A centralized healthcare call center helps immensely with patient access thereby leading to higher patient acquisition, patient retention, patient satisfaction, better patient reviews. These, in turn, lead to higher medical practice reputation scores, which in turn contribute to more patient appointment calls. Of course, this translates to a much easier medical marketing and patient pipeline.
MGMA had done a pretty good study on centralized call centers (read here).
“Today’s healthcare consumers are seeking out care that is convenient and easily accessible at a date and time they want to be seen. If today’s patients (new or existing to the system) do not get the appointment date and time requested, they will continue to search for a provider that meets their expectations.”
That’s precisely what our medical call center team that handles inbound calls for multiple practice groups has seen as well.
What is a centralized healthcare call center
Healthcare is a “local” business. In most cases, medical practices and healthcare organizations have each one of their locations manage their patient communications locally.
Each location typically has its own local phone number for patients to remember and call as well.
The front desk at each location handles scheduling (new appointments, recalls, rescheduling, cancellations, follow up appointments).
While the patients are in the clinic, the front desk also handles patient admission, discharge, transfers.
In addition to this, the front desk answers and routes incoming calls about prescriptions, medical billing as well.
A centralized healthcare call center essentially just centralizes these functions to a single team.
The centralized call center typically handles all incoming calls, makes all necessary outbound calls, and handles the majority of scheduling activities.
The team in itself doesn’t necessarily have to be co-located. It is, however, important that they laser focus on these functions.
Centralizing your healthcare call center alleviates much of these front desk tasks and allows the front desk to do what’s most important – improve patient flow and patient experience while the patients are in the clinic.
Generally, a centralized call center team is located away from the offices. However, in our opinion, that doesn’t necessarily have to be the case. As long as they are not pulled into the clinic activities and can focus solely on their tasks without in-clinic patient related distractions, it could work just as well.
It is important, however, to ensure that the same processes and workflows are followed by the entire centralized call center team.
Well, then, what’s a decentralized healthcare call center?
In a centralized healthcare call center, you are effectively, centrally housing all your call center agents.
You are centralizing the technology and the infrastructure into one.
In centralized call centers, you are centralizing the management and oversight of the call center into a single space.
You are centralizing the call types that your consolidated call center will handle.
Consolidating the training, security protocols, management into one place.
You are centralizing telecom costs into one as well.
How about decentralized healthcare call center model?
Now, consider the decentralized healthcare call center approach. In this situation, you have multiple sites servicing your patient communications.
Your agents are geographically distributed.
This could mean that your non-call staff are located at multiple sites. Although, arguably, this doesn’t necessarily have to be.
With a decentralized call center, your real estate footprint at each location / site could also be a lot smaller.
The telecom, call center technology and infrastructure are also now spread across the multiple locations / sites.
You are not limited to the talent pool of a consolidated/centralized call center. Therefore, this allows you to tap into the talent pool of the various sites / locations.
For example, to support various languages, you could have multiple sites located across various countries / regions.
Your training and hiring will also be spread across those decentralized sites. While this means that you have access to the local talent pool at each location, you might also have to have training that’s local to each site.
While your footprint is a lot smaller at each location, your risks at each location are lower as well.
Here’s a list of all answering services that we provide, to create an amazing patient contact center for improved patient satisfaction.
Centralized vs decentralized healthcare call center
The pros and cons of centralized healthcare call centers vs decentralized ones have been a perennial debate.
There’s no single, slam dunk formula that you can use or apply to come to an answer.
Rule of thumb
One general rule of thumb that we’d like to point out – a centralized call center brings in economies of scale and all the benefits from achieving economies of scale.
If your call center is going to be staffed with only a handful of staff, there would be no economies of scale to achieve.
This means that you don’t have the need to scale.
Let’s look at some points about total costs of ownership next.
Total costs of ownership
Operating costs of a location would generally break down into a few well known categories.
You’re going to have:
- Real estate costs
- Infrastructure costs
- Utilities costs
- Hiring costs
- Training costs
- Payroll expenses
With a centralized call center these are items that you achieve economies of scale with.
In a decentralized healthcare call center, you’ll have to incur those same costs at each location.
However, a decentralized call center model allows you to leverage several benefits as well.
Labor arbitrage across locations wherein certain locations might be significantly cheaper than other locations.
Real estate costs across locations might also vary significantly.
Having multiple locations allows you to have a backup site (of sorts) in case of natural disasters in one of your other call center sites.
In certain businesses, customers might simply prefer being served in their local languages. Some customers might prefer being able to actually see and interact with their customer service representatives as well.
As we mentioned before, these factors have to be studied carefully before you can make a decision between a centralized vs decentralized call center to service your patients.
The need for a centralized healthcare call center
The need for a centralized healthcare call center is higher now, more than ever. Most smaller healthcare practices, in our opinion, remain small because they are not very business savvy. We understand that our stance might sound controversial.
We have run into many healthcare practices that grew solely due to luck and the fact that healthcare is a recession proof, evergreen business. They did not have any business / marketing plans. These practices are headed by physician practitioners that were good at being doctors.
We have seen even hospitals, federally qualified health centers, health systems operate this way as well.
Most of these organizations have their front desk handle multiple tasks. Let’s go through a typical front desk person’s daily life.
Day in the life of the front desk staff
The front desk person is checking a patient that just walked in. She is busy asking the patients for their demographics and insurance details to confirm that billing would not have any problems after the patient leaves. The front desk is busy with scanning the patient’s insurance cards, driver’s license for identity verification – so she can scan those as a PDF into the patient’s EMR record.
