Case study: an Rx for healthcare communication; Outsourcing and offshoring Medicall call centers for competitive advantage.There is a chronic condition plaguing the U.S. healthcare U.S. Healthcare is a now-defunct healthcare company. The logo had an apple. The merger with Aetna
In 1996, the company merged with Aetna, calling it Aetna U.S. Healthcare. The U.S. Healthcare apple logo was next to the Aetna name, and U.S. Healthcare under it. U.S. industry, with no cure in sight: a shortage of qualified nurses. For the first time ever, the U.S. Department of Labor, in its February 2004 Monthly Labor Review The Monthly Labor Review is a publication by the Bureau of Labor Statistics. Monthly publications are usually published by topic. Researchers outside of the BLS are welcome to submit their articles. External links
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. the National Council of State Boards state boards Examinations administered by a US state board of medical examiners to license a physician in a particular state; these examinations play an ever-decreasing role in state medical licensure, as these bodies now rely on standardized national examinations of Nursing, the number of candidates taking the NCLEX-RN NCLEX-RN National Council Licensure Exam for Registered Nurses Exam actually decreased by 10 percent over the last decade, declining to 87,085 in 2004.
In 2003, to respond to this growing problem, MediCall developed a nurse-based communications center located in the Philippines. MediCall provides communications services to hospitals, health plans and physician group practices that are facing increasing challenges due to overworked nursing staffs, growing patient loads and more stringent reporting and compliance requirements.
The MediCall model enables entities such as health plans, managed care organizations, workers' compensation workers' compensation, payment by employers for some part of the cost of injuries, or in some cases of occupational diseases, received by employees in the course of their work. organizations, medical-device companies and integrated healthcare delivery systems to offload a number of staff-intensive, costly programs. MediCall helps eliminate expenses related to member and provider services, educational and training programs, clinical trials, and case and disease management support.
Using a state-of-the-art contact center, MediCall supplies skilled, experienced healthcare professionals to address routine inbound/outbound patient communications. The services run the gamut from new member welcome calls, health risk assessments and compliance calls to disease and case management support services support services Psychology Non-health care-related ancillary services–eg, transportation, financial aid, support groups, homemaker services, respite services, and other services , patient satisfaction follow-ups and more; duties that, in the past, have often fallen on nurses to complete.
MediCall considers its business model to be both innovative and sorely needed. For it to work, however, two key elements were necessary. The first was access to a ready supply of qualified, experienced, English-speaking healthcare professionals, and the other was a top-notch communication center infrastructure.
To satisfy the first requirement, MediCall partnered with Ayala Systems Technology, Inc., a subsidiary of Ayala Corporation, one of the oldest and largest public companies in the Philippines. An abundant supply of world-class certified healthcare specialists make the Philippines a destination of choice when it comes to outsourcing. The country boasts more than 200 nursing schools with many graduates emigrating to the U.S. and eventually becoming RNs. According to an October 2004 study by the University of the Philippines In 2004, the University's seal and the Oblation were registered in the Philippine Intellectual Property Office to prevent unauthorized use and multiplication of the symbols for the centennial of the University in 2008. National Institutes of Health, more than 50,000 Filipino nurses have immigrated to the U.S. since 2000. Some of the largest offshore medical-related call centers are located in the Philippines, which has a large pool of well-trained, English-speaking healthcare professionals. To become a nurse in the Philippines, a four-year college education is required prior to taking the certification exam. By leveraging Ayala's extensive resources, MediCall was able to assemble a Philippines-based pool of certified and experienced nurses, physicians and pharmacists.
All of MediCall's contact center personnel have a minimum of 10 years' English education in school. In addition, they are required by the company to take courses in American English and business idioms to ensure even greater fluency with MediCall's specialized work.
