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Delivering Front-Line Health Care Provider Support

HealthCareProvider

Introduction

Any business must deliver quality interactions if it seeks to build consumer loyalty. However, for healthcare providers, this requirement is magnified. Servicing end-users efficiently and compassionately, while also doing everything possible to ensure repeat business, is one of the most challenging imperatives in this space.

In an era when captive contact center operations face significant cost pressures, working with a third-party provider is becoming a viable alternative. Provider management is under more strain than ever.

Delivering first-class care is becoming more challenging due to heavier demand in resources for front-line interactions, a trend that will only increase as demographics shift toward an older, less healthy population. This is why many healthcare provision executives are now considering working with experienced outsourcing partners for their contact center needs.

ACO healthcare delivery priorities in 2017 and beyond

Accountable Care Organizations (ACOs) have not formally existed long, but their impact is being felt by a large swath of Americans. In fact, these entities now handle the coverage of thirty-two million patients across all fifty states – this accounts for roughly ten percent of the US population. However, as ACOs evolve in health care provision, their priorities are becoming more defined in the context of how they interact with patients.

Managing interactions with chronically ill patients

If there is one thing that strikes as a challenge for ACOs, it is interacting with patients that suffer from chronic illnesses. This was quantified in the recently-published 2017 ACO Survey, in which roughly half the respondents stated that their organization had not fully implemented programs to manage specific chronic diseases. This is compounded by the number of ACOs that claim not to have in place strategies designed to mitigate preventable hospital readmissions.

While potentially due to a number of factors (such as tight resources), this lack of ubiquitous implementation in itself is worrying, as it places patient quality of life at risk. It is also a leading cause of patients coming back to hospitals, in circumstances that could otherwise be avoided.

Thus, for ACOs, managing chronic care interactions efficiently and, cost-effectively must be a priority in their ongoing pursuit of maintaining a strong quality of life for the individuals in question. This is driving many ACOs to look at the possibility of working with third-party partners that can assist in these aspects of healthcare delivery, ensuring both compassion and efficiency for those chronically ill patients.

Driving administrative efficiencies within ACOs

Like organizations across all sectors, ACOs are prone to the high costs of administrative burdens in their daily operations. It can be argued that this trend is more acute in the healthcare sector, which is being plagued by ever-changing regulation and heavier costs, due to the increased demand for services by the aging, less health-conscious US population.

Particular areas of administrative concern for ACOs include those that are relatively routine, but increasingly difficult to manage. However, as ACOs continue to grow their list of these services (such as scheduling, post-discharge follow-ups with patients, the coordination of non-medical services, and various interactions that have to do with medication), in order to remain relevant, being able to deliver seamlessly will be essential.

If handled properly, these services also lead to patients remaining out of the hospital. For many ACOs, these administrative functions are now best outsourced to experienced third-party providers.

This permits the ACO to focus on the core of its healthcare delivery value proposition, while the more administrative elements can be handled by qualified partners. This provides increased flexibility to the ACO and contributes to better outcomes for the patient.

As US demographics shift toward an aging population (and with MACRA requirements now in place), the need for healthcare providers to manage larger numbers of interactions will intensify.

This is being compounded by higher delivery costs, evolving regulation and changes in frontline communication technologies. Amid this disruption, many healthcare providers are choosing to optimize contact center operations by working with a third-party vendor as an alternative to deliver high-quality interactions at a reasonable cost.

Accessing the right healthcare contact center technology

The intense cost pressures that ACOs face in acquiring the most up-to-date technologies to best deliver chronic care management should not be understated. Whether it is patient-facing solutions or the back-office platforms required to optimize efficiencies, having the right technology in place can impact the performance of any provider. But, with so many enterprises in the healthcare sector, including ACOs, facing tight CRM budgets (please see graphic below), these solutions may be out of reach.


Anticipated CRM investment flexibility among healthcare enterprises, 2017 & 2018

The importance of ensuring strong chronic care management solutions

Providers are at the front-line of the challenges faced by the US healthcare system. They can expect a great deal of pressure in terms of their service lines in the coming years, and nowhere more so than chronic care management. The rapid rise in the number of Americans over 65 years old (noted in the graphic below) is but one strain on healthcare provision; there is also the increase in obesity, which impacts over one-third of Americans and is a leading contributor to many different illnesses.

Millions of Americans 65 or older, 2000 & 2016

In 2010, Medicare noted that nearly half its outlays went to patients with ongoing health conditions. Thus, for providers, having the right chronic care management solution in place has never been more important. With health care costs constantly on the rise, it is becoming much more challenging to engage with patients between clinical visits.

However, with the objectives of ensuring that people with chronic conditions have the chance to recover and to enjoy an improved quality of life, this communication is essential. This is why more providers are looking toward contact center outsourcers to help achieve their chronic care management objectives.

Centro Global Solutions as partner for healthcare providers

Centro Global Solutions supports U.S. healthcare end-users through both voice and digital channels from its contact center in Virginia. It also provides healthcare clients with a number of administrative-focused back-office solutions.

In 2015, Centro Global Solutions implemented the Health Insurance Portability and Accountability Act (HIPAA) as safeguard for all ePHI information handled within the organization and its clients. It is also working towards SOC II Type II, which is expected to be completed by early 2018. Centro Global Solutions counts the following among its three most important provider-focused solutions.

Chronic care management: Centro Global Solutions has developed solutions that help ease the front-line and administrative burdens of chronic care management on healthcare providers while maintaining the compassion that patients require. These include:

  • Time management – there are two components to the Centro Global Solutions chronic care management approach. The first relates to enrollment. Centro Global Solutions offers providers enrollment services that combine automated dialing technology with specialist agents with experience onboarding new patients.The second part of Centro Global Solutions’ time management service relates to clinical encounters, in which its agents can assist patients in basic medical telephone triage. 
  • Access to technology –Centro Global Solutions offers healthcare clients the technology associated with the principal billing platforms associated with chronic care management. These include:
    • Third-party platform management (including MD Revolution and Vivify Health)
    • The client’s proprietary electronic health records management system

Revenue cycle management (RCM)–The key RCM services provided by Centro Global Solutions include:

  • Revenue growth management – Centro Global Solutions’ team of certified medical billers work to maximize patient billings through accurate coding practices.
  • Decreased days in claims maturation –Centro Global Solutions files all client claims within 24 hours of consultation. It chases any outstanding claims if not paid within 30 days.
  • Patient collections – Centro Global Solutions performs eligibility checks to verify how much coverage each patient is allocated so that providers can collect at time of the clinical consultation. Centro Global Solutions also works with providers to establish precise collection rules as required by the provider.

Reception and scheduling management – Using live agents, Centro Global Solutions works with provider clients to handle the most frequent patient interaction types (such as appointment setting and prescription refills).

Conclusion

Healthcare has always been an incredibly complex industry for the provision of front-line interactions. First-rate customer experience is no easy task in an era of an aging population concurrent with rapid technological advances in the healthcare industry.

The use of experienced third-party partners is on the rise among pharmacies, as a means of driving strong contact center interactions. The efforts that outsourcers make to improve interactions and efficiencies in the pharmacy sector need to be commercial, while at the same time compassionate. Oering solutions that drive efficient interactions while increasing loyalty are important facets of what a provider can bring to pharmacy clients in today’s market.

About Ryan Strategic Advisory

Ryan Strategic Advisory provides clients across the contact center and BPO spectrum with a variety of value-add, strategic services such as market insights, brand development and consultative services. With a long history of delivering qualitative and quantitative intelligence for clients across the contact center services ecosystem, Ryan Strategic Advisory specializes in providing actionable data and insights needed to succeed in this dynamic and ever-changing sector.

Their vast experience helps clients grow their presence in the global BPO sector, using a variety of platforms to communicate the most important elements of the outsourcer’s value proposition. By offering a varied range of bespoke services, clients can expect realistic, frank business counsel. Tailored solutions mean rapid resolution to the outsourcing business challenges.
Please visit: www.ryanadvisory.com

About Centro Healthcare

Centro Healthcare offers a diverse portfolio of outsourced healthcare services, using both clinical and non-clinical resources, and leveraging analytics as well as state-of-the-art technology partners. We provide solutions for Population Health, Patient Engagement, Care Coordination, 24/7 Nurse Hotlines and Centralized Appointment Scheduling/Referral Management. Centro Healthcare’s mission is to maximize returns for providers, health plans, and Accountable Care Organizations (ACOs), while helping drive improved patient outcomes and satisfaction.
Please visit: www.centrohealthcare.com

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