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 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, cited registered nurses as the top occupation in terms of job growth through the year 2012. Yet according to the National Council of State Boards of Nursing, the number of candidates taking the NCLEX-RN 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 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, 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 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) to electronic medical record (EMR) and medical practice management (MPM) systems was also imperative.

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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.

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' SAS70 certified network operations center (NOC) 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, housing medical records offshore is a problem. Echopass' NOC is located in Salt Lake City, Utah, 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 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 Plan support. The company currently manages a program in support of Health Plan Medicare Prescription Drug Plans (PDP). Nurse agents, staffing toll-free hotlines, use client information systems to manage formulary 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, ACD, 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 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 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

MediCall