Enter the surgery candidate patient
Meanwhile, a technician comes in to drop off surgery forms for a patient that has been identified as a surgical candidate. The surgeon has decided to do the surgery at an ASC that he prefers. Keeping in mind that the patient has waited (usually a long time) to see the doctor, has gone through the wait times involved in working with a technician and finally got to a doctor. After seeing the doctor, the patient is now really anxious to leave the office. They don’t want to have to wait another 15-20 minutes until the front desk is done serving the current patient.
The front desk now pauses work on checking in the patient she was helping and immediately draws up the papers specific to the surgery center that the surgeon chose. She hands them to the patient to fill out (even though she has ALL the information she really needs to be used in the surgery forms – right in her EMR). While the patient is already anxious to leave and even more anxious about the surgery, she acquiesces to re-typing all that information for the front desk staff.
Enter the patient with follow up appointment
Meanwhile, another patient comes in with a follow up appointment request that the doctor has ordered.
Just like with the surgery candidate, this patient has also spent quite some time in the hospital / clinic, so they have to be tended to immediately as well. So, the front desk person now has to tend to this patient’s follow up date. She spends a good 10 minutes negotiating with the patient about their preferred date/time and the doctor’s availability.
Point to note here is that this doctor’s availability is still not nailed down – since the schedule is not set up that far ahead yet (3-6 months). So, any appointment given to the patient will most likely have to change anyway.
At this point, the recalled patient got their appointment. The front desk staff now goes back to checking in the patient she was handling before.
A new patient walks in
While she is doing so, a patient walks in for their scheduled appointment. She has to check the patient’s temperature to ensure adherence to COVID policies.
Meanwhile, she has completely forgotten that she kept an incoming call on hold.
At the end of the day, the front desk probably didn’t even get any time to make outbound calls for appointment reminders, recalls, reactivating patients fallen out of care – nothing.
Made up story? Not really
This is not a made up story – this is exactly what your front desk looks like.
Patients acting as consumers
With a short attention span.
Advisory.com has published a few articles about the rising changes in patient expectations and demands. They have also discussed how patient access is the key to business viability, reputation and sustainability.
How would you rate your patient access? How quickly can patients get appointments with you? Do you really think patients are waiting patiently for weeks to see you for their care?
Patients are moving on to the first available appointment at the next available provider.
Now, think about practice growth.
According to the CMS, an average person spends about $10K per year on healthcare costs. Even CMS claims Medicaid enrollment will continue to rise for another decade.
If you decide to not grow and see 15-20 patients per day, you are going to be eaten up by the hospitals and larger competitors sooner or later. You’ve already seen this happening as the numbers of solo practitioners have been dwindling for the past decade.
How are you going to respond to this increase in demand?
That’s where centralized healthcare call centers come into the picture.
You did not go into healthcare to manage front desk staff – did you?
As you are well aware of, training and hiring are significantly expensive. On top of this, you have to create a talent pool bench to provide uninterrupted service. As your team grows, you need mid level managers to manage the team.
Call center technology and infrastructure are another set of necessary headaches to take on. For this, you need to hire a reliable IT team that’s experienced in call center technologies.
Your front desk and whoever answers your phone are your brand ambassadors. Patients, pharmacies and everyone else experiences your brand through their experience with your front desk. How are you going to ensure that the experience is consistent?
You are going to need a QA (quality assurance) process for this. To be able to handle QA, you are going to need to hire experienced QA folks. Do you, yourself, have the experience in managing QA teams?
A majority of each patient call is spent on gathering demographics and patient insurance information. Payers and their plans have become increasingly complex – your front desk needs to ensure that the patient visit will get reimbursed. That alone is a good 10 mins spent on the phone per patient that called in for an appointment.
Based on where you practice, your no-show rates could very well be as high as 35%. Those 10 mins spent on each incoming appointment request call, could very well be a complete waste. This means that you are going to have to constantly overbook patients by at least 30%).
Will your front desk be handling appointment reminders, recalling patients that are no shows or have fallen out of care? It rarely happens.
Centralized healthcare call centers – a necessity
At some point in time, call centers used to be a luxury afforded only to larger hospitals. These days – it is a necessity. It’s a whole different business altogether. A business that you, as a provider, never signed up for.
Determine whether you need a centralized call center or not
Advisory board had published an article “Must-Have Upgrades for the Consumer-Focused Health System” that shows the current state of patient access and makes a case of why health systems, primary care and specialists need to make patient access a high priority. They go on to explain why patient consumerism is forcing providers to change the way they do business.
According to that report “Access a Major Decision Factor 6 of the top 10 decision drivers are related to access and convenience, when choosing a primary care Physician“. Also, “42% of consumers report “short travel distance” as a top-three driver when choosing a specialty care provider”
Our own healthcare call center experience has taught us that patients are simply not willing to wait. If you’re not answering their calls within a minute, they are already calling another provider (probably, your competitor). Our experience has been that if a patient does not get an appointment for their desired/convenient dates/times, they will seek another provider or, at the very least, be a no-show.
A centralized call center has its benefits and its pitfalls. The first step to even begin thinking about a centralized healthcare call center is to judge what your patient access experience looks like. Try being a patient at your own practice / health system to find out what a typical patient access experience is like.
