ACA Opportunities Abound for Healthcare Call Centers

By Mark Dwyer

On June 28, millions of Americans anxiously awaited the long-anticipated Supreme Court ruling on the Affordable Care Act (ACA), otherwise known as “Obamacare.” I imagine everyone in the healthcare profession shared my apprehension that day. Leading up to the decision, there was much talk about what upholding or dismantling the ACA would mean to the healthcare profession and to the communities it serves.

Today, we now know much of the ACA was upheld. So, it’s full-steam ahead into an uncertain future. Whether you were for or against the ACA, the fact is it is here, and we must adapt appropriately. My personal opinion of the law aside, I believe, regardless of the Supreme Court ruling, healthcare call centers are positioned to play a more significant role.

The net effect will be millions of newly-covered people in the healthcare system. People who would otherwise forgo care or seek it at the emergency room will now be in search of a primary care provider and other preventive services. People who let their chronic diseases become major issues can now access disease management resources.

It does not take a social scientist to see that a large number of these newly-covered people will be looking for guidance on how to best manage their health. That’s where the healthcare call center becomes indispensable.

Healthcare call centers are an important key to improved efficiency in the healthcare field. As the ACA enters the implementation phase, here are some of the ways LVM sees healthcare call centers contributing or leading.

Hospital Readmission Reduction: One of the provisions of the ACA is a financial penalty for healthcare organizations that fall into the top quartile in terms of 30-day readmissions for selected disease states. For example, if a hospital has a large number of in-patients with a DRG (disease related group) of heart failure (HF) who are readmitted within 30-days of discharge, that hospital is at risk for losing a percentage of its overall Medicare reimbursement for the year.

Healthcare call centers are a logical and efficient means for monitoring the post-discharge progress of patients who were admitted with HF, acute myocardial infraction, or pneumonia.

Physician and Facility Referral: In some metropolitan areas, the number of newly-covered people in the healthcare system may number in the tens of thousands. Many of these people will be looking for primary care providers, as well as specialists. Is your call center prepared to deal with increased traffic?

Disease Management and Prevention: Under the ACA, there are several preventive treatments covered at no cost to the patient. Many of these preventive services are geared toward women. For example, women entering into the healthcare market can now schedule services like mammography, well-woman visits, and cervical cancer screenings via the hospital’s call center.

Moreover, the ACA provides a variety of grants for disease management functions like surveillance, research, and tracking. Here, healthcare call centers can take the lead, collecting pertinent data over the life of the individual patient. Call centers can collect and analyze patient data, interfacing with an electronic health records database or an ADT file, enabling data to be shared and available in real-time.

Even More: This is just the tip of the healthcare call center iceberg. There will be plenty of opportunities to offer improved services like telephone triage, class registrations, physician-to-physician referrals, and so on.

In addition, the healthcare call center is now being used as a guidance center for those people seeking a health insurance plan for themselves or their family. As new insurance companies enter the marketplace, consumers will most likely seek guidance on what type of plan or carrier is best for their needs. Healthcare call centers can play a crucial role as this approach evolves.

Former British Prime Minister Benjamin Disraeli once said, “The secret of success is to be ready when your opportunity comes.” Whether you were for or against the ACA, the opportunities it presents position the healthcare call center industry for current and future significance.

Are you ready?

Mark Dwyer is chief operations officer at LVM Systems, providers of the healthcare call center software suite, Centaurus.

[From the August/September 2012 issue of AnswerStat magazine]