Changes on the Healthcare Horizon
by Amy Wagner on April 16th, 2012
Thanks to everyone who attended our webinar last week on Building Member and Provider Loyalty at Every Interaction. If you weren’t able to join us and would still like to view the presentation, we’ll be posting the recording soon on aspect.com.
As pointed out during our discussion, we anticipate that new healthcare regulations associated with the Patient Protection and Affordable Care Act (PPACA) will bring large numbers of new members into the system. Plans that adopt improved controls, tools and reporting will be better equipped to effectively comply with regulatory changes.
All areas of the healthcare sector should be preparing now for the changes the new law will bring. Here’s an overview of what to expect:
Physicians’ offices
With the expansion of coverage, doctors will have a larger pool of prospective patients, theoretically increasing revenues. If many of those patients are on Medicare or Medicaid, low reimbursement rates could offset those revenues. Under the Sunshine provision in the law, doctors must disclose every payment from drug and biotech companies over $100, including drug samples. This could add complexity to office accounting. The law gives precedence to primary care doctors, which could put specialists at a disadvantage. The law also effectively prohibits doctors from having an ownership interest in a hospital.
Hospitals
Hospital emergency rooms could see a drop-off in uninsured patients as the requirement for health insurance coverage kicks in. As emergency room care is the most expensive form of care, this could result in cost savings for hospitals. Non-profit hospitals will be required to submit a community needs assessment. They will also need to tread carefully when billing patients on financial assistance; hospitals must first limit charges to such patients and then avoid extraordinary collections actions. Medicare and Medicaid patients account for more than 50 percent of the care provided by hospitals. The expansion of these programs and the government’s cost-cutting initiatives may impact hospital revenues.
Nursing Homes and Assisted Living Facilities
Nursing homes receive the bulk of their revenues from Medicare and Medicaid, and the PPACA will cut reimbursements. At the same time, the new law encourages patients to receive care in their homes, which is less expensive, creating additional competitive pressure. To remain profitable, facilities may have to raise prices for private-pay patients.
Managed Healthcare
The PPACA requires all Americans to have health insurance, either through their employers or through health insurance exchanges. This will have the effect of increasing the eligible pool of customers, but may also increase the number of high-risk individuals. MCOs will not be allowed to place lifetime limits on coverage for individuals and cannot deny coverage for a pre-existing condition of a child. Adults with pre-existing conditions will be covered under a temporary national high-risk pool. Coverage for dependent children will be expanded to age 26.
I’ll be keeping an eye on the case currently with the Supreme Court to bring you any updates on policies and regulations as they take effect. Until next time!
Health Plan Hopscotch: How back office optimization can help
by Amy Wagner on April 5th, 2012
According to Peter Cunningham and Linda Kohn’s article in Health Affairs, current economic conditions have forced many consumers to be increasingly focused on their out-of-pocket premium cost in evaluating plan options offered during annual open enrollment periods. From the plan perspective, this annual “plan hopping” leads many to conclude that lower cost, no-frills offerings are of greater value to employers and members. These tend to be the plans that generate the most attention, although they may be potentially less lucrative. Of those reporting a change in plan, 31.9 percent were made due to a job loss or change while 15.9 percent of changes were made to a lower cost plan – generally to an HMO.
Enrollment and membership numbers are just one of the many ways in which health plans’ needs can shift rapidly, unleashing the brunt of this impact on back office and fulfillment staff.
The back office, while typically hidden from members’ “view,” actually has a significant role to play in customer service and satisfaction. According to ICMI, back office processing issues (such as data entry errors, workflow delays, billing mistakes, etc.) can comprise 10-20 percent of the entire inbound call volume for a contact center. Up to 60 percent of the sources for customer dissatisfaction can be traced to the back office, says TARP Worldwide, a firm known for its customer experience fulfillment work. It’s also worth noting that Forrester Research has reported that 17 percent of a customer’s loyalty is a result of operational efficiency, which ties directly to back office quality and processes.