What call types should a centralized call center handle
The call types your healthcare call center handles depends a lot on your organizational and marketing goals.
When you start planning for a healthcare call center (be it outsourced or in house), create a plan that’s tied to your goals.
Increasing patient access
As patients are becoming more and more demanding, your initial goal might be to increase patient access.
The ability to answer patient calls within 30 seconds does wonders for your patient satisfaction.
This, in turn, contributes to better practice reputation and increased patient volumes.
Your patients are looking for the first available appointment.
If your current schedule allows for patients to get the first appointment weeks or months from today, you might want to divert those patients to other locations of your health system where an earlier appointment might be available.
Patients do not need / access care only during office hours.
As years have progressed, patients have become more mobile, more text and chat based.
They are looking to book appointments without having to get on the phone. They are looking to get answers via chat immediately.
Your goal might be to add more communication channels for patients to be able to interact with you.
Maximizing provider, equipment and office utilization
Improving provider utilization and the ability to forecast appointment pipeline + revenues might be your focus at the moment.
To be able to improve provider utilization, you will have to pack more appointments per day, by adjusting for typical no show rates.
This needs your team to make a significant amount of outbound calls to ensure patients truly do show up.
You would have to invest a lot in outbound calling to ensure that patients are being recalled on a predetermined periodic basis (e.g. once a quarter).
Community outreach calls and community outreach mailers would be another thing to look at, from an investment point of view.
Effectively, this means that you would have to be a lot more proactive about business development for this goal.
We have noticed that typically, organizations just dipping their toes into centralized healthcare call centers start with outbound dialing.
Improving patient experience at your locations
Your goal could also very well be to improve patient experience in your offices.
As discussed before, when the front desk is tasked with multiple responsibilities, patients rarely have a good experience.
You could decide to have all calls being handled by your centralized call center team.
This would allow your front desk to handle patients, manage patient flow, while your call center team handles incoming calls and triages all calls.
What is your goal with a centralized healthcare call center?
You could decide on a transition of one call type at a time to your call center by making changes to your IVR as well.
Effectively, your business goal will drive the call types and activities that your call center should be handling.
Gather the baseline numbers / KPIs before you get started with your medical call center
Before you get started on this initiative (or any digital transformation initiative), you want to document the business as it is today. For our client, there were no KPIs to gather because they were never being measured.
If you can, try to gather at least the following metrics / business intelligence
- Scheduling correct appointment
- Average speed to answer
- Duration of call
- Call hold times
- Total or % abandoned calls
- Call volumes per week/month
- Call volume trends by day of week (for this medical group, Monday-Wednesday had the highest call volumes)
- Patient satisfaction (if you have a patient reviews or patient satisfaction survey initiative, it will be reflected there)
- No show rates of appointments that were scheduled more than 2-3 weeks before appointment date
Identify the people that will lead your healthcare call center initiative
This is a disruptive and transformative change in your small business or your medical practice. Make sure you identify a steering committee that will take on this initiative and will guide/coach the team.
This could include your office manager, site supervisors, patient access director (if you have one), front desk/receptionists and a lead from your medical billing department.
For our client, this included the receptionists from each office location and the office manager. We had excluded the medical billing department and found out that they have a LOT of inputs into what the receptionist must do / the information that the front desk must gather from patients to avoid downstream issues in the medical billing process.
Keep in mind that appointment scheduling service and revenue cycle management services teams go hand in hand. Two peas in a pod.
Determine the locations and providers participating in the centralized medical call center roll out
You could take one of these approaches to the centralized call center roll out.
All practice locations and all doctors
– in this approach you decide on a cut over date and transition your entire practice and all its providers to your centralized healthcare call center. There are several pros and cons to this approach.
Pros – Planning tends to be very thorough in this case and the committee tends to view this a lot more seriously (as there’s no rolling back). Standards are made quite stringent due to the same reason. Participation is a lot more active from all stakeholders as they realize that all functions are being transitioned over the call center. Various scheduling gaps are identified in this process because all locations come together towards the same goal. A centralized scheduling workflow is developed that is consistent with best practices and does not allow for variations based on doctors’ personal preferences
Cons – This is a big bang approach and investments are made up front, in one shot. The risks are higher in this approach as this could lead to larger disruptions, should the roll out not work perfectly from the get-go. Providers are hesitant because of their perception of loss of control over their own schedules. Planning requires more time – hence, executive management tends to view this as analysis-paralysis.
Opt–in of doctors
– in this approach, your providers / doctors make the decision whether they want to participate / open up their schedules to a centralized call center or not. For the providers that do accept to participate, all their locations are made available for scheduling.
Pros – This has the biggest provider buy in from the get go. It is a lot easier to handle as the staff has to manage only those providers’ preferences. It also allows patients to “follow” a doctor / provider of their choice. This allows us to test the waters and iron out the kinks in the transition process before bringing other providers onboard.
Cons – This is only a stop gap solution. If the end goal is to transition to a full fledged centralized healthcare call center, then this does add a bit to the confusions during the interim. Staff typically get confused about which schedules are available to the centralized call center vs which ones are not. There are also several dependencies between provider schedules (based on visit types) that are not accounted for in this approach.
Opt–in of locations
– in this approach, you start a trial / pilot with only a few locations (or even a single location).
Pros – This allows you to start with locations that have a lower call volume. This also allows you to start this “trial”, iron out the issues in call handling/scheduling before transitioning the entire practice / health system to using the centralized call center.
