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Clinical Contact Centers: Epicenter of the New Health Care Business Model?

Outpatient services are poised to grow by 14% over the next five years. This growth, coupled with increased costs, service complexity and access challenges, is encouraging systems to innovate to meet consumers’ needs. Leading health care organizations are meeting the challenge by combining technology with a high-caliber workforce to redesign care within a contemporary clinical contact center framework. For organizations that have the right stuff, clinical contact centers provide the opportunity to reinvent the delivery model, seamlessly integrate consumer health services, enhance patient experience and grow the bottom line.

What Is a Clinical Contact Center and Why So Much Interest?
Health systems often have several call centers that provide general service information, limited appointment scheduling and physician referrals. These centers are typically part of the organization’s marketing department, have limited utilization and lack integration. Contemporary centers are centralized hubs that proactively integrate access across sites, provide virtual visits and care coordination, and consolidate financial and nonclinical activities. Organizations building contemporary contact centers evaluate their return on investment through improved consumer access and satisfaction that in turn reduce leakage, enhance population health capabilities and provide cost savings.

Contemporary Contact Center Services

Clinical Services Navigation Financial/Operational
  • Nurse triage
  • Navigation and care coordination
  • Physician visit and chart preparation
  • Virtual health services (e-visits, remote monitoring)
  • Medication refill
  • Centralized scheduling across hospital and physician practices
  • 24/7 call intake
  • Primary and specialty care navigation
  • Proactive postvisit care follow-up and scheduling
  • Registration
  • Preprocedure price estimates and financial counseling
  • Previsit copay and deductible collection
  • Precertification for referrals and visits

 

Primary market factors are driving interest in clinical contact centers:

  • Consumer out-of-pocket costs are growing. According to Aon Hewitt, employees will pay an average of $2,487 in out-of-pocket costs in 2015, in addition to health care premiums. This fuels higher service expectations and demand for increased transparency.
  • Technology such as EMRs, integrated scheduling platforms and virtual technology enable care to be managed and delivered across the continuum as well as outside the local physician office and hospital.
  • Increased competition, new retail-based health care offerings and the growth of narrow networks in some markets are raising the stakes.

How Does a Contact Center Work?
Contact centers provide a variety of services to ease the process of accessing and purchasing health care services. The following example illustrates how a contact center with centralized scheduling uses nurse triage to ensure access to primary care services across the health system:

Health System A

  • Sam, a healthy 52-year-old, wakes up with minor abdominal discomfort and calls his PCP office to schedule an appointment.
  • By design, Sam’s call automatically gets routed to Health System A’s contact center, where a nurse triages Sam’s complaint using an approved protocol. The nurse has visibility to Sam’s provider’s schedule and sees that it is full. After scanning available primary care options, she directs Sam to Health System A’s closest urgent care center where there is only a 10-minute wait.
  • Sam is diagnosed, provided medication to resolve his minor indigestion and provided orders to follow up with his PCP. Because the system proactively provided Sam access options that met his needs, Sam is satisfied with the service received by his provider and recommends Health System A to his friends.

Health System B

  • Mary, a 35-year-old business entrepreneur, has headache and sinus pressure symptoms while at work and realizes she needs to see her physician.
  • Health System B does not have a clinical contact center, and, after unsuccessfully attempting to schedule a visit with her physician, Mary gets frustrated and schedules an appointment with a physician at a competing health system.

What Are the First Steps in Developing a Contact Center?

  1. Research your consumers’ needs by segment. Instead of using typical segmentation based on patient demographics, consider segmenting by visit types such as: healthy maintenance care, primary and specialty care, emergent care, scheduled ambulatory surgery or chronic care management. Like a grocery store visit, consumers have different purchasing behaviors and expectations depending on the services, when they are needed and how much they cost.
  2. Catalog where major care transition gaps exist. Acute and ambulatory settings should be included in your analysis. Once these gaps are identified, they can be prioritized and eliminated through care redesign efforts led by the contact center and supported by management engineers.
  3. Empower a medical director. A clinical leader who has the vision and passion to integrate clinical care and enhance the consumer experience, and who has a background in delivering integrated care is key to success.
  4. Start small. For those interested in centralizing patient scheduling and registration for their owned physician practices, begin on a small scale using pilot projects with physician practices that are open to change. Market pilot successes to other practices and health system leadership before integrating the next practice.

Implementing a clinical contact center involves a series of care redesign processes that will unfold over several years. It is up to physician and operational leadership to maintain the support and vision, break down barriers and continue to add new services to the mix.

As ambulatory spending continues to accelerate and health systems look for new ways to expand access, lower costs and improve the consumer experience, Sg2 anticipates that clinical contact centers will play a growing role in health systems’ integration strategy. Well-connected systems with strong medical leadership are best positioned to be first movers toward the new “super health systems” of the future.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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