Forward-thinking organizations are finding ways to meet these challenges by examining — and in some cases transforming – their end-to-end processes in order to meet member and provider expectations. This can include:
- Aligning front and back office customer engagement strategies
- Training and ongoing coaching to improve fulfillment adherence
- Providing full visibility into outbound customer contact strategies to anticipate increased fulfillment activity
- Aligning staffing to high cycle times
- Increasing collaboration between the call center and back office
- Generating proactive communications with members/providers/employers alerting them to milestones to the fulfillment process – reducing call center activity seeking follow up information
- Limited automation for the less complex communications with member – apt reminders from case managers, prescription reminders from pharmacy benefits managers, etc., save the agents for the activity that matters – i.e. generating revenue, new member solicitation, etc)
An optimized workforce
One Aspect client, Transcom, implemented an advanced, scalable workforce management solution to solve many of the challenges faced by its contact center environment, one that must handle calls in 20+ languages and remain up to date on the government labor regulations of almost 30 nations. Their solution efficiently and effectively schedules a large pool of agents and back office workers, aligning staffing with high cycle times. It facilitates a comprehensive staffing plan across the front and back office, using accurate forecasting to anticipate strategic business needs and reduce costs. They are also able to manage back office processes more effectively using the capabilities of Microsoft SharePoint such as application integration, forms, workflow and workforce optimization. Any bottlenecks and inefficiencies in the staff and processes are quickly identified and resolved.
As a result:
- Forecasting accuracy improved to 90%
- Scheduling accuracy increased to an average of 88%
- Enhanced daily agent efficiency
- Automated agent self-scheduling reduced demands on managers’ time
- Facilitated customer pricing based on forecasting data
Be sure to join our upcoming webinar on April 12 for more on how Aspect can help transform the end-to-end processes necessary to address the rapidly changing needs of health plans to meet and exceed member and provider interaction expectations.
Healthcare Reform? It’s (Still) Debatable
by Amy Wagner on March 30th, 2012
A very wise person I know recently said, “The healthcare system in the US is designed to fix problems after they occur. With few exceptions, patients are accustomed to waiting until something is really painful, bloody, or non-functioning before they seek medical attention.”
Speaking of which… I went rollerblading over the weekend (I know) and not even my pride came back unscathed. I limped home with friction burns and bruises where I didn’t even know it was possible to contact the
pavement. This was days ago, but you wouldn’t believe how much it still hurts! And I have a slowly healing wound on my knee that I’m using to scare the neighborhood children. So am I going to see a doctor? Ha. Of course not.
Wait-and-see legislation
In the wings now is a Supreme Court decision weighing in on several provisions of the Patient Protection and Affordable Care Act (PPACA), most notably its mandatory individual insurance coverage mandate and Medicaid expansion at the state level. Challenges raised this past week by Florida and 25 other states and business groups have brought into question the constitutionality of these provisions, which, if ruled out of the law, would then require justices to determine how much of the Act could be salvaged without the inclusion of those provisions.
The intent of the PPACA is to protect all Americans as patients. This means providing sustainable access to affordable health coverage, guaranteeing gapless care for the most vulnerable patients and providing new ways to bring costs down while improving the quality of care. To counteract the optimism, there are also plenty of dismal predictions about how PPACA will overwhelm existing programs and coerce individuals into purchasing plans they can’t afford.
If the legislation does go into effect as planned, I’m sure we can all anticipate some bumps along the way. (After all, being Americans, we did wait until the system was really painful, bloody, and non-functioning before attempting to fix it.) But healthcare is a business, plain and simple. Health plans should start looking for ways now to safeguard business operations against upcoming proposed changes so they don’t find themselves at odds with the interests of the patients they serve.
What impact can plans expect?
Currently, there are four widely diverse classifications for health plan members covered by insurance companies and providers:
- Members covered under a current employer plan
- Members covered under a current retiree plan
- Members who were covered under an employer plan and lost their job and need to self-insure
- Members who are currently self-insured and are looking for a better deal
In its current incarnation, PPACA will go into effect in 2014 bringing a fifth classification of “member” into existence:
5. Potential members who were previously ineligible for traditional coverage due to financial ineligibility or pre-existing conditions
With the right planning, advance action and creativity, states should be able to stay ahead of, anticipate and divert much of their increased member service workload.
As I mentioned in my previous post, one of the ways to achieve this will be through cost-effective and operationally efficient member self-service channels. Solutions such as those offered by Aspect provide the ability for individuals to seamlessly transition from online self-service to agent support, without losing track of the interaction.
In addition, some states such as Florida are planning to launch a state health insurance exchange, and others are participating in Accountable Care Organizations (ACOs,) care management systems comprised of networks of local healthcare providers.