Cons – These are very similar to the issues you will face with the option above (opt in providers)
We ended up taking approach #1.
Centralized call center location – how to establish a location with enough space to accommodate increases in call center staff when needed
We knew that once the centralized call center started providing tangible benefits to the practice, this would increase the volumes of patient calls and would increase the volume of patients seen. This in turn would also improve the practice reputation, which will contribute to increased patient visits and appointment calls.
We needed to be ready for the growth of this practice – which in turn would grow the call center staffing and the team size as well.
Based on the latest increase in minimum wages in the USA, our first approach was to have this call center location in USA states where the minimum wage was not as high as that of NYC. However, after a lot of budgetary discussions and calculations, this option turned out to not be sustainable moving forward with the growth plans of the practice.
Next option was to locate the call center in Asia (India or philippines). Considering the fact that a large part of the patient population spoke South asian languages, our call center location needed to be based in India.
Director of patient access for the centralized call center
Initially, this might not seem as very important, but having a single coordinator / director of all patient access challenges is crucial. This person is directly responsible for patient access, satisfaction, maintaining KPIs related to patient AND provider satisfaction.
Translate current scheduling system to a centralized scheduling system
Our client was using CareCloud’s EPM for scheduling. Each location had receptionists and front desk staff that would book appointments. There were several scheduling rules based on provider timings per day as well. On top of this, some specialists wanted to see specific visit types (e.g. RETINA, GLAUCOMA etc) while some ODs could very easily do other consults. In addition to this, not all providers were at par with various payers, hence not all patients could be easily assigned to / appointed with all doctors. Some patients had personal histories with specific providers as well – all added to the complexities of scheduling.
Most health systems’ front desk / receptionists have to deal with this situation wherein it is nearly impossible to translate such “localized knowledge” to a systemized process. This almost always also leads to longer training and onboarding time needed to get a new hire started / productive.
When patients called for appointments, it took almost 10 minutes to get the patient an appropriate appointment that would work both for the patient and the practice.
The idea was to have the “system” do most of the work by processing these rules and presenting appropriate available appointment dates/times to the patient. The longer term goal that we kept in mind was that the same functionality would also be made available on our client’s website – so that patients can self schedule their appointments.
Based on our goals, we connected our custom scheduling software to Carecloud, pulled in all the providers, schedules, block-outs, appointment templates etc and used a business rules engine in our custom software to achieve this. The intent was to reduce scheduling times to less than 1 minute
Integrate practice management software with your call center software
Call centers are run using one of many call center software available in the market (e.g. Vicidial, Five9, Amazon Connect etc). However, none of the call center software is really integrated with your practice management software. That’s where most of the challenges crop up. For a call center customer service representative to be effective, they need to have easy access to your EMR / EPM and their access needs to be up-to-date in real time, as changes to your appointment calendar occurs, as patients flow in and out of the system.
This step is crucial for success and should not be overlooked. You can try to get by with assembling spreadsheets to get the job done. However, keep in mind that as soon as you export data from your practice management software into a spreadsheet, that data is, effectively, stale and out of date.
We use Amazon connect for our custom healthcare call center software. Our call center software integrates with most, if not all leading practice management software. For this particular client, we needed to connect with Carecloud and our team was able to connect with Carecloud using its APIs. We also have the option to connect via HL7 – should we choose to. But, typically, integrating with HL7 is associated with added costs, hence we opted to not take that route and stuck with APIs instead.
Hiring the right call center supervisor and call center agents
The talent pool for call center customer service representatives is large and in many call centers, you can get away with having remote agents working from home. However, healthcare call centers face a challenge wherein they need to handle HIPAA and SOC2 compliance very seriously.
Hiring a call center supervisor is crucial and depending on the size of your call center team, you might have to hire more than 1 team leads as well. Our general recommendation is that one manager should have no more than 10 direct reports. So, if you have 30 call center agents, you are going to need 3 managers (at a minimum).
Our recommendation is not to skimp on hiring a call center supervisor. Call centers have a work culture of their own and unless you have led a call center before, you are in for a rude shock. The industry behaves in a certain way and agent burnout + attrition is very high. You need to constantly be hiring and maintaining a bench of call center customer service representatives to be good at this game.
You also need to be very careful of the agents you hire for your centralized healthcare call center. Keep in mind that these are patients you are dealing with and patients need to be handled in a slightly different fashion than any other traditional call center customer.
You need to hire call center agents with empathy.. That’s quite possibly the biggest job requirement. You also need to hire bilingual agents. In our case, we hire customer service representatives that speak English, South asian languages and Spanish. We have noticed that only about 10% of callers truly do need Spanish support (we had thought otherwise).
Do not underestimate the training program for your call center. We cannot state this strongly enough.
HIPAA security and SOC2 compliance of your call center
One of the primary items in getting your call center to be SOC 2 compliant is the integration between your patient relationship management software / tool and your existing systems (EMR, EPM etc). You need to follow a SOC 2 compliance checklist that guides you through these processes and includes measures like firewalls and malware protection.
You need to be able to demonstrate SOC2 compliance thus:
- Security protocols around how patient data is handled, how patient data access is tracked, time of access etc.
- Demonstrate training of employees to ensure that each customer service representative, supervisor, MIS personnel involved know security risks, procedures, and protocols
- Prove your compliance via extensive real-time and historical auditing of adherence to procedures and processes.