For the second requirement, a world-class communications platform, the MediCall technical team drew up a stringent list of voice and online service specifications. Because communications are the lifeblood at MediCall, it was critical to find a technical infrastructure that would be available with guaranteed round-the-clock service uptime. Voice, Web chat and routed e-mail options were needed for patient contact, plus the ability to add other on-demand capabilities in the future. Finally, the ability to integrate our platform with existing customer applications, from customer relationship management (CRM (Customer Relationship Management) An integrated information system that is used to plan, schedule and control the presales and postsales activities in an organization. ) to electronic medical record (EMR (ElectroMagnetic Radiation) The emanation of energy from everything in the universe. Although the EMR from electrical and electronic devices is typically measured for practical, every-day situations, every object, including humans, emanates energy. ) and medical practice management (MPM MPM Multi-Processing Module (Apache)
MPM Manufacturing Process Management
MPM Milwaukee Public Museum
MPM MMW (Millimeter Wave) Power Module
MPM Master of Project Management (degree) ) systems was also imperative.
Because in 2003 MediCall was a startup operation, it was determined that an on-demand, Web-based contact center platform made the most sense since it would eliminate the large upfront capital layout required to purchase hardware and software. Additionally, using a hosted system allowed MediCall to add capacity and features as needed as needed prn. See prn order. .
With these criteria in mind, MediCall's executives researched various on-demand contact center alternatives. We selected Echopass and its EchoSystem contact center service integration platform because it offered an impressive full-featured and end-to-end solution.
The location of Echopass' SAS (1) (SAS Institute Inc., Cary, NC, www.sas.com) A software company that specializes in data warehousing and decision support software based on the SAS System. Founded in 1976, SAS is one of the world's largest privately held software companies. See SAS System. 70 certified network operations center See NOC.
Network Operations Center - (NOC) A location from which the operation of a network or internet is monitored. Additionally, this center usually serves as a clearinghouse for connectivity problems and efforts to resolve those problems. (NOC (Network Operations Center) A central or regional location for monitoring a large network. Also called a "network management center" (NMC), "service management center" (SMC) or "network control center" (NCC), a NOC may be used to manage a large enterprise network, ) solved a key regulatory concern, one that both MediCall and its customers would face: According to the mandates of the U.S. Government's Health Information Portability and Accountability Act, better known as HIPAA (Health Insurance Portability & Accountability Act of 1996, Public Law 104-191) Also known as the "Kennedy-Kassebaum Act," this U.S. law protects employees' health insurance coverage when they change or lose their jobs (Title I) and provides standards for patient health, , housing medical records offshore is a problem. Echopass' NOC is located in Salt Lake City, Utah For ships of the United States Navy of the same name, see .
Salt Lake City is the capital and the most populous city of the U.S. state of Utah. The name of the city is often shortened to Salt Lake, or its initials, S.L.C. , which means that all data remain within the continental U.S. As long as the Manila-based agents have no ability to print out or otherwise save or duplicate a record on their end, MediCall is able to assure total HIPAA compliance for its clients.
A high level of security is essential to outsourcing medical-related services. When an organization deploys call center services that are hosted in the U.S. with thin-client network computers at the offshore call center, customer service representatives are unable to download, print or copy information to a CD or floppy disk because the data reside on U.S.-based servers. Hosted services also keep start-up costs to a minimum as customer service representatives need only a PC on a LAN (Local Area Network) A communications network that serves users within a confined geographical area. The "clients" are the user's workstations typically running Windows, although Mac and Linux clients are also used. or a DSL connection if they work at home.
Here's how it works. An organization's toll-free numbers, Web links and e-mail addresses are pointed to the hosting vendor's communications center. All contacts are queued and routed to nurse customer service representatives in the offshore call center based on routing rules via a data network. Voice calls are delivered via VoIP. Web chat, Web callback, e-mail and faxback services broaden the range of communication options for both the consumer and the medical provider.
One program example is Medicare Part D Prescription Drug prescription drug Prescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug, Plan support. The company currently manages a program in support of Health Plan Medicare Prescription Drug Plans (PDP (1) (Plasma Display Panel) See plasma display.