Of course I’m not going to see a doctor about my knee. I’m being dramatic; it’s actually healing up fine. I don’t need a doctor to tell me that, but I know there are some people with insurance who probably do. That’s the balance in the system right now. If my knee was turning ugly and I didn’t have insurance, then would I see a doctor? I’m not sure. I have a feeling I would wait it out a lot longer if I knew there was no insurance card in my wallet.
We’ll be talking much more in-depth on this topic at the upcoming panel discussion, Tackling the Business Impact of Healthcare Reform at 2 pm CDT on April 12. Be sure to register, if you haven’t already.
Health Plan Questions: Is self-service the answer?
by Amy Wagner on March 23rd, 2012
When grocery chains began rolling out self-service checkout stations across the nation in the early 2000’s, consumer reaction was somewhat mixed. Some hailed the technology as an easier, speedier way for busy shoppers to pick up a few items on the way home after work, while others groused that this was clearly a big-business profit grab at the expense of much-needed human interaction and neighborhood jobs.
By the end of 2008, there were reportedly 92,600 self-checkout units worldwide, and at least a portion of shoppers appeared to be holding on to their angst. An excellent point by one blogger: “What’s the point of all of this technology if it only aggravates your customers and makes them unhappy?”
As technology improves, the percentage of those annoyed by self-service
technology seems to be shrinking at a steady pace – and in fact, today’s customers actually prefer to help themselves by as much as 85%.
Whether in the checkout lane, at the ATM, at a gas station, or on a company’s website, it would appear that offering self-service through multiple channels even has the potential to increase customer loyalty.
This is all very good news for businesses, particularly in the health plan industry.
Plans are facing a countdown to 2014, at which time the Patient Protection and Affordable Care Act (PPACA) will go into effect. This new legislation extends eligibility for healthcare insurance coverage to an estimated 45 million currently uninsured individuals, necessitating that these individuals will be seeking out information on plans and providers. Lots of information. And as newcomers to the insurance arena, you can bet they’ll have questions.
Think about that for a second. That’s a potential influx of 45 million new individuals reaching out for assistance and information from a group of agents already dedicated to full-time member service and fulfillment.
The only realistic response is to anticipate this workflow by implementing self-service channels. Fortunately, this the response most customers want.
And here’s more good news for business: Not only do customers prefer self-service, these channels are also vastly more cost-effective than contact center resolution. Self-service costs on average about ten cents per interaction, as opposed to $7 USD per call.
So in order to optimize your customer experience and efficiency, my recommendation would be to provide both intelligent, self-service options as well as the ability to engage with the right resource to improve first contact resolution and satisfaction. Offer individuals the ability to seamlessly transition from self-service to agent support without losing track of the interaction.
Aspect can help you develop this type of seamless interaction now, before PPACA goes into effect. The closer we get to 2014, the greater the risk of your agents’ workload slipping from “manageable” to “sort-of manageable” to “self-service as self-defense.” Just please… don’t wait until you’ve reached “zombie apocalypse” workload!
I’ll be taking part in a panel discussion on this topic at 2 p.m. EST on April 12, 2012, Tackling the Business Impact of Healthcare Reform, together with fellow RN Sally Bleeks, recently retired from Blue Cross Blue Shield. Please join us!
The fear factor in healthcare
by Amy Wagner on September 20th, 2011
As I was sitting poolside with a colleague, we began to discuss the world, our families, our jobs, and specifically what scares us. We all have fear in our lives but try to mitigate it through social connection, family, meaningful work, and hobbies. What seemed to be a common theme was the fear for our continued health and specifically the fear of disease, aging, and being part of the healthcare system as a patient.
What is there to be afraid of in healthcare? As a patient, one can easily get “lost” amid the cacophony of providers, which is the last thing patients and their families need during an acute or a chronic illness.
The Affordable Care Act (ACA) mandates that employers must take on the cost of providing health coverage to all employees. The ACA’s many goals include protecting families’ financial health, making coverage affordable, aiming for universality of coverage, providing portability of coverage, and guaranteeing consumers a choice among insurance plans and healthcare providers. The law also aims to invest in prevention and wellness. The ACA seeks to make changes in the delivery of healthcare services to improve quality, patient safety, and quality of care.
As a provider, one can be afraid of increased workloads, decreased revenue/reimbursements, and regulation. Currently, healthcare providers and hospitals are generally paid for volume, so the more services they provide, the greater the payment. The ACA moves payment incentives away from volume toward a greater focus on value of services and health outcomes, including fewer hospitalizations. The goal is to provide the right patient the right care at the right time in the right place and at the right price. Of course, as providers, we also fear the ever-present threat of real or perceived malpractice or negligence.
