In the previous two installments of this blog series, we looked at where call centers began and how they have evolved up until the present time, as well as at some predictions about the call center of the future. In this last installment, we’ll discuss some new uses for the call center.
Healthcare has undergone tremendous change over the past several years. One of the greatest drivers of change has been the passage of the Affordable Care Act (ACA) with all its associated rules and regulations. Two important concepts that have sprung from the ACA are Accountable Care Organizations (ACOs) and population health management.
ACOs are essentially what the name implies: a means by which to better coordinate and deliver patient care with improved outcomes. Population health involves "the health outcomes of a group of individuals, including the distribution of health outcomes within the group." The call center can be a valuable resource for ACOs and population health management, providing health information, assistance with patient compliance and adherence and other patient care services.
Three needs that are common to ACOs and population health management are:
- Management of chronic illnesses
- Adherence to treatment plans
- Follow-up care.
The call center can be an integral component to provide the necessary patient outreach and communication for these needs.
Let’s examine three real-world examples of call center utilization for ACO and population health management settings.
Case Study: Rio Grande Valley ACO
Cameron and Hidalgo counties, located in the Rio Grande Valley in Texas, have the dubious distinction of being two of the three poorest metropolitan areas in the US. In addition, almost 30% of the population in the area has diabetes. The Rio Grande Valley (RGV) ACO, one of the first Medicare ACOs in the US, serves both counties. Close to 42% of RGV ACO’s Medicare beneficiaries have diabetes.
Diabetes is a major chronic disease that can – and often does – lead to serious complications. Couple a high incidence of the disease with an area of pervasive poverty, and you have very serious health concerns. Improving care for these patients can be quite challenging.
CMS has identified five quality measures for assessing treatment outcomes for ACO patients with diabetes: blood pressure control, lipids (cholesterol and triglycerides) control, blood glucose control, aspirin use and tobacco avoidance. Patients must be compliant in all five areas in order for the ACO to be deemed compliant with treatment.
In 2012, the RGV ACO achieved 70-80% compliance in individual quality measures, but only 23% compliance in meeting all the quality measures. In order to improve overall compliance, efforts were ramped up, including the establishment of a diabetes education center. A team of medical assistants and licensed vocational nurses (LVNs) were trained to serve as care coordinators by a certified diabetes educator, and a care coordinator was placed in each clinic. Using the HER system, a concerted effort was made to help patients improve their compliance with all five quality measures. A call center was established that made routine calls to survey blood sugar levels, and remind patients to take their cholesterol and blood pressure medications.
By 2013, RGV ACO’s compliance had improved to 75-90% with individual quality measures, and 48% compliance with all five; an overall 100% improvement.
Case Study: Community Care of North Carolina (CCNC)
CCNC is a state-wide organization comprised of 14 local networks in North Carolina that provide healthcare to rural and under-served populations using the medical home model. A call center was established in 2011 to assist CCNC in achieving its goals and initiatives through telephonic patient contact.
The primary goal for CCNC is to decrease unnecessary ER admissions. To that end, when CCNC is informed of a non-emergent ER visit, call center staff follow-up with the patient to reiterate the importance of using the medical home and identify additional local resources and options for the patient. In most cases, only a single phone call is made, but in the case of patients who continue to over-use the ER for non-emergent visits, an RN from the call center will attempt to follow-up with these patients to identify any care gaps or new health issues that can be referred to the networks.
Additional functions of the CCNC call center include provide:
- Information to new enrollees regarding appropriate use of the ER and urgent care; accessible local resources; medical home provider-specific information; information on provider visit and prescription co-pays; and how to access specialists.
- Health coaching for the CCNC Medicaid population, using RNs who are certified health coaches.
Case Study: North Shore-LIJ Health System
Rather than having patients hear the ubiquitous “If this is an emergency, hang-up and call 9-1-1 or go to the emergency room” message that can drive them to use inappropriate or out-of-network resources, North Shore-LIJ opted to establish a 24/7 central phone bank that is linked to physician offices, care managers, on-call triage nurses and physicians.
The phone service handles calls from North Shore-LIJ’s 5,000-patient cohort in the Montefiore Medicare Pioneer ACO, 12,000 patients in its individual health plan, 50,000 patients in its self-funded employee benefit plan, and several ACO and pay-for-performance contracts with commercial insurers. It also serves the system’s Medicare bundled payment service which launched this year. Overall, about 7 percent of the system’s revenues came from at-risk contracts in 2014, projected to rise to 10 percent or more in 2015.
The call center provides these functions:
- Appointment scheduling
- Routine prescription requests
- Answering clinical questions
- Directing patients to network physician offices or urgent care when needed.
As healthcare continues to change and evolve, so can the call center, as illustrated by the above examples. The call center has the potential to be an integral component of healthcare delivery for many years to come.