- HIPAA compliance is not very far away from SOC2 compliance in the sense that access, transmittal, mode of transmittal of ePHI is to be managed, monitored, audited and reported on. There are some excellent guidelines for enabling HIPAA compliance in your call center (e.g. read here).
Determine the right staffing for your call center
For this, you really do need to understand and implement the call center industry standard – Erlang C model. There are several handy calculators you can use to determine your staffing need based on the Erlang C calculator. (e.g. here’s one).
Before you determine the right amount of staff you need, make sure that you know the total number of inbound calls handled per week/month and also understand the seasonality of call volumes. You need to understand (from the steps above) which days a week call volumes are highest and staff accordingly.
Take care to understand what the typical call duration is and also find out which call types have what durations. E.g. your inbound appointment requests might need more time on call to go towards resolution while you pharmacy related calls might immediately be forwarded to your healthcare technicians (or otherwise).
Once you have figured out how many agents you need on the floor at all times, take some time to adjust for call center attrition, training, leaves etc. We typically adjust the right staff size needed by 20% to account for bench and having the same staff sizing on the floor at all times.
Transition existing scheduling coordinators into this centralized team
Our recommendation is to hire someone with at least 2-3 years of scheduling experience in your practice as being a critical part of your team and being a mentor for new agents. Healthcare practices typically do have high attrition rates in front desk/ receptionist staff. Your mileage may vary on this one as you might not have folks with 3 years experience in scheduling your providers.
In that case, any of your existing scheduling coordinators would suffice – as they are required to train the centralized call center agents on the ins and outs or idiosyncrasies in scheduling for your practice.
Before you get started, ensure that you have an entire standard operating procedure written up by the scheduling coordinator(s) that are going to be doing the training / knowledge transfer. This helps because new agents should have material for self-help and training before they spend 1-1 time on scheduling training.
Training on accuracy of scheduling appointments
Accuracy of appointments scheduled ends up being a sticking point for most of these transitions. While the ability to handle more patient calls is great (and that’s why you started the call center in the first place), patient experience and appropriate / accurate appointment scheduling takes priority over volume of calls.
There are several items to check before we consider a scheduled appointment to be accurate. E.g.
- Correct patient name spelling,
- 1 or more patient phone numbers (mobile preferred),
- Correct DOB of patient,
- Whether doctor’s “desired” schedule was matched or not,
- Was the right doctor selected for the visit type,
- Was the appointment selected as per Nature Of Visit,
- Was the appointment booked as Per call notes,
- Was the call documented correctly (chief complaint, reason for visit etc)
- Referring provider / PCP info – was that collected or not
- Did we collect the source of patient appt (e.g. “where did they hear about us”)
- Was the correct payer name, plan name, member ID collected or not
- Was the patient advised on whether we accept that insurance or not
There should be a training program / orientation program for call center agents so they clearly understand the importance of gathering each info and do actually gather all the information requested by management.
Try to develop training courses that are ready to go before agents are even starting with their first calls. Try to have agents participate in mock calls before they take live calls from patients.
Call recordings – for supervision and training
Most call center software have the ability to record all calls. Some of them face challenges because of where those call recordings are stored. Medical call recordings have to be stored in a HIPAA compliant manner and therefore many of the industry leading call center software cannot be used.
We use Amazon Connect and it is very easy for us to record all calls in a HIPAA secure manner, and quite cheaply as well (AWS S3 storage is quite cheap).
Call recordings are a must have – you are going to need them for quality audit purposes and you are also going to need it for training purposes.
While there is a lot of value in training your call center agents via live 1-1 or a group training session, nothing beats the kind of training an agent can get if they listen to representative call recordings for the workflow they would be handling.
Auditing call recordings for supervisory purposes is mandatory. While it is never going to be possible for your supervisor to audit all call recordings, a random sampling of 10% of call recordings every day is more than enough.
There are several factors to audit recordings on – here are the ones we use.. E.g.
- Call opening
- Call probing
- Empathy displayed during the call
- Call resolution
- Script adherence
- Call closing
- Call compliance
These are just guidelines and your medical call center, along with your existing scheduling staff should develop their own metrics.
Create phone scripts for your call center agents
Sometimes it is better to not have all calls scripted – but we recommend preparing scripts for agents as you begin this journey. While we do not force call center agents to follow the script religiously, we do expect the call center agents to follow the general guidelines of the script.
Having these scripts created also helps immensely with training and onboarding of call center agents.
At a minimum, you need to have scripts for the following workflows:
|Inbound calls related||Outbound calls related|
|appointments scheduling, rescheduling, cancellations|
pharmacy / medication related issues
insurance / eligibility related issues
billing related issues
no show patients
reactivation of patients that have fallen out of care
patients that made an appointment and never showed up (no-encounter patients)
patient balance reminders and collections
getting new patient referrals from existing patients
Do keep in mind that if you are calling on behalf of your own medical practice, you are a first party collector and do not have to handle Miranda rights to the extent that a third party collector has to.
Get a single number for the entire practice
We have dealt with situations where each location has its own phone number and patients have to remember each number. However, our recommendation is that if you are creating a centralized healthcare call center, you should get a single, well branded number to represent your entire practice and all its locations.
For our client, we purchased the numbers from tollfreenumber – this process was really easy and we received the Toll Free Birth Certificate very quickly as well. The next step was for us to port this toll free number to Amazon Connect.
Of course, the existing local phone numbers for each practice location also had to be ported into Amazon Connect. After that, we simply ensured that we updated our client’s IVR to announce the new phone number to all our callers so they could update their own records.
