The Trifecta of Working From Home

The option of working from home is an offering that is commonplace in a variety of industries such as hospitality, banking, retail, and finally – healthcare. Almost one-third American employees work at home – at least part of the time. The discipline of nursing has perfected the remote care of patients over the past decade and is one of the most in-demand clinical service lines in the continuum of care. This article will highlight why and how the “The Trifecta” is beneficial to 1) the patient, 2) the nurses/healthcare workers, and 3) the organization.

If you are feeling skeptical about the cost and logistics, allow me to explain. The implementation and equipment costs are often less than the cost of the real state and boarding expense of an in-house worker. McKesson, the American Healthcare company estimates a savings of $2 million annually since allowing employees to work at home. Training and access to resources including charge nurse support parallels what is available to brick and mortar located staff and for all your operations people- the ability to monitor and supervise the performance and productivity of work at home staff is just as accurate, if not better than the activity in a traditional setting. Here are the winners and the reasons why:

PATIENTS

  • A sign of an organization that is committed to providing exceptional patient experiences is one that provides their patients access to 24/7 nurse triage services. Market studies indicate today’s consumers want what they want when they want it–including clinical care. Providing patients with the option to speak directly to a triage nurse at any time is now an industry expectation. A high percentage of this work is done by nurses working from home. One of the most established medical call centers in the USA currently has 85% of their nursing team practicing out of their homes. In many cases, the outcome does not involve a trip to the ED. Patients don’t need to leave their homes, drive across town to a network facility or wait in a crowded waiting room for hours waiting to be seen.  Telephone Nurse Triage can definitely enrich your patients’ experiences while providing optimal outcomes. Patient satisfaction improves!
  • With nurses working from home and when a patient feels the need to talk to a nurse, regardless of the time day has the potential to ensure that once a thorough assessment is performed by the skilled RN and the patient is advised to seek the most appropriate level of care (in the most appropriate setting) and there is no risk for a delay in care. The biggest winner of all is the patient with an improvement in health outcomes.

NURSES

  • Telephone triage is a relatively new specialty of nursing that has evolved over the past 20 years. Being educated in the skill of remotely caring for a patient is a unique opportunity for experienced nurses to expand their clinical knowledge base and fill a gap in the patient’s plan of care. The prospect of working as a nurse from the comfort of home is intriguing to many and helps with recruitment efforts. An established outsourced call center reports considerable increase in employee satisfaction scores among work from home staff and a 2017 retention rate of 93%. That translates to a cost savings in new hire onboarding and training. A win-win!
  • Roberta RN, started at the call center in late 2016. Within six months she was working from home. “Never in my 23 years of being a nurse did I ever think it would be possible to help patients from my home office. There are so many perks that I never even imagined. My ride into work was at least 45 minutes; I figure I’ve gained about 10 hours a week that I spent in the car and I’m saving at least $50 weekly in gasoline. With the extra time I have in the morning I started walking. I’m up to three miles a day, never felt better, and I lost 33 lbs. I not only care for patients, but I have been able to improve my own health. I love my job.”
  • Marcy worked in a busy inner-city Emergency Department for most of her career. Her years of ED experience made her a great candidate for a part-time triage RN position at her organization’s medical call center. “Initially I was very nervous about giving people nursing advice when I couldn’t see them, touch them or be in the same room with them. Luckily, my department had a very detailed training process, and assigned me a preceptor who worked the same schedule as me for my first 90 days. Slowly but surely I began to feel more comfortable and had come to appreciate the impact we were having on patient access. When the opportunity came up for me to work from my home, I was hesitant to apply, but I did go for it. Every written resource, cheat sheet, medication chart, and approved websites that I had at my fingertips and had come to depend on, was available to me at home. I was able to communicate in real time with the other RNs working on my shift as well as my charge nurse. The support was unbelievable. The feeling of being part of a team was something I really needed and something my company made sure was a priority regardless of where you were practicing.”
  • Nora, an RN, shared this: “Calls usually take about 10-12 minutes. That is time I am spending 1:1 with that patient; dedicated to their needs and collaborating with them on their plan of care. I came from a very busy med-surg floor where we often had up to six assignments per shift. It got really crazy at times, you were constantly being interrupted, called away from your patient to help with another patient, and having to admit new patients all evening long. Taking care of all the needs of one patient, is ideal and reminds me of my early years as a nurse when we practiced ‘primary nursing’. I live in upper Michigan where winter temperatures drop to sub-zero levels and being able to triage pediatric patients from the warmth of my home, while working in my sweats, and commuting to the basement is a dream come true for a nurse.”
  • Samuel Joseph told us, “Of course I am grateful to have the chance to take care of patients over the phone set up in my house, but I am also shocked at the money I am saving. I’m a guy and I guess I must be tough on my work scrubs (and terrible at doing laundry) because I was always spending money on new scrubs when I was working in the hospital. Not anymore! I take a quick shower throw on a pair of jeans and a tee shirt and I’m dressed for work. It’s very cool! I just turned in my leased car and it was the first time ever that I didn’t have to pay for being over the mileage allowed. And one more thing – I used to spend at least $10 a day on coffee, lunches and Diet Cokes I bought whenever I worked. With that savings alone, I have an extra $200 a month. It is an awesome job! “

