Patient Experience Contact Centers Respond to a Confluence of Industry Challenges

By Richard D. Stier, MBA

Patient experience failure, the incentivized reduction of avoidable readmissions, increasing rates of physician burnout, and the escalating priority of revenue cycle management, have all combined to incubate an unexpected solution. The patient experience contact center is born. Exit the call center. Discontinue generic transactions.

Enter the era of thoughtfully deployed patient experiences beginning at the first point of contact. In contrast to yesterday’s call centers, which processed physician referrals and class enrollments, today’s patient experience contact centers are a health network’s communications nerve center. They deliver intentionally memorable experiences that strengthen preference, mitigate risk, reduce unnecessary readmissions, serve as physician practice extenders, and solidify patient loyalty.

Patient Experience Failure: Currently healthcare has a 29 percent patient experience failure rate, according to research by Hospital Compare. Only 71 percent of inpatient patients receiving care report that they received the “Best Possible Care.”

In what universe is a 29 percent failure rate acceptable? Could we miss revenue projections by 29 percent? Be over budget by 29 percent? Would it ever be acceptable to miss quality standards by 29 percent? “We only dropped 29 percent of newborns, so we met the standard.” Seriously?

“Best Possible Care” experiences begin before a patient receives care and continues after the patient returns home. Healthcare contact centers are uniquely positioned. They serve as the virtual front door for personalized support and referrals before using a clinical service and for individualized follow-up and coaching after discharge.

With the launch of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program by CMS in 2006, hospitals have dedicated significant time and resources to improving the results of CAHPS surveys. The shift from a transaction-focused call center to an experience-driven contact center is an investment to improve the experience of care beginning at the first touchpoint when someone new to the community calls to request a referral to a primary care physician (PCP), to after discharge when a contact center navigator calls to confirm a follow-up visit with that PCP.

That first touchpoint is critical. According to SHSMD (2012), the first three seconds of that initial interaction influences hospital selection and preference. Whether on the phone or online, healthcare contact centers can intentionally deliver a transformative first patient experience.

Patient experience contact centers respond: A large, backlit sign at the entrance to a leading healthcare contact center boldly proclaims: “We own the patient experience.” At another, team members wear purple t-shirts that announce in large white letters: “I give phone hugs!”

Yet another patient experience contact center conducts their own ongoing patient satisfaction surveys to identify opportunities for improvement before the next CAHPS survey is conducted. By the time the CAHPS results are published, they have proactively improved their scores.

Incentivized Reduction of Avoidable Readmissions: One-half of all hospitals in the United States (2,597) will be penalized by the Centers for Medicare & Medicaid Services (CMS) for unnecessary readmissions in FY 2017. In 2017, penalties will total $528 million, over $100 million more than in FY 2016. During 2016 forty-nine hospitals received the maximum penalty of 3 percent withholding from Medicare funding. A total of 1,621 hospitals have been fined over each of the five years. (Source: HealthStream SUMMIT 2016)

Preventable readmissions represent a substantial portion of unnecessary medical spending. According to data from the Center for Health Information and Analysis (CHIA), the estimated annual cost of this problem for Medicare is $26 billion annually, $17 billion of which is considered avoidable. (Source: Provider Advisor 2016 Volume 2, Issue 2 p 4.)

It’s about to get even harder. For FY 2017, CMS is adding open-heart surgery—a more complex, longer stay procedure—to the list of clinical conditions monitored for avoidable readmissions.

Patient experience contact centers respond: A leading Midwest health network was fined $2.5 million for excessive preventable readmissions. The patient experience contact center became an intentional, centralized source for reducing avoidable readmissions. Here’s what they achieved:

  • Readmission rate declined from 25 to 15 percent
  • $2.5 million fine from CMS was reduced by $1.9 million over two years
  • The contact center asks patients at discharge for permission to contact a family member or caregiver—and store that information in the patient record—to be accessed when it’s time to make certain they are able to get to their follow-up physician appointment. They have raised the kept appointment rate for post-discharge physician visits to 87 percent.