Meanwhile, we also ensured the the call flow for each one of the older inbound phone numbers were the same as that of the new, main phone number we acquired for our client. This call flow would be routed to our inbound call center agents, so callers/patients never really knew the difference in which number is actually being answered.
Each one of these individual offices had their phones hosted using freePBX.org and there were extensions for each staff. To resolve this challenge, we purchased a few more local numbers that were never to be published to the outside world and associated those phone extensions to the staff / doctors.
Whenever the call center received a phone call that needed to be routed to a particular staff, they would simply dial the “secret” phone number of the practice and dial the required extension.
Amazon connect does have a challenge wherein it does not allow for voicemails very easily. This issue was resolved quite well by having a general voicemail box on one of these local phone numbers that would collect all the incoming voicemails for the call center agents. The call center agents had access to the voicemail box and could return calls as needed/appropriate.
While this transition was being planned and prepared for, we also had all the marketing materials of our client updated (including the website).
Our client had ongoing PPC campaigns and these campaigns did use call tracking numbers. This became a challenge because these call tracking numbers were allocated to each practice location. That was the only hiccup we faced during this entire transition.
TEST, TEST, TEST before you roll this out
Before we rolled out the centralized call center, we took the time to test things out first. The existing inbound numbers remained as they were. We simply had the call center agents take mock calls on the inbound phone number that we purchased.
We called in with various scenarios that inbound calls typically come in for. We also tested the call volumes that are expected on Mondays- Wednesdays for our client.
As expected, the call center IVR, call center agent response times, call drops etc went well – however we still had to tweak the appointment scheduler a bit. The business rules that were powering the appointment scheduler database were not enough and the agents had to spend more than necessary time on scheduling an appointment.
We spent some more time on the appointment scheduler logic that reduced the time spent by a call center agent on scheduling an appointment. On top of this, it also reduced the amount of auditing work that needed to be done that appointments were being scheduled correctly.
Only after a test run of 1 week, did we actually transition all the existing local numbers to Amazon Connect. Do note that this porting process takes 1-2 weeks so we kicked off the porting process before we started our trial.
On the day of the actual porting activity (handled by amazon connect support entirely), it barely took 1-2 hours before wrap up. However, our systems were thoroughly tested already.
Escalation channels – have that prepared before you get started (there will be escalations)
During our planning and design phase, we created a plan to address patient, provider, and staff issues/concerns. As noted above, we designated a patient access director that greatly helped ease these challenges/complaints.
We had the patient access director be a liaison between the call center supervisor and the practice staff + providers.
Healthcare call center metrics – know what you are going to measure and prepare for it
We had already established the call center metrics that we were going to monitor moving forward. A brief list of those metrics that were planned for are below. Note that Amazon connect does give us a few of these metrics in its daily reports. The only challenge with Amazon’s reports are that they are limited to 3K rows of data (and we had a lot more than 3000 calls per day).
|Inbound calls handled per agent|
Inbound calls response time
Abandoned calls per day
Longest call hold times
Peak hour traffic (for us, this is early during the day Mon-Wednesdays)
No shows reappointed per agent
Patients reactivated per agent
Patient balances collected per agent
Average call handle time
Call source (“where did you hear about us”) per agent
Agent utilization per day
New patients acquired per agent
|After call work time per agent|
% calls answered within the first 20 seconds.
Calls resolved on first contact
Appointment reminders made successfully per agent
New patients acquired per agent via community outreach
New patients acquired per agent via patient referrals
New referrals received per agent via inbound calls
New referrals processed per agent via outbound calls
Steps to set up an inbound call center
In our opinion, you should start with the inbound call center as you see the biggest bang for the buck. The practice locations become quieter, calmer and in office staff, practitioners become a lot more productive.
First – set up proper expectations. A call center takes months to build from scratch (we are not talking about the technology part here). Plan for a minimum of 6 months and if the initiative is large enough, plan for more than a year (from planning to going live).
Because setting up phone lines is the easiest part of an inbound call center.
Starting a healthcare call center is not a “side project”. It needs your (or someone’s) full attention.
The main components? People, processes, technology, location, facilities.
Inbound contact center – People needed
Your agents will make or break your call center initiative.
Call center leads (quality assurance, team leads etc) your hire will make or break your agents.
You will have patient access director(s) / management will make or break your call center leads.
Hiring these key people will help you ensure a smooth transition to a centralized call center. A healthcare call center is a tad different from other call centers. We are sure you recognize that as well.
Customers are patients. Your agents need to be high on empathy. Your KPIs cannot be based on “number of dials” or “number of new appointments made” alone.
Make empathy part of your culture. Hire people with empathy – even if they don’t have enough experience.
Empathy is crucial. We cannot stress on this enough.
Inbound contact center – Recruitment
Recruitment is key and not to be underestimated.
Call center is a high attrition and high burn out business. You will need to set up a good talent pipeline and be competitive in your local market. On top of this, you always need to have a “bench” created to address absenteeism while still meeting patient needs.
Inbound contact center -Training
Training is another very big aspect – we cannot stress on this enough.
Set up your recruitment and your training by experienced folks.
Hire dedicated trainers with enough experience in your industry.
Quality analysis and quality assurance is a constant process (usually daily). You can offload some of this to the latest and greatest artificial intelligence software, but not all of it.
Hire quality analysts that are experienced in your industry.