THE ORGANIZATION

  • No healthcare organization will invest money or allocated resources – especially nurses without a proven contribution to the overarching strategic goals. Whatever the discipline under consideration to work at home, be it clinical or administrative caregivers, one thing for certain – they must at the very least support, if not completely resolve, many of the requirements imposed by the shift to value-based care.
  • Nurses working from home promote better patient health, improved population health and a reduction in the cost of care. If one didn’t know better, it would seem that the specialty practice was developed with the Triple Aim in mind.
  • Access to clinical care is there when the patients deem it necessary. Work from home staff guarantees that care is provided regardless of the time of day, volume of calls, or hours of operation of the PCP’s clinics. Giving patients more control over their healthcare needs will foster engagement, compliance, and, ultimately, outcomes. Better outcomes result in a cost savings across the continuum of care.
  • Remote triage nurses should be proud of the influence they have in the organization’s effort to optimally use all resources. This is most obvious with referrals to the ED. Triage nurses are trained to refer patients away from the ED and towards more appropriate locations of care such as urgent cares, express clinics, or virtual visits. Patients appreciate the collateral benefit of a co-pay savings of hundreds of dollars out of pocket.

The possibility of working from home may sound too good to be true. That may be the case in many professions, but not Telephone Triage Nursing. Patients are better served, nurses love their job and the organization reaps countless benefits. Remote Nursing is truly the Trifecta of healthcare – a Win-Win- Win strategy!


Gina Tabone, MSN, RNC serves as the Vice President of Strategic Clinical Solutions for the TeamHealth Medical Call Center.

Prior to joining TeamHealth, she served as the Administrator of Cleveland Clinic’s NURSE on CALL 24/7 nurse triage program. Under her direction, ED utilization declined, continuous care coordination improved, performance metric targets dropped from 33% ABD to less than 5%, URAC accreditation was achieved, and the call center grew from covering 350 physicians to the integration of more than 1,500 employed and affiliated providers.

I’ve Got Good News: Medical Call Centers are Here to Stay!

Changes to the American political scene are upon us and most certainly will have an impact on the provision of healthcare. Regardless of party affiliation, there are several healthcare reform objectives that need to be remain in the forefront by future government leaders. Examples include enhancing quality of care, interdisciplinary coordination and collaboration and better utilization of available resources.

Focusing on those concepts will contribute to the goal of improved outcomes for both individuals and overall patient populations we serve. The benefits achieved from the implementation of the Triple Aim must continue regardless of who is leading the country. Nurse Triage as a component of an Integrated Medical Call Center is a pivotal intervention and no longer optional.

The world of Medical Call Centers (MCC) has finally gained the recognition and credibility in the healthcare marketplace that many of us have been trying to expound for two decades. Centralized MCCs are rapidly emerging as the backbone of health systems because they are integral in achieving better patient outcomes.

