The Contact Center’s Revitalized Role for Population Health Improvement

By Richard D. Stier, MBA

At the recent SHSMD13 conference, Michelle von Dambrowski made the following comment about contact center solutions: “You guys are at the center of the whole shift to population health.” She gets it. The contact center can be vital to population health management (PHM) for your organization.

Healthcare call centers are now more relevant than ever. They are a pivotal tool in meeting the triple aim objectives of improving the experience of care, reducing costs, and managing the health of a population.

Call centers are moving from a siloed support function to a critical role as a communication hub at the center of the healthcare continuum. As stated in 2013 at the 25th Annual Conference of Healthcare Call Centers, “The contact center is the nerve center at the heart of the new structure.”

A statement from the Society for Healthcare Strategy and Market Development (SHSMD) at their 2013 conference is likewise instructive: “The new role of marketing is personal health relationship management.” Notice the words relationship management. The call center is re-imagined as a central communication hub, the organization’s connection nerve center that assists the newly insured, supports ACO and medical home physicians, and creates economies of scale.

This communication hub is a vital tool for strengthening relationships with key stakeholders.

For Physicians: A key factor that pivots a CEO search away from an external candidate and toward an internal applicant is previously built physician relationships. “Having the trust of physicians is huge,” said Molly Gamble (“Notes from the Field: 7 Things to Know About Hospital CEO Searches” in Becker’s Hospital Review, October 11, 2013).

How can the contact center communication hub strengthen relationships with physicians?

  • Ask physicians two key questions: What can we do to help you succeed at our hospital?” and “How can our contact center better support for your practice?” Listen carefully to their answers.
  • Provide navigation support by coordinating follow-up appointments and referrals to specialists and appropriate classes.
  • Make referrals and appointments to primary care physicians for ED patients without a primary care provider.
  • Facilitate physician consults for referring physicians with one call access to specialists.
  • Schedule follow-up primary care appointments prior to hospital discharge.
  • Conduct post-discharge follow-up calls to reduce avoidable readmissions, identify medication compliance problems, and determine durable medical equipment needs.
  • Deploy evidence-based clinical triage and shorten appointment wait times by collaborating with physicians’ offices to hold a few priority slots for patients needing earlier appointments and document kept appointments.

For Payers: A key trend driven by payers is reference pricing. Reference pricing occurs when an employer or employer group identifies the average price charged for a particular procedure and agrees to pay that amount – and only that amount – with any overage paid by the insured. Now, there is a tangible financial incentive for the insured to find a provider who will accept the reference price. By October of 2013, only 8% of employers nationally were engaged in reference pricing, while 59% of employers across the country are planning to adopt it (Joe Flower, SHSMD13 keynote address, September 29, 2013).

For example, because of reference pricing, the average price for knee implants in California has fallen significantly. The California Public Employees’ Retirement System (CALPERS) identified that for their service areas, while the charge for knee implants ranged up to $36,000, the average price was $23,000. CALPERS set the reference price it would pay for knee implants at $23,000 and invited hospitals in its service area to participate. Initially, forty-eight hospitals signed on. Subsequently, six more hospitals signed up, deciding they would rather have $23,000 than nothing.

Employers across the country are taking note. Reference pricing is expected to proliferate across specialties. Here are ways the contact center communication hub can strengthen relationships with payers:

Become the communication conduit for reference pricing referrals:Research and understand reference pricing for each plan in your service area, and enter the participating hospitals into your contact center software. “Oh, yes, Mrs. Smith. I understand. You’re on CALPERS. St. ABC Hospital is a participating hospital for knee implant referrals. Would you like me to schedule an appointment for you with one of their affiliated physicians?”

Decrease ED utilization and related costs by providing telephone nurse triage to employer groups:For example, nurse-operated telephone triage programs that provide patients with prompt medical advice reduced ED utilization by 4.3 percent and produced annual net savings of nearly $400,000, (O’Connell JM, Johnson DA, Stallmayer J, et al., A satisfaction and return-on-investment of a nurse triage service, American Journal of Managed Care, 2001;7(2), pages 159-169).