Without them, you will never know the quality you team is delivering to your customers (patients).
Inbound contact center -Location
Where you locate your call center is pretty important in many ways.
First of all, it has a direct impact on your monthly rental / real estate cash outflow.
It also governs the talent pool you will have access to.
When you want to compete in a good talented pool, you will also have stiff competition. Be prepared to pay premium prices. But, like they say – you get what you pay for.
If you choose not to locate your centralized call center in a competitive place, be prepared to have a much longer training period. Also, expect to have to train a large portion of your employee base.
Having your office located close to public transportation is quite important as well. If you run a 24/7 call center, you also need to start thinking about good parking facilities.
Location plays a big role in employees choosing you as an employer as well. Keep that in mind.
Inbound contact center – Facilities
Once you have nailed down the location, you need to be prepared to spend a pretty penny on making good facilities available for your call center.
Keep in mind that call centers are high stress environments. You need to think about making slightly higher facilities available for your agents.
Software developers might revel in working out of a garage. That’s never going to be the case for a call center team.
You need to plan for break rooms, meeting rooms, recreation rooms etc as well. As we mentioned, this is a high volume, high stress environment.
Treat your team well and they will treat your customers as you want them to.
They are representing your brand. Invest in them.
Inbound contact center -Processes
If you are to be successful in this venture, you need to have rock solid processes set up. More often than not, we find that healthcare customers do not even have their existing workflows documented.
If you do not document your workflows, how do you transition them to another team?
Some customers we onboard do not have KPIs (key performance indicators) set up for their front desk. They recognize that they have an issue they need to fix. “Something is going wrong”. But they do not have specific goals set up nor a framework set up for them to determine what is “right” or “wrong”.
We are usually VERY careful before onboarding these customers. Unless KPIs are established and documented, we do not even get started with these customers.
Inbound contact center – KPIs and SLAs
Because if they do not have KPIs, what are they going to judge us against?
What service level agreements do we need to adhere to? Are those SLAs even achievable?
What would make the customer happy?
If you do not what would make you happy, then take some time to document what your expectations are.
Once you document your expectations and your current workflows, you are in a better position to start transitioning these activities and workflows to your call center team.
Inbound contact center – Questions you need to have solid answers for:
- What happens when the phone rings or the website chat starts or the whatsapp chat starts? What are the expected SLAs?
- How about when the call is finished? What after call work needs to be done?
- And when the call is on? What if the agent cannot provide resolution on first contact?
- How about escalation points? What are the escalation channels?
- What are the resolution channels?
- Think about what to do when the patient asks a billing question?
- What to do when the patient asks a medically advanced question?
- How should the agent handle a payment if the patient wants to pay on the phone?
- How are those charges posted each day?
- What happens when the patient has a pharmacy question? How is it escalated? How is it resolved
Map out all the processes your front desk follows at the moment. Then, map out how they will be transitioned.
Inbound contact center – Technologies
Traditionally, call centers have operated via PBX. Call centers were not the first ones to accept VOIP or cloud based options.
A large part of call centers did finally take the plunge towards using VOIP solutions. Even then, they were not always comfortable placing their entire call center in the cloud.
However, over the last few years, there has been a shift towards acceptance of cloud based call center infrastructures.
Our cloud contact center of choice has been Amazon Connect Contact Center from AWS.
Minimum todo technology list you need to start with
At a minimum, you are going to need to plan for:
|Inbound phone numbers that you provision via your carrier or a VOIP provider.|
Extension set ups or direct inward dial (DID) numbers for each team member.
Physical phones if that’s how your call center will operate
Voicemail set up if you need it
Web based chat software if you support that channel at your call center
Software to enable patients to text your call center
Soft phones (not all soft phones are alike)
A rock solid, reputable call center software
|Automated call distribution capabilities|
Skill based routing capabilities
Call queues and routing profiles capabilities
CRM – how else would your agents look up patient data or enter their conversation details
Call recordings – Audio file storage facility (cloud or otherwise)
IVR set up (it should not take you weeks just to set up your IVR)
Reporting and analytics software
Whatsapp support software if your call center supports that channel
Facebook chat if you support that channel
iMessage software if your call center supports it as a channel
HIPAA controls and audit software
SOC2 compliance controls and audit software
This doesn’t cover the entire list of things you need to think about, but at least it gives you good introduction to things you should be thinking about when launching your inbound healthcare call center
Considering Amazon Connect Contact Center For your Healthcare contact center
We will always recommend them because our own teams use them and have thrived by using them.
Why Amazon Connect Contact Center? Here’s our journey into the patient contact center line of business, why we chose Amazon Connect and how we became Amazon Connect Contact Center partners. After running for months.. We found out that our actual cost per agent per month, along with dialing charges were around $70/month.
How we started our patient contact center
We didn’t start our patient contact center with Amazon Connect right from the start. Heck, our patient contact center didn’t even start as a patient contact center to begin with. While working with one of our healthcare customers, we noticed that their EMR was filled with patients that had not been seen (recalled) in more than a quarter. Considering our experience with regimented outreach, we felt that things could be a lot better.
Starting with reactivation of patients not seen in more than a quarter
We decided to just pick up the phone and start dialing patients that had not confirmed their appointments. We started with Skype 🙂 We didn’t quite call ourselves a patient contact center back then. We were just making sure that our client’s patients showed up. The experiment was a huge success. We added 5,200 new patient appointments in 2 months with 3-6 agents calling each day. We grew our team from an initial size of 6 people.
