The Call Center: Coordinating Care and Managing Transitions


By Mark Dwyer

Historically, nurse triage and marketing referral services have been the cornerstone of most healthcare call centers. But recent healthcare reform initiatives have positioned healthcare call center nurses to play a far broader role. Their experience in assisting patients with complex care needs, supporting specialty referral, offering disease management, overseeing transfer management, providing behavioral health intake, delivering medication management, and even providing hospital readmission reduction programs have positioned the call center nurse as an integral player in the organization’s overall population health initiatives.

For the purposes of this article, we will define population health as a proactive solution with personalized care and a focus on wellness that includes all aspects of health (physical, mental, etc.), as well as social determinants of health. Population health goes beyond traditional disease management and incorporates both preventive and chronic care needs. It requires collaboration among healthcare providers to identify gaps in care on evidence-based guidelines and builds on practices to ensure high-quality, efficient healthcare.

As a healthcare organization responsible for patient care, today’s nurse call centers must ensure patients have easy access to healthcare resources and that they take necessary steps to prevent adverse health outcomes.

To effectively engage patients in proactive management of their health, the call center needs to change from a focus on episodic care in response to inbound calls to one of outbound interactions to leverage the full power of the call center to positively impact patient’s lives. The cornerstone of such a strategy is an effective care coordination program that automates a series of defined interventions and supports communication with all stakeholders. A successful care coordination program must support multi-morbidity patients and include detailed health education materials, associated surveys, and targeted next steps.

The best care coordination programs support the management of individuals with co-morbidities. These plans focus on preventive standards of care based on age and gender, along with education and interventions for managing chronic conditions. Patient-centered care, as well as patient engagement and activation, are necessary to succeed in population health management. Self-management support contributes to increasing patients’ confidence and skill, so they can be the manager of their illness. This not only lowers costs but also redefines healthcare as an activity that encompasses far more than sick care.

The more we learn about the Affordable Care Act, the more we understand that prevention and management are of increasing importance. In many cases, the failure to prevent hospital readmission adversely affects a healthcare organization’s bottom line. When managed correctly, the call center can effectively decrease the penalties tied to high readmission rates. Active management of follow-up calls to verify the patient has filled and is taking the right prescriptions, scheduled and attended a follow-up visit, and is adhering to other post-discharge instructions are all verifiable through scheduled follow-up calls or other forms of communication conducted by the call center nurse.

Using an in-depth, post-admission course of care can greatly reduce the probability of the patient returning during the initial thirty days post-discharge, as well as facilitate behavior change over time. It represents the best in evidence-based theory and application.

Whether you choose to invest in a single-source solution to manage these population health components or select best-in-breed solutions interfaced with other internal patient data systems, it is critical that all aspects of the patient’s care be accessible by the call center nurse. A coordinated effort delivered by the call center can improve the coordination of care for numerous individuals while successfully reducing unnecessary costs tied to the delivery of multiple redundant programs.

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Mark Dwyer is a 32-year veteran of the healthcare call center industry. Mark is in his sixteenth year at LVM Systems where he serves as COO. LVM Systems provides healthcare call center software. For more information or a demonstration of LVM’s call center solutions contact Carol Zeek, regional VP, sales, at 480-633-8200 x279 or Leann Delaney, regional VP, sales at 480-633-8200 x286