Guest Column | April 18, 2016

How To Manage A Patient's Experience To Maximize Reimbursement

HTO Reimbursement

By Scott Logan, vice president of marketing, Enghouse Interactive

The state of healthcare reimbursement in the U.S. is in extreme flux. It is being rewritten from the ground up, and healthcare providers and health systems are having a hard time keeping track of how they should plan for their financial survival.

Beginning in 2016, 30 percent of Medicare reimbursement will be based on value-based care measures, and this will be upped to 50 percent by 2018. Value-based care will entail making sure patients have a good experience and are actively engaged in their own healthcare, and that care is streamlined, made more efficient, boosts quality, and improves outcomes. No small feat and the use of technology to achieve value-based care will be critical.

How Can Providers Use IT To Achieve Value-Based Care?
Healthcare management has long believed in the value of call centers in terms of the overall cost of providing patient care. However, patient needs and expectations become more demanding as technology advances, and call center agents don’t have the right tools to keep pace.

In the context of the contact center, a broad arsenal of technological weapons can give providers the advantage in achieving the best healthcare outcomes and optimum patient experiences needed for reimbursement under value-based care. Chief among their options is embracing the emergence of omni-channel interactions to improve workflows and deliver a more positive patient experience.

Today’s patients expect the same level of service regardless of whether they choose to contact you by phone, email, chat, social media, video, or text. However, existing infrastructure must be updated and agents must receive the proper training to effectively engage patients on various channels. Following are some key features and their direct benefits.

Interactive voice response can reduce readmission rates. Interactive voice response (IVR) can help tired and weak patients who are struggling with recovery at home to monitor their progress and help care providers to spot those who need help before complications require a re-hospitalization. IVR is an automated telephone system that interacts with callers, gathers information, and routes calls to the appropriate recipient. An IVR system accepts a combination of voice telephone input and touch-tone keypad selection and provides appropriate responses in the form of voice, fax, callback, e-mail, and other media.

A study conducted by Geisinger Health Plan (GHP) and published in Population Health Management found telemonitoring of patients recovering from heart failure reduced 30-day readmission rates by 44 percent, saved GHP 11 percent in care costs, and produced a return on investment of approximately 3.3 percent.

This kind of savings, improvement of outcomes, and empowerment of patients is exactly what the federal government is looking to accomplish under value-based care.

Multimedia queuing and intelligent call routing personalizes care and improves patient satisfaction. Wait times aren’t necessarily a good way to measure patient satisfaction, writes James Merlino, chief experience officer and associate chief of staff of the Cleveland Clinic Health System. In an article in Health Catalyst, Merlino says a Cleveland Clinic survey on patient satisfaction discovered that what patients want most of all is respect and displays of caring and concern.

Multimedia queuing lets you route, manage, and measure all types of contact using a single workflow engine. Functionality that was previously only available for phone calls, such as skills-based routing and real-time reporting, can be applied to popular new media such as chat, text, and social media. Intelligent routing ensures the patient is connected to the most skilled agent — the right person who can help them — upon first contact.

Proactive outbound messaging that includes schedule reminders is another way providers can enhance patient satisfaction. With omni-channel functionality, doctors and other care providers can deliver messages, reminders, and communications according to how a patient would like to receive them.

Push notifications can send appointment reminders and scheduling changes directly to the patient’s mobile phone, helping to decrease no-shows and smooth patient flow.

These are the kinds of things patients notice and add up in patient satisfaction surveys. Happy patients mean a healthy bottom line in the value-based care model.

Quality management is critical for maintaining patient satisfaction. Quality management and interaction analytics can have a dramatic, direct impact on patient satisfaction through monitoring and maintaining the quality of interactions. When integrated with speech analytics, managers can automatically measure speaking behaviors and evaluate service performance in real time.

A survey conducted by Enghouse Interactive found poor customer service drives 60 percent of customers away. Patients should be recognized as healthcare consumers. The federal government is looking at them this way, and adjusting reimbursement models accordingly. Smart healthcare providers will do everything in their power to secure patient satisfaction.

In the context of the healthcare contact center, quality management, call recording, interaction monitoring, and analytics are valuable assets for avoiding millions of dollars in liability, non-compliance, regulatory fines, and litigation fees.

As they say, if it can’t be measured, it can’t be improved. “Patients’ impressions about their phone interactions with office staff are a significant contributor to their overall satisfaction with physicians’ offices,” notes an article in American Medical News.

It’s important to note the changes ahead have only just begun. Through recent passage of laws and regulations, the federal government has made it clear it plans to focus on patient satisfaction, encouraging the use of IT to do so. This is an important aspect of value-based care and shouldn’t be lost in the effort to improve outcomes and lower costs. In fact, it can help a provider achieve all of the aspects required under value-based care.

About The Author
Scott Logan is vice president of marketing for Enghouse Interactive, a global contact center software and solutions provider. Enghouse Interactive delivers technology and expertise to maximize the value of every customer interaction.