serve your customers better.

Though it’s sometimes difficult for companies to trust an outsource partner with their customers, the customer experience is almost always improved. When companies are ill-equipped to handle customers efficiently – when customers are on hold too long, are transferred several times, have to repeat information, or their problems aren’t solved – is when customer satisfaction suffers most.

Don’t Give Up Control: The thought of giving up control of an integral part of your business, such as the contact center, may be a bit worrisome. However, many companies find that when they outsource their contact center services, they actually gain more control of the operations because of the measurability outsourcing provides. The contact center industry is likely one of the most measurable industries in the world and with advanced technology, companies can literally see how every minute in the call center is spent.

In the traditional in-house model, companies tracked according to budget and service level. By using an outsourcing partner, companies can track these areas and how their contact center operations align with business metrics and objectives, providing a higher-level, full-scale view of how contact center operations affect the business as a whole.

Don’t Outsource Just to Outsource: Outsourcing doesn’t make sense for every company in every situation. If a company is planning to retain contact center staff along with an outsource partner, the job duplication usually cancels out any significant cost sav`ings. If the existing staff is essential to the business, outsourcing is probably not your best option.

One of the greatest challenges companies face when deciding whether or not to outsource is the human element – the potential for lost jobs and the cultural differences in some offshore contact centers. Though outsourcing companies are taking numerous steps to improve these situations, even implementing accent neutralization programs, these concerns are very real and should be carefully considered in the decision process.

For companies around the world in virtually every industry, outsourcing can mean significant cost savings and increased efficiencies that directly impact the bottom line. However, companies must be in the right position, choose the right partner, and properly manage the transition process to truly achieve outsourcing success.

This article was written by William McKinney, Theresa Enebo, and Michael Ringman of TeleTech, a customer management pioneer since 1983.

[From the August/September 2005 issue of AnswerStat magazine]

Outsource Case Study: Blue Shield of California

By Pam Greenberg

With 3.2 million members, Blue Shield of California (BSC) is one of the largest nonprofit entities in the country and one of the nation’s top 20 health plans. In 2001, BSC faced a balancing act: how to reduce the cost of handling customer interactions with physicians and hospitals, while maintaining the level of quality that had always been a hallmark of its brand. In the years since, BSC has decreased its cost per call by 35 percent, racked up quality scores consistently in the 96 to 98 percent range and kept center uptime at 99.99 percent – all of this while making the transition to an outsourced contact center solution. So how exactly did BSC manage to make such strong transition and how did they make it look so easy?

The Decision to Outsource

More organizations than ever are turning to experts to help them manage their contact centers. They see an opportunity to employ the most advanced technology available, without the large-scale investment that binds them to infrastructure that may be outdated in a matter of months.

In 2001, BSC chose business process outsourcing expert TeleTech to help the organization manage its relationships with healthcare providers. A 20-plus year veteran of contact center outsourcing, TeleTech was quick to provide ideas to successfully transition the program, using a combination of onshore and offshore centers.

After assessing BSC’s contact center operations and technology, TeleTech established an onshore “staging area” in Enfield, CT, in the heart of the Northeast insurance corridor. The outsourcer also redesigned the training program for customer service reps, reducing training time from six to four weeks and boasting a graduation rate of 95 percent.

The Enfield operation went live in November 2001 with 60 customer service reps, handling 50 percent of BSC’s eligibility and benefits call volume. By early 2002, the operation had already proven itself in head-to-head competition with BSC’s in-house resources. High productivity led to an increase from 50 to 100 percent of provider eligibility and benefits calls by the end of the first year, with zero transfers back to BSC. The operation was handling 185,000 calls per month and demonstrating success at every turn.

Further Cost Cuts With International Operations

Following 18 months of successful service, TeleTech successfully transitioned the less complicated calls to its contact center in the Philippine capital of Manila, making room for more complex interactions at the Enfield location. Manila was selected as an optimal offshore location due to its American-accented, service-minded agents, presence of medical skills, and compelling cost savings.

There were three keys to a successful launch of high-quality operation in Manila. The first was selective hiring, with a five-percent acceptance rate. The second key was the appointment of an expatriate management team with extensive call center experience. The final key to success was making a significant investment in onsite resources – BSC sent one person for three months and TeleTech sent seven people for three weeks each.

To route calls to the offshore center, BSC used dynamic call routing via a Voice over Internet Protocol (VoIP) network. VoIP allows voice and data to traverse the same network, providing flexibility in how companies route and handle customer contacts. Perhaps the most important trend in call center technology today, VoIP takes the place of large, costly, technology-laden customer contact sites and allows companies to easily shift their telephone traffic anywhere in the world. Deployment of VoIP technology supported a seamless transition to the Manila center. Another cost savings of using VoIP is that the technology reduced onshore telecommunications costs by 80 percent. The result of shifting calls to the center was an average cost per call that was 35 percent lower than BSC’s in-house centers.

Measuring a Successful Program

By January 2004, outsourced contact centers were taking 100 percent of all provider calls and meeting or exceeding all designated goals. By late 2004, TeleTech handled the five-millionth call for BSC.

“During our three year relationship, our contact center operation has performed above expectations by delivering strategies that streamline operations, leverage technology, and decrease costs,” said Ken Wood, Chief Operating Officer and Executive Vice President of Blue Shield of California.

Additional measurements of program success:

  • Delivered cost per call is 20 to 25 percent lower than internal benchmarks.
  • Earned quality scores are in 95 to 97 percent range, equal to or superior to internal centers.
  • First call resolution is 99.9 percent.
  • Average handle time was reduced 37 percent from January through September 2002.
  • Number of customer service reps grew from 60 in November 2001 to 100 in January 2003.
  • Interactive Voice Response (IVR) enhancements reduced provider call volume by 20 percent.

Outsourcing its contact center operation has made a dramatic impact on BSC’s bottom line. It has given the organization the freedom to focus on what is does best – providing access to high-quality health care at a reasonable price.

[From the August/September 2005 issue of AnswerStat magazine]