Increasing Physician Burnout: Nine out of ten physicians discourage others from joining the profession. Currently about 300 physicians commit suicide every year. (Source: Daniela Drake, The daily Beast, 2014.)

As many as one in three physicians is suffering from burnout, which is linked to a list of pervasively negative consequences including lower patient satisfaction and care quality, higher medical error rates, greater malpractice risk, higher physician turnover, physician alcohol and drug abuse and addiction, and physician suicide. (Source: Dike Drummond, MD “Stop Physician Burnout”)

Physicians face increasing burdens including the complexities of ICD-10 coding; new billing models; responding to new government regulations; dealing with a changing landscape of health plans; sharing information across the network; inefficiencies of credentialing, provider enrollment and onboarding; documenting quality, cyber security, loss of autonomy, threats from alternative providers; and the “retailization” of primary care.

And, here comes the value-based reimbursement plan for physicians: MACRA (Medicare Access and CHIP Reauthorization Act). Beginning in 2019, physicians will be reimbursed on various performance metrics including quality, advancing care quality, resource use, and clinical practice improvement. According to Deloitte, “Providers are in for a notable awakening when the law takes place in 2017.”

On top of this avalanche of stressors a physician must keep up to date clinically, build practice volume, and improve their patients’ experiences. Are you exhausted yet?

Patient experience contact centers respond: Patient experience contact centers are providing resources to serve as practice extenders: decreasing the burden and filling their practices. One locates a contact center ambassador in each of their emergency departments to capture patients without a PCP, and keep them in network. It has become a gift that keeps on giving with a steady stream of newly aligned patients referred to in-network primary care physicians.

Another built a network of family medicine centers and established a patient experience contact center to fill the practices. Still another focused their contact center on physician-to-physician consults for referring physicians to the health system’s specialists and sub-specialists. They received physician-to-physician referrals from dozens of states and several foreign countries. Annual multimillion-dollar results prompted the organization’s president to declare the contact center as her “secret weapon.”

Several patient experience-focused contact centers now include patient ratings and the comments in online provider directories. The scores and comments about a particular physician from previous patients give prospective patients vital information and increase the likelihood of a good match between patient and provider.

Growing focus on Revenue Cycle Management: The Affordable Care Act (ACA) and Medicaid expansion has created an influx of previously uninsured patients that has left healthcare organizations scrambling to accommodate increased demand while simultaneously experiencing lower margins. Because consumers are assuming greater financial responsibility for their own healthcare, healthcare delivery networks have to shift from a wholesale to a retail environment where they are interacting directly with patients on issues including pricing, billing, and payment. Unfortunately, hospitals and health networks are experiencing a strong correlation between the use of high deductible plans and the amount of bad debt they are incurring. (Source: HealthCare Finance, 2016)

Concurrently, few healthcare organizations have taken the steps necessary to integrate the many information systems that support revenue cycle management. Systems are incompatible across service lines, locations, and functionality. Different software solutions are frequently employed to support disparate functions such as registration, clinical documentation, and billing.

Even worse, some of these functions may be done manually or are only partially automated, making data analysis incomplete or impossible. As the industry migrates toward value-based care, healthcare organizations are entering new collaborations, taking on risk contracts, exploring alternative sources of revenue, and being pressured to document outcomes.

Patient experience contact centers respond: A leading patient experience contact center offers a patient hotline that strengthens patient trust while managing the organization’s revenue cycle. Contact center agents work with patients to understand their best health plan for them to remain in-network, secure financial clearance, and arrange for a deposit prior to the visit.

This organization celebrates “phone hugs” and is shifting the culture from processing transactions to building relationships with patients through transformative, empathetic conversations.

Summary: Patient experience contact centers are a timely response to a myriad of industry pressures. Redeploying a legacy transaction-focused call center as a patient experience contact center can strengthen preference for your organization, mitigate risk, reduce unnecessary readmissions, serve as a physician practice extender, and solidify patient loyalty.

Richard D. Stier, MBA is vice president marketing for Echo – A HealthStream Company. He is a passionate and results-proven proponent of delivering transformative patient experiences.