The new Administration has wisely sought healthcare advice from the most innovative physician leaders in America. Toby Cosgrove of Cleveland Clinic and John Noteworthy of the Mayo Clinic were invited to meet with President Trump to share their thoughts on the Affordable Care Act (ACA) and ideas to plot out the best plans for the future.

Concerns were expressed that the current model needs to focus more on patient health and wellness and less on the avalanche of paperwork. This has negatively impacted day to day responsibilities of clinicians accountable for reporting on 100’s of quality indicators. These points of contention are agreed upon by most caregivers. Cleveland Clinic and Mayo Clinic have improved patient access, outcomes, and satisfaction by integrating state of the art integrated call centers with clinical access across their multi-state enterprises.

Hopefully, their example will resonate and motivate other organizations to rapidly integrate outsourced or optimized in-house MCC’s as a proven solution for reaching the goals of the Triple Aim: improving the patient care experience, improving population health and reducing per capita cost of health care.

Improving Patient Experience of Care requires open access channels to care. Access means that patients are able to receive the most appropriate level of care needed, in a time frame best determined by specially trained nurses guided by evidence-based tools. The patient learns to expect reliable advice, taking into account their current health state and is consistently available day or night.

Gaps in care are eliminated and delays are avoided, leading to favorable patient outcomes and higher reimbursements in a fee for value model. When patients’ well-being is enhanced, everyone gains – most especially the patients! Medical Call Centers’ can stake a claim for making that happen.

2017 will have many organizations taking a close look at their operations and making tough choices about what functions are best accomplished internally and which ones can be entrusted to an outside partner. IT is a department that is being outsourced by some of the largest hospital systems in the country. IBM is by far the vendor of choice. Patient Financial Services is another service with options for outsourcing where the benefits to an organization outweigh the costs incurred. Incentives for meeting targets are common. Lastly, there is a surge by strategic decision makers to explore Nurse Triage services being performed by an outside call center partner. The common denominator in all three areas where outsourcing is increasing is the fact that there is a reliance on human capital and all of the contingency costs that goes along with being an employer. High labor costs often consume up to 70% of many call centers operating budgets. Outside partners can assume the responsibilities with greater efficiency, better outcomes and at a lower cost. There is also the possibility that many vendors are willing to assume some of the risks associated with the successful attainment of goals. The choice to retain, outsource or develop a hybrid of both is a multifaceted decision that is reserved for leaders at a higher level than the call center. Organizations have to thoroughly evaluate the options which one best aligns with their mission, vision for the future and strategic plans.

MCC’s are branching out and taking on a variety of responsibilities that are well suited to be conducted remotely and reliant of state of the art technology and a dedicated work force. Once the technological infrastructure is created, the MCC can be enhanced to take on additional functions. The function of appointment scheduling is the most common function of many MCC’s and often happens in tandem with the strategy of centralization. Electronic Medical Records (EMR) products have customized templates embedded with providers’ schedules that are used for office visits, imaging or procedural appointments. Outbound calling campaigns are often conducted in conjunction with scheduling for appointment reminders.

Centralizing all medication refill requests is emerging as a successful addition to many MCC’s. Call center technology such as CRM allows for requests to be tracked, acted upon and measured ensuring that established targets are being met in a timely manner. Without measurement there is possibility for improvement. Patients can expect a standard process for medication needs, and defined time frames responses or resolution. Medication management and compliance is critical for optimal outcomes, so implementing a process that fosters it is a good idea. Patients stratified as high risk garner the most advantages which contribute to maximum reimbursements for medical treatments.

MCC’s have taken on the significant task of not only caring for the acute needs of primary care patients as well as the chronic needs of vulnerable high risk patients as well. Successfully coordinating and transitioning of care is central to every health systems strategy for sustainability today and growth tomorrow. Nurses are the clinicians assigned to figure out how to morph from case management to transitional care coordinators. Regular communication between the patient and the caregiver is vital and is often by telephone, text or email. Training the newly created care/transitional care nurses in the fundamentals of remote patient care is imperative and is based on the standards of care for Telephone Triage Nurses. The practice of triaging the acute symptoms has branched out and will serve as the starting point for nurses involved in coordinating care.