(2) (Policy Decision Point) See COPS and XACML.
(3) (Programmed Data P ). Nurse agents, staffing toll-free hotlines, use client information systems to manage formulary formulary /for·mu·lary/ (for´mu-lar?e) a collection of recipes, formulas, and prescriptions.
National Formulary see under N.
n. lookups and benefit questions.
Another program example is medical records transcription applications. Inputting information into an electronic medical records system is a time-consuming task. Patient records must be located and written notes reviewed; at that point, pertinent information must be typed into the system and reviewed.
Using an outsourced EMR transcription service as an example, doctors and nurses dial a toll-free number when finished with a patient, input the patient's I.D. and name, and dictate the information. Patient records are updated on a near real-time basis. In an industry that places a premium on time, the payoff of outsourced EMR transcription is high--doctors and nurses decrease the amount of time spent on this task by up to 70 percent.
Yet another example is a MediCall customer that provides home diabetes supplies. Disease management is a growing trend in healthcare. Today, most health insurers outsource some or all of their disease management programs and the foundation of these disease management programs is the call center, which is often staffed by registered nurses who monitor patients' health by phone and the Internet. Using MediCall, the home diabetes supply company is able to provide callers with health and lifestyle management education, as well as ready information on nutrition and other daily diabetic concerns. Nurses in the Philippines, who have specialized training in diabetes and can educate callers about the disease, deliver supplies, handle insurance claims and support existing nurse staff by doing the data collection, data entry, follow-up and contact. This frees the U.S.-based RN staff to manage their patients more effectively, offering higher levels of service at lower average costs.
The Echopass EchoSystem service integration platform combines state-of-the-art technologies from across the telecom and call center industries in a unified, flexible and affordable call and contact center solution, delivered as a service over the Internet. In addition to inbound and outbound call processing, Echopass' integrations include IVR (Interactive Voice Response) An automated telephone information system that speaks to the caller with a combination of fixed voice menus and data extracted from databases in real time. , ACD (Automatic Call Distributor) A computerized phone system that responds to the caller with a voice menu and connects the call to the appropriate agent. It can also distribute calls equally to agents. , computer-telephony integration, database screen pops, universal queuing and routed e-mail. Additionally, because Echopass is VoIP-based, calls are placed over the Internet at correspondingly low rates.
In MediCall's new business presentations, it takes only one call to the Philippines contact center to make believers of a prospective customer's nursing staff. Nurses are understandably concerned that their patients will be well cared for. After hearing the quality of the phone call via Echopass and the professionalism of our staff, they tell us our services are superior to their own internal system. Our demonstration never fails to produce a "wow."
Outsourcing healthcare services increases effectiveness and flexibility, allows concentration on core competency and lowers costs. Other industries that deal with sensitive information, such as banking and government, have experienced success with offshore outsourcing and keeping their data secure. There is currently a growing list of health-related services being outsourced, including healthcare communications. Offshore healthcare services outsourcing should not be viewed as a replacement for U.S. call centers. Instead, it should be used to assist domestic centers through good coordination and management efforts. Today, we are seeing only the tip of the iceberg tip of the iceberg
n. pl. tips of the iceberg
A small evident part or aspect of something largely hidden: afraid that these few reported cases of the disease might only be the tip of the iceberg. of outsourcing medical-related services. The offshore call center, as a silent partner trained in your protocols, will continue to rise in value as its benefits are better understood.
John Chess, President and CEO (1) (Chief Executive Officer) The highest individual in command of an organization. Typically the president of the company, the CEO reports to the Chairman of the Board. of MediCall, has over 20 years experience in the electronics outsourcing field. He was one of three founders of UXComm, which provided a suite of management software to the embedded processor marketplace. Prior to that, Chess was a co-founder of Cosine Communications, a company that pioneered its concept of an IP service delivery platform to the telecom industry.
By John Chess