As Melissa, an RN, writes in a post on HealthOMG, “The culture of fear that permeates the healthcare system effectively blocks open communication and collaboration that is necessary to resolve conflict and provide the safe working environment necessary for quality healthcare. Rather than learning from medical mistakes and resolving conflict, healthcare managers and leaders place blame for errors squarely on doctors’ and nurses’ shoulders.”
How can we mitigate fear and support hospital staff, including doctors and nurses, when every bed is full and the staff is stretched thin? Chances are that when it’s time for change of shift, nurses will receive reports on numerous patients with chronic conditions who could be cared for in other settings. This problem is a growing one, and Aspect has real-time solutions to address it and other challenges.
Consider our Patient Throughput solution for Emergency Departments:
ED Throughput mitigates fear in providers by offering visibility into bottlenecks, cost/time savings from more timely information, and rapid correction of business processes. This solution allows nurse managers to understand in real time where attention needs to be focused and to immediately assign resources to handle each situation. Invariably, it’s about patient safety; if staffing isn’t allocated appropriately, patient safety can be compromised. This solution allows hospitals to avoid many pitfalls facing ED departments today, ensuring that patients receive the proper medical attention while reducing fear for the patients and their families.
In upcoming blogs, I will discuss other ways in which technology solutions can assist patients, providers, and payers; enable rapid user adoption; effect positive change in the healthcare workplace; and create open communication among all parties. Doesn’t this make you feel better already?
From nursing to the 19th hole
by Amy Wagner on August 1st, 2011
So I graduated from nursing school as a registered nurse and moved hundreds of miles from home, confident I would help those who couldn’t help themselves and maybe change the world in some way. Then reality set in. Heavy patient loads, staff shortages, overtime, and loads of paperwork (documentation, documentation, and more documentation―I wanted to insert a link here to illustrate the magnitude of the healthcare documentation challenge, from past to present, but when Binging “healthcare documentation” I received 50,400,000 results―feel free to investigate on your own!).
In this way, I moved through my career: inpatient services, outpatient services, ambulatory services, inpatient management, then outpatient management. Along the way, the business of healthcare changed, albeit slowly, but it did change. The industry moved from a solely paper-based business to a hybrid of paper and electronic document imaging to where we are today, which is an industry reliant on document imaging, automated workflow, electronic data capture, and data/care collaboration. The healthcare industry also changed from focusing on providers and the provider experience to (surprise!) placing the focus on patients and the patient experience.
During this profound industry transformation, many patient-centered healthcare resources resisted eHealth, claiming “There’s no time,” “It takes the focus away from my primary responsibility: patient care,” and “I don’t want to learn one more new thing which will slow me down more!” But for some reason, I did not resist―much. My curious, open-minded attitude paved the way for me to completely change my career trajectory and propel me into the healthcare technology industry.
Ironically, the focus is still the same; documentation, documentation, and more documentation, but now the areas to improve include efficiencies, patient care and safety, patient outcomes, staffing, saving money, and increasing revenue. Most important, we must not forget to please the patients (and their families) so they tell their friends, families and coworkers how awesome their inpatient, outpatient, or ancillary health services experience is (or at least provide a satisfactory experience so they don’t complain too much to too many people―including, but not limited to, plaintiff attorneys).
This is where I am today at Aspect: focusing on our healthcare solutions; helping providers and providers of providers to document, improve efficiencies, provide safe patient care, improve outcomes, staff appropriately, save money, and increase revenue. As the team’s healthcare evangelist, I thoroughly enjoy working with all facets of our solution and product groups, in addition to working with healthcare customers and providing subject-matter expertise along with a healthy dose of healthcare resource reality.
So in addition to tackling and advising on eHealthcare, I am personally challenging myself to a new set of rules involving tees, fairways, greens, myriad dangerous-looking tools called clubs, and searching for the “mysterious” 19th hole. Ironically, when Binging “19th hole,” I received 26,300,000 results, which has now put me in information overload. When beginning this journey fresh out of college, I could not have known any of this would be in my future.
Going forward, look for my blogs on the role of information technology in the healthcare industry.
Improving the way companies communicate internally and externally with their customers is an important objective for all organizations. This blog is focused on levaraging the collective knowledge withing Aspect.