It is up to those of us established in the Medical Call Center industry to continue to proclaim the unlimited value of a MCC to the healthcare industry. In many healthcare organizations more than 10% of employees spend the majority of their day, doing their job on the telephone. The benefits of centralizing and consolidating the work they do are undeniable.

C-suite leaders must accept the fact that Medical Call Centers are no longer considered an expense, but an investment with impactful ROI.

Initially there were call center, then access centers, followed by a contact centers, and in 2017 we are Engagement Centers. The task at hand is to capture the limited attention of decision makers and educate them on the role MCCs play in a fee for value system and the distinct results that are possible. The future may be uncertain but there remains a need for products, services and expertise that bring the call center to the forefront of patient care.

By |September 26, 2017|Blog|Comments Off on I’ve Got Good News: Medical Call Centers are Here to Stay!

Case Study: THMCC Outbound Call Campaign Connects FQHC to 14,000 Patients

The Challenge:

In 2015, a large Federally Qualified Health Center (FQHC) in South Texas needed to notify their entire patient population of an important change to their insurance, and that to continue seeing their primary care provider or specialist, they would need to change insurance plans.

This change would have an impact on their ability to continue providing care to more than 14,000 patients. This health center needed a coordinated campaign to send a notice of the changes via email, and then complete a follow up phone call to ensure that the patient received the notice and answer any questions.

The Solution:

TeamHealth Medical Call Center offered a two-pronged solution that included a live call and automated call.

The program includes the following:

  • A follow up phone call from a nonclinical patient coordinator tasked with ensuring:
    • The patient received the notification via email.
    • Answer any questions the patient had.
    • Offer to transfer to the state Medicaid hotline if the patient was ready to make an insurance change while on the line.
  • An additional follow up automated phone call with a prerecorded message to patients who were unable to be first reached by a patient coordinator. The automated call offered a hotline where the patient could call back and have any questions answered.

The Results:

The outbound campaign exceeded the anticipated results.

  • 51% of patients successfully completed the call with the following results:
    • Requested to be transferred to change insurance plans during the course of the call.
    • Patient had already made the insurance change prior to receiving the call.
    • Were unable to be transferred at the time of the call, but requested the information on how to do so at a later time.
    • Did not request a transfer or info.
  • Of the 51% of total patient successfully reached, more than 75% either requested to be transferred, requested the contact info to do so later, or had already made the insurance change.
  • For the more than 4,500 patients receiving an automated call, THMCC achieved a 90% reach rate.
  • Of this, more than 3,800 (95%) of patients listened to the initial message.
By |August 24, 2016|Case Study|Comments Off on Case Study: THMCC Outbound Call Campaign Connects FQHC to 14,000 Patients

Case Study: TeamHealth Medical Call Center Drives Utilization of Appropriate Care for Pediatric Client

The Challenge:

One goal among health care organizations is to appropriate level of care treatment for patients. For a large pediatric TeamHealth client in California, one aspect of consistent care is appropriate level of care when care is needed and to allow their physicians to service those needs whenever possible.

To achieve this goal, the following objectives needed to be met:

  1. Reserve Emergency Department referrals exclusively for patients who require that level of care.
  2. Direct parents/caregivers to follow up with their child’s physician network PCP in cases where waiting until the office re-opens is a clinically viable solution.
  3. Utilize existing client facilities staffed with pediatric resources whenever possible, if imminent care was required after hours.

The Solution:

The client’s after-hours children’s clinic is considered a hybrid urgent care facility with ‘ED-type’ capabilities. The facility is staffed weeknights, weekends and holidays. TeamHealth worked closely with the client to refine referral directives related to specific patient conditions and outcomes and this facility’s ability to deal with more clinically complex cases. TeamHealth met with the client’s business and clinical leaders regularly to review clinical cases and discuss refocusing the ‘post-triage’ process as it related to the appropriate referral of the patient depending on the care needed. These meetings resulted in:

  • The creation of an actively managed “Exceptions List” to the guide the RN’s to refer to the after-hours children’s clinic or defer to another client location, depending on the care needed
  • Refinement of TeamHealth internal system processes
  • Backline communication established between TeamHealth RN’s and client staff in the after-hours children’s clinic for appointment purposes.