In 2011, AtlantiCare provided clinical triage services through its access center to its own employees and their dependents. “As a result, just nineteen percent of those callers ended up in the emergency department; fifty-nine percent were treated at a lower level of care, primary or urgent,” (Society for Healthcare Strategy and Marketing Development SPECTRUM magazine, “From Silo to Hub: Not Your Father’s Call Center” May/June, 2013, page 10).

For Hospitals and Facilities: Integrate all first point of contact services such as scheduling, transfers, physician referral, class registration, physician-to-physician referral, nurse triage, and switchboard to reduce redundant costs. A key success factor is cross-training communication hub staff to provide all communication and navigation experiences.

Another opportunity to reduce redundant costs is to integrate multiple sources of physician information. We can no longer afford seventy-six sources of physician information. “A single source of truth is essential. Data exchange and HLS7 interfaces are a requisite part of the future,” said Joe Flower.

For the Community: The healthcare contact center is frequently a patient’s first interpersonal experience with a hospital or health system. The first three seconds of that interaction are critically important because that initial connection is a strong indicator of patient preference and subsequent hospital selection.

If your goal is to improve transactions, you’ve already lost. The future is about delivering transformative experiences at the first point of contact. Make the equivalent shift from coffee as a commodity to the experience at Starbucks or from shelter at a generic motel to the experience at Ritz Carlton. Role-play trust-building interactions before the first call and after every difficult call.

“PHM requires providers to connect with patients where they are,” said Joe Flower . Think of your contact center as an ongoing connection, a running dialogue with key stakeholders your organization needs you to influence.

SoLoMo: In addition to strengthening relationships with key stakeholders, the contact center communication hub must integrate with and personalize communications on social and mobile media. Social media, geo-location targeting, and mobile communications, or SoLoMo, enable contact center communication hubs to connect with key stakeholders where they already are.


  • Promote and register for upcoming classes and events
  • Enable online physician referral
  • Provide health information
  • Post ER wait times with directions
  • Support service recovery
  • Recruit candidates
  • Build an online community around the call center
  • Monitor organization mentions or comments and respond as appropriate
  • Engage with employees and key stakeholders

Geo-Location Targeting

  • GPS directions to physician offices, urgent care, outpatient, and hospital locations
  • QR code information on ER wait time and the ability to check-in

Mobile: Worldwide, by the end of 2013, there will be more mobile devices than people (Cisco’s Visual Networking Index Global Mobile Data Traffic Forecast Update). Additionally, there are currently more than 97,000 mobile apps available related to health and fitness (Research2guidance’s new report, Mobile Health Market Report 2013-2017: The Commercialization of mHealth Applications”).

Contact centers can offer the following services:

  • Class/event information and registration
  • Physician finder
  • Symptom-based triage
  • Drug reference guides
  • Directions
  • ER wait times
  • Monitor and respond to mobile communications and clinical data feeds
  • Mobile, SMS, and text appointment reminders
  • Back up or support for Website and mobile site visitors
  • “Face Time” enables triage nurses to observe patient responses and visualize an injury
  • Patient access to physician appointments
  • Virtual healthcare visits

Six Opportunities: Yourcontact center can be essential to population health management for your organization. Here are six immediate opportunities:

  1. Integrate first point of access functions into a contact center communication hub that assists the newly insured, supports ACO and medical home physicians, and creates economies of scale.
  2. Redeploy your contact center to serve as a trust-building resource for participating physicians.
  3. Become the communication conduit to provide referrals for reference pricing.
  4. Provide telephone triage and advice to employer groups to reduce ED utilization.
  5. Shift your call center’s focus from transactions to transformations by creating memorable experiences at the first point of contact for your health delivery network.
  6. Build a plan to leverage personalized social and mobile media opportunities.

Rick Stier has a thirty-year record of results as a healthcare marketing executive and consultant. He is vice president of marketing at HealthLine Systems, Inc., a provider of software and consulting solutions to over one thousand healthcare organizations across North America.

[From the December 2013/January 2014 issue of AnswerStat magazine]