The Role of Call Centers Under the New Healthcare Law

By Charu G. Raheja, PhD

The new Affordable Care Act is starting to reach full swing, and new data is coming forward on how providing insurance to previously uninsured Americans may affect their behavior.

How Are New Medicaid Patients Using Their Health Benefits? According to the Wall Street Journal, a recent study followed Oregon residents who obtained health insurance through a special lottery. The study found these newly insured patients visited ERs 40% more often than those without insurance. Some of these visits may have been because of overdue healthcare needs, but many of the problems treated could have been addressed at doctors’ offices. These results show we still have a lot of work to do in educating and helping patients before we can evaluate the benefits of the new law.

The Role of Nurse Triage and Call Centers in Helping Patients: People need easy and available healthcare support that allows them to ask healthcare questions and evaluate their condition. This is where call centers can come in.

We all look for experts to help us with the different tasks in our daily life. Healthcare is no different. Someone with a health condition can benefit by being able to speak to and be evaluated by a health expert. Many uninformed patients go to the emergency room because they don’t know where else to go for medical help and an expert opinion.

The development of telephone medicine and emerging communication channels has made it easier for people to receive healthcare guidance. Medical call centers provide an inexpensive and extremely effective solution for providing patients with the expert opinion needed to help them make healthcare decisions.

For example, in a previous article published in AnswerStat (“Patient Data Can Improve the Delivery of Care While Reducing Healthcare Costs”), we found that almost 70% of the patients who thought they needed to go to the emergency room were advised to stay home after discussing their symptoms with a telephone triage nurse. Not only does nurse triage help in preventing unnecessary emergency room visits, but it also helps improve patient health and prevent potential morbidity. In another AnswerStat article (“Case Study: Saving Lives with Telephone Triage”), we found that almost 10% of the patients who called and did not think that they had an emergency actually needed immediate care.

How Can Call Centers Better Prepare Themselves? Call centers will need to be involved in numerous aspects of patient care to encourage use of their services. For example, call centers should provide health-related protocols, make patient appointments, and help coordinate care between doctors and patients.

Current trends indicate that customers and patients are using online reviews, social media, and Internet searches to help determine where to do business. They want instant, 24-hour access to assistance and care, respect of their time, and multiple forms of communication including Websites, online chat, email, text messaging, and smartphone and mobile apps. Call centers that keep up with technology and customer needs will see the most increase in their involvement in patient health.

Conclusion: The goal of the new Affordable Care Act is to increase health availability and access to health services for Americans. The act has started giving access, but questions remain about the feasibility of the law because of the costs involved. Call centers can play a crucial role in helping coordinate health services and ensure the right patients get the right level of care at the right time.

Charu Raheja, PhD, has been the chair, CEO, and co-founder of TriageLogic since its start in 2005. She has a passion for using finance and economics to create business solutions that help people. For more information, call 855-832-6852.

[From the February/March 2014 issue of AnswerStat magazine]