The Results:

  • During the next 12 months, 91% of all referred callers were directed to a client facility. The other 9% of referred callers were comprised of parents and caregivers that refused a referral or were undecided (6%), or decided to go to a different non-client facility (3%).
  • The number of ED referrals also dropped significantly.

“We look forward to continuing our partnership with TeamHealth to provide excellent after hours care to our pediatric patient population.”
– Client Manager of Clinical Operation

High Level Detail

Detailed Breakdown

By |June 29, 2016|Case Study|Comments Off on Case Study: TeamHealth Medical Call Center Drives Utilization of Appropriate Care for Pediatric Client

Change is the Only Constant

Change is the Only ConstantIn the year 535 BC, Greek philosopher Heraclitus declared, “The only thing that is constant is change.” For many of us working in the healthcare industry, we wholeheartedly agree that these timeless words continue to ring true, year after year. The word ‘change’ evokes a different response from each of us – but what exactly is change? How is change manifesting itself in today’s healthcare environment and how can we, as leaders, incorporate the implications of change into our organizational cultures?

Webster’s Merriam Dictionary defines change as: 1. To become different; 2. To make (something or someone) different; 3. To become something else. Change is a modification to the process of doing something. In many cases, the modification is made in hopes of creating a better outcome. Often, the expectation of positive change is put on us without tangible evidence to support a better outcome. Today’s healthcare leaders rely on innovators and thought leaders who ‘think out of the box.’ Their role is to introduce variations (changes) to current practices that will ultimately improve patient outcomes, engage their workforce and contribute to the goals of the organization. Identifying and implementing these variations are vital if we hope to improve outcomes. For example, without changes within the healthcare industry, there would never have been advancements in immunizations, birth control and organ transplantation. No change typically means no growth, and no growth is not a sustainable option for any organization.

There are many examples of changes occurring in today’s healthcare environment. The stimuli for most of the modifications are the requisites of the Affordable Healthcare Act. A list must include: healthcare for all, coordination of care, fee for value of care and accountability for outcomes. Programs such as post-discharge call backs, 24/7 access to clinical care, integrated communication via electronic medical records and robust patient satisfaction efforts are all outcomes affected by changes that have evolved in an effort to comply with the new regulations. The collateral benefit is quality, efficiency and exceptional care.

Mention the word ‘change’ to employees, and in many cases, the reaction is predictable. We have all observed rolling eyes, defensive comments, irritation, anxiety and one characteristic response to change – resistance. Change represents the unknown, which can be very intimidating. Those in charge of healthcare organizations need a long-term change management strategy for their organization and the people affected by it—a strategy that encompasses all aspects of the change, from conception through completion.

A leader who is sincere, humble and willing to admit to a level of personal angst when going through changes will have more success with overall buy-in efforts from all levels of an organization. Reminders of past organizational achievements often convince employees to give the ‘change’ a chance. It will hopefully strike a positive chord with front line staff as well, reminding them that they have dealt with change before with positive results. Directly involving those most impacted by the changes is a great way to gain support and alleviate concerns. It is crucial to communicate the fact that the changes occurring are designed to improve patient quality, become more efficient and enhance both the patient AND provider experience.

Change is here to stay; we can count on that. Many of us may not be as open to change, but we can do our best to understand what initiated it and, more importantly, how our role in the process has the potential to influence the accomplishment of organizational goals.

In the famous words of Heraclitus, “The only thing that is constant is change.”

Gina Tabone, MSN, RNCGina Tabone MSN, RNC
Vice President Strategic Clinical Solutions
TeamHealth Medical Call Center

By |June 6, 2016|Blog|Comments Off on Change is the Only Constant