Adding appointment reminders
We also started noticing that our customer’s no-show rates were consistently high. They were relying entirely on their CareCloud EHR to send patients text messages for confirmations. This customer’s team was not really calling patients to remind them of their appointments. Not because they didn’t care to, but because they were simply overwhelmed. Considering that it was an ophthalmology practice with mainly older patients, we were pretty sure that text messaging alone was not going to cut it.
Challenges with Skype
While we did operate on Skype for a month, it was becoming a headache. Thankfully we were not handling inbound calls / inbound IVR so we didn’t really have that big of a problem yet. Skype numbers did receive inbound calls, but patients started to call at all times of the evening/morning – beyond business hours. That didn’t go over well with our agents. Plus, each week, we had to ask the agents for their call logs. Agents are NOT technically savvy folks 🙂 Getting them to send us calls and SMS logs was… a bit of a challenge 🙂 Considering that we were a data led business, we really didn’t know what was going on with our call center. We couldn’t figure out average handling times that easily. We were wrangling spreadsheets (CSV files exported from Skype) to get typical call center metrics and KPIs out the door for ourselves and our client. Agents were going through hell trying to get phone numbers from google sheets and calling them from Skype. We had to get off of Skype soon.
The hunt for a call center software
Remember, we were not really thinking of being a call center 🙂 We did our research and of course, we gathered a list of the top call center software in the market – Vicidial, Talkdesk, BrightPattern, NICE Incontact, Five9, FluentStream.
We were dialing manually and were averaging about 150 calls / day / agent X 6 agents = 900-1000 calls per day. In a month, we were averaging 20,000 calls. Our average call handling time was around 5-7 mins per call.
What we needed from our call center back then
Our needs were quite basic – we just needed a way to:
- Dial outbound numbers using a browser
- Receive inbound calls using a browser
- Have defined business hours
- Be able to pull call center metrics and KPIs (real time and historic)
- Be able to transfer calls to our client’s team as and when needed
- Not be bound to a contract
- Be able to scale up as needed
- Be able to integrate with and leverage the rest of the AWS ecosystem (this was super important to us)
Costs of various call center software
From our research, here’s what we gathered
- Vicidial – $400 per server per month hosting fee (after first month) plus cost of minutes. 1.5 cents per minute for outbound calls as well as inbound toll calls. 2.8 cents per minute for inbound toll-free calls
- Talkdesk – Talkdesk starts at $65 per seat per month. Talkdesk also provides telephony (using Twilio) and charges a price per minute starting at $0.02 per minute for inbound calls and $0.03 per minute for outbound calls.
- Bright Pattern – Bright Pattern pricing starts at $70.00 per month, per user. They do not have a free version.
- NICE inContact – NICE inContact pricing starts at $100.00/month/user,
- Five9 – Five9 pricing starts at $100.00 per month, per user. They do not have a free version.
- FluentStream – FluentStream’s “Essential” package starts at $20 per user per month. However, for access to more advanced features, such as integration and SMS capabilities, you might have to upgrade to their “Advanced” ($30 per user per month) or “Complete” ($45 per user per month) package.
All of the above didn’t include the pricing for dial minutes.. Which adds to the costs even more so.
So, doing some basic math.. With the lowest of around $ Our small call center of 6 people would cost a bare minimum of $200/- for seat costs plus the dialing charges. If our team grew to 50, seat costs would be a minimum of $1,500/- per month
Comparing to Amazon Connect
Doing a quick comparison with amazon connect’s pricing,
- Direct Inward Dial number costs less than $1 per month.
- Inbound dialing costs were $0.0022 /minute (0.22 cents per minute)
- Inbound dialing costs were $0.0048 /minute (0.48 cents per minute)
So, Amazon connect already beat the per minute pricing for all the other providers.
Next up was to compare how much it would cost to use for 8 hrs / day * 20 days a month
Amazon prices it as (Voice usage) $0.018 per minute. So, that would cost us around $172/month per month per agent if they use the software constantly for 8 hrs per day (which we hope they would).
Comparing this to the “per seat” cost of the other software, this seemed the most expensive. What we saved on dialing costs, were partially lost to this “per agent” cost.
NOTE: After running for months.. We found out that our actual cost per agent per month, along with dialing charges were around $70/month
Customizing our contact center
Almost every call center software integrates with some CRM or the other. We got a little stuck here. We needed to be 100% HIPAA compliant. So, we couldn’t really use any traditional CRMs. We were already using a no-frills healthcare CRM that helped our agents daily anyway. It was HIPAA compliant and we needed our call center software to be able to integrate with it easily. Early on, our management team had already decided that we are not going to be a traditional patient contact center that is in the business of selling “agents”. We wanted to be in a different line of business. We wanted to lead with technology and provide agents for the final mile.
Forecasting future needs
Being in the healthcare business for a while, we knew that software alone will never solve all the problems. Humans are needed for the final mile. Healthcare is so fragmented that we knew we could not rest on our laurels by just connecting to a CRM. We had to connect to a CRM that somehow connects to an EMR and probably an EPM. We lived in the world of faxes – unlike any other industry. So, we knew we would have to connect voice, chat, faxes and more channels of communication.
Our patients would write to us via SMS, whatsapp, iMessage. Our partners would send us faxes. Some of our calls to payers would last more than an hour. In other words, healthcare was (and still is).. A bