“It’s time to shine” is simply a moment to show off one’s skills or abilities. For Healthcare (HC) Contact Centers, widely known as “Access Centers,” that moment is now. The COVID-19 pandemic highlighted the value and importance of Contact Centers in keeping industries operational during the shutdown. Healthcare was no exception. Thankfully, that period is now past and it is time to build on HC Contact Center achievements, value, and plans for the future.
The Value of Centralization
I believe that HC Access Centers have an opportunity to craft a plan for growth that optimizes investment made in centralizing physician appointment scheduling and celebrates the value delivered to the enterprise. The future for HC Access Centers is full of possibilities that are already likely to be topics of conversation at the executive level. Now is the time to shine a light on the expertise and value of your Access Center and identify more ways to centralize services that improve the Patient/Provider Experience, gain efficiencies, and contribute to the financial health of the organization. Yes, these are high goals. But they are necessary given current challenges in Healthcare.
“The future depends on what you do today.” —Mahatma Gandhi
Changes in Healthcare
Few industries have seen more changes over the past couple of decades than Healthcare. Hospitals are centralizing, large systems are growing by acquisition; venture capitalists are buying high-revenue practices like Dermatology, Cardiology, and Orthopedics; and pharmacies are offering tests and vaccinations. It is the wild, wild west of Healthcare Access!
Contact Center professionals in all industries must understand the marketplace in which they operate. For Healthcare, the landscape is changing and it is important to stay informed. Consider the fact that Walmart recently announced that it would close all 51 of its Health Centers and Virtual Health Services. The company said that after just five years, “a challenging reimbursement environment and increasing operating costs make the (ambulatory care) business model unsustainable.” Walmart also states that it will remain in the pharmaceutical and eye care business (I guess because they must be … profitable).
The COVID-19 pandemic highlighted the value and importance of Contact Centers in keeping industries operational during the shutdown.
Essentially, a company focused on generating profits has informed the market that providing actual patient facing care is simply not profitable. This highlights the challenges that all Healthcare providers face: “a challenging reimbursement environment” (insurance companies) and “increasing operating costs” (providers at all levels, admins, lab techs, facilities, tools, etc.).
This situation makes the recent years of systems’ growth in Healthcare and massive consolidation easier to understand; it also positions Access Centers for growth in order to support ongoing efficiency gains and improve the Patient Experience.
Access Centers have an organizational and operational environment well-suited to handle additional services currently provided by overburdened practice personnel. Access Centers have systems, processes, analysts, trainers, quality assurance, and workforce management all in place and if they were built right … all are SCALABLE!
Access Centers are well-positioned to contribute to both financial wellbeing and the Patient Experience by working with executives and Practice Administrators to identify additional activities and tasks suitable for centralization.
I will focus on three areas to consider for Contact Center centralization. (There are many others.) These are Physician Referrals, Prior Authorizations, and Radiology Scheduling. Each is part of the Patient Access journey as they represent pre-appointment tasks and significant revenue improvement opportunities.
Physician Referrals
Physician referrals are a clear revenue stream as they result in a patient requesting an appointment. Primary Care providers generate a huge percentage of referrals to specialists and have various processes to follow depending on specialists’ widely-varied scheduling protocols.
For many Healthcare systems, the handling of Physician Referrals is a decentralized activity (handled in the provider’s office) and in many cases as informal as it is inefficient. When admins in provider offices are assigned to handle referrals, among their many other tasks, it is largely because they have always done it that way. This might have started 20 years ago!
Contact Center professionals in all industries must understand the marketplace in which they operate.
Referrals are often paper driven, arrive by fax, and are “distributed” by hand to whomever is responsible that day. This “shared” responsibility model is fraught with risk. Limited tracking and reporting minimizes management’s ability to understand the demand level. The lack of systematic processes and documented procedures may cause confusion/chaos within the practice, delay patient care, and negatively impact revenue.
The Access Center has greater capabilities to manage this important revenue stream by providing a more centralized, seamless, and user-friendly experience for patients and providers.
Prior Authorization
Prior Authorization (PA) is one of the most frustrating and inefficient aspects of today’s Healthcare system for patients, providers, and staff. According to the American Medical Association (AMA) provider practices complete an average of 43 prior authorizations per physician per week; this takes about 12 hours of physician and staff time. Typically, securing prior authorizations falls to the already overburdened physician’s office staff where training, standardization, and analytics are often lacking. Poor handling of PAs leads to administrative frustration, delays in patient care, unexpected bills due to PA denials, and financial losses to the enterprise. These conditions also significantly impact telephone calls to the practice.
Centralization improves communication and coordination among different departments and stakeholders.
The Access Center has greater capabilities to manage this important revenue stream as it provides a more seamless and user-friendly experience for patients. Centralization to an Access Center improves efficiency, streamlines the process, reduces redundancy, and ensures that requests are handled promptly and accurately. This helps minimize delays in patient care and optimizes the use of resources. Access Centers are also equipped to develop teams specifically trained to handle PAs. These teams stay up-to-date on the latest requirements and best practices. This adds to more effective and accurate PA submissions.
Overall, centralization improves communication and coordination among different departments and stakeholders. Centralizing PAs in the Access Center also provides clearer career paths for staff; this offers opportunities for growth and specialization within the organization.
Radiology Scheduling
Radiology is an important factor in both patient care and system revenue. Scheduling radiology procedures scales from the simple to the complex. Centralization streamlines the scheduling process, reduces duplication of efforts, and ensures that resources are used more effectively. It can help optimize appointment slots, reduce staff idle time, and maximize the use of equipment and staff. The centralized approach ensures that scheduling policies and procedures are consistent across the entire system. This reduces the risk of errors and miscommunications and leads to more reliable and predictable operations.
The centralized handling of Referrals, PAs, and Radiology in the Access Center connects many touchpoints on the patient’s journey. Each of these activities relates to patient care and revenue generation, two significant business drivers. In addition, the Access Center provides a single source of data that can be analyzed to track key performance indicators, identify bottlenecks, and make data-driven decisions for process improvements. This is also an opportunity to expand Workforce Management’s analytical role to include Business Analytics, a process that is way overdue.
While this article focuses on Healthcare, other industry Contact Centers should consider what additional services they can offer. How can the Contact Center contribute to enterprise goals? How can it showcase skills and scalability? How can it proactively promote capabilities and identify additional opportunities to centralize?
Finally, centralization forces the streamlining of processes. This is a critical success factor when it comes to digital access and deploying Artificial Intelligence (likely to play a significant role in managing PAs). Begin now and get ahead of the game!
It is truly time to shine for Healthcare Access/Contact Center leaders to proactively leverage their capabilities as assets while building a strong and scalable operational model of the future.