When your first call resolution (FCR) rate is zero, it's pretty clear that your customer service operations have room for improvement.
Such was the case when Group Health Cooperative, a provider of health insurance and healthcare in Idaho and Washington, embarked on a project to improve not only customer satisfaction but patient care.
"The idea is, by providing greater access to caregivers for patients, we could actually lower [the] overall cost of healthcare for the patient as well as [for] us," said Ernie Hood, CIO of Group Health.
In 2007, Seattle-based Group Health began a process improvement initiative to make the organization leaner and charged a cross-functional team with improving processes with a patient focus. That team included doctors, nurses, IT and back-office employees. What emerged was the Medical Home Project. Under the project, Group Health pre-existing care teams began taking patient calls. It was an area in need of improvement.
"Patients would call, and they get lost through the phone system," Hood said. "Some were able to figure out the right number to call to the clinic where they get care. But then it was pot luck who they caught hold of."
The patient experience was the same at Group Health as it was with most doctors' offices, Hood explained. Patients would call and get hold of an administrator or a nurse, who would scribble down a note and hand it to the doctor at some point later in the day. Patients never got their problem resolved on the first try. In fact, it could take nine hours and multiple phone calls to get an issue resolved.
With the Care Teams, doctors, nurses, physician assistants and medical assistants all took shifts taking patient calls. It didn't take long to convince the doctors of the benefits.
"Once they started seeing, 'Hey I could answer a two-minute question over the phone and prevent that person from coming into the clinic,' they were thrilled," said Dave Ditzler, manager of information technology for Group Health. "By doing that, we've enabled the team to have lower workload in terms of reactive care so they would have some capacity to do proactive care."
Because doctors had participated in the process and helped establish the Medical Home Project, they were not only willing but eager to take calls, Hood said. Had IT or operations forced the program upon them, it would have been a tougher sell.
Patient satisfaction took off as well. They were thrilled to actually be talking to their doctor over the phone, and some even refused to believe it was a doctor on the end of the line, Ditzler said.
Improved call center technology infrastructure supports FCR goals
Group Health has been an Avaya shop for about 20 years, according to Hood. But to launch the Medical Home Project, it added the Avaya Communication Manager and Avaya Voice Portal. It created a hub to route calls throughout the organization.
Group Health has 25 primary care sites running the Group Home service and an enrollment of about 560,000 patients.
"We have 50 locations, but we look like one big phone system," Ditzler said. "The network looks like one big call center ACD. Calls come in, we route them to the proper place. It's all based on that consumer number. Once they call in, we know a lot about them."
The Avaya Call Center Express also uses screen pops to bring up information from back-end systems like Epic, its electronic medical record (EMR) system. Patients are then able to access their own records over the Internet. There are currently 2,500 seats running the computer telephony integration and screen pops out of the primary call center.
"We took a holistic approach here, so we supplement what we do over the phone with Web-based access as well," Hood said. "The whole concept is we have an electronic medical record. It enables the Care Team to access the latest info about patients. That's connected to the Internet, and patients can access it and interact through it with the Care Team."
"We want to provide our customers the easiest way possible to contact us," Ditzler said. "Just yesterday morning I went into a doctor's appointment, and by the afternoon all the notes were in EMR."
On top of the Care Teams, Group Health is doing outbound messaging using the Voice Portal. For example, high-risk patients, like those who are HIV positive or have cancer, get calls to make sure medications have been received. They're fed into the Voice Portal and led through touchtone prompts connecting them to a pharmacist if needed.
The project appears to be paying off. According to Hood, the number of secure messages passed to patients has gone up 90% since the program began, and face-to-face visits have decreased 6%. Patient satisfaction is up 5%, emergency room visits have dropped 29%, and surgical referrals are down 5%.
And, notably, FCR reached 72% in the first year.
Hood said: "We hypothesize that by providing this access and proactive outreach, we're taking better care of people and keeping them out of the surgery room and the need to have surgery.”