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

Nurse Triage – Don’t Leave Home Without It

Nurse Triage - Don't Leave Home Without ItA few months ago, I took some time off to spend a rejuvenating week at the beach. The sun was hot and bright, the waves were churning and the breeze was refreshing. Everyone around us was on vacation and relishing the fact that they did not have to wake up to an early morning alarm, attend a meeting or meet a deadline. There was no mention or thought of work from any beachgoer–except for me.

Don’t get me wrong; it was not a bad thing to be thinking of work while on vacation. It was quite the contrary, in fact. See, I am a nurse, and I work in the one constant specialty of healthcare: after-hours nurse triage. On three separate occasions, my fellow vacationers shared stories with me about how their lives or the lives of their loved ones had been saved or drastically improved—simply by having access to a nurse while they were on vacation.

It made me proud.

One morning, an elderly woman was strolling down a sandy stretch of beach with her two sisters, as they enjoyed their annual trip to the Atlantic. One of them had accidentally left her carry-on bag in an airport restroom while traveling, and had not realized it until arriving at her destination. She was not initially concerned when thinking about the magazines and snacks that were in the bag, but began to panic when she realized all of her medications had also been in that bag.

Unsure what to do, she called her daughter at home and explained the situation. The daughter had a very active role in her mother’s health care provision, and knew that her Primary Care Physician (PCP) had a 24/7 nurse line that they had utilized in the past with other dire issues. It was well after her mother’s PCP office had closed, but with one call to the nurse line, a friendly voice on the other end assured them an RN was available at that moment to assist them.

For senior citizens, immediate access to medications is often a vital necessity. Not having that access can be the basis for potential disaster, especially when the individual is nowhere near their PCP office. For the elderly vacationer, it had become a frightening reality. However, this problem was one of many a triage nurse is specifically accustomed to solving. She alleviated the woman’s anxiety and reassured her that the situation was under control. The nurse directed the woman to a store one block from the beach and provided enough of her prescription to get her through the entire vacation. The woman and daughter thanked the triage nurse for her help–and then the nurse reminded her to be sure to wear sunscreen while walking along the beach!

One evening as I sat looking at the ocean and listening to the waves, I was interrupted by the familiar sound of a siren approaching. Looking down the road, I noticed an ambulance pulling in to the driveway of a beach house just down the road from ours. In any setting, that picture is cause for alarm, but it is even worse when you are away from home. A short time later we saw the ambulance head back up the road, most likely to a local hospital or other healthcare facility. The next day while visiting with some neighbors, we learned that a 54 year-old man had been sitting on his deck watching sunset with his wife (just as I had been doing) when he began experiencing chest pain. His wife knew he needed medical care, but had no idea what to do or where to go. She remembered seeing a magnet on the refrigerator door with a phone number to call for medical emergencies. The emergency service was staffed by community triage nurses and available to anyone in need. The skilled nurse directed the woman to have her husband lie down and remain on the line while she contacted EMS for assistance. The nurse offered support and reassurance to the wife, and was even able to speak to the husband. Once the emergency responders arrived, the triage nurse hung up and let them take over.

The chest pain ultimately ended up being cardiac in nature and potentially life threatening. Once the local Emergency Department stabilized the man, he was transferred to the nearest major medical center. The wife called the rental company and thanked them for placing the magnet on the refrigerator. She said that the ‘wonderful’ triage nurse helped her and her husband through one of the worst experiences of their lives.

Although I did not know that nurse, I was so proud of her and wished that she could have heard their heartfelt compliment.

I heard one final story while sitting in the airport. As we waited for our flight home, I noticed a toddler with a bright red sunburn on her face and arms. That is an unusual sight these days, since many parents I know cover their children from head to toe with the highest SPF, water-proof lotions available. The child’s mother must have noticed me looking at her daughter with concern. She said, “You should have seen her yesterday.”

She went on to explain that a family friend had offered to put sunscreen on the toddler prior to a family outing. The mother assured me she always uses a high quality, high SPF sunscreen approved by her daughter’s pediatrician. In this case, the family friend unknowingly applied a SPF 8 tanning lotion instead of the mom’s sunscreen. After walking in the sun for only 20 minutes, the toddler’s cheeks and forearms began to turn red and blotchy. They decided to get out of the sun and assess the child’s condition. While her arms and face were warm to the touch, the young girl was happy and interacting with her family as normal.

Regardless, the mother was very concerned about any present or future harm the sunburn may cause to her daughter. She decided to call Mary Jo, the triage nurse at her pediatrician’s office, as she does whenever she has health concerns for her daughter. Mary Jo asked some specific questions about the symptoms related to the sunburn and assured the mother that it appeared the little girl was going to be fine. She suggested some basic home care instructions, which included giving her daughter a lukewarm oatmeal bath, moisturizing the area while the skin is still moist and administering a dose of an OTC analgesic if her daughter was uncomfortable.

The mother expressed to me her complete trust in the advice she receives when calling her nurse help line. She especially appreciates the respect and understanding she receives when calling, never being made to feel that her question is foolish or that she is overreacting. That is very important to any concerned parent who only wishes to make sure their child is going to be okay.

There is no denying the fact that a call to a trained triage nurse is often the first step taken whenever a need for medical advice or instruction arises. Having this type of access to definitive health care is both comforting and effective. I was very proud to hear these heartfelt stories from three separate strangers during my vacation. It further confirmed to me the value of a service that I have felt to be invaluable for decades. Nurse Triage – Don’t leave home without it.

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

By |May 26, 2016|Customer Service|Comments Off on Nurse Triage – Don’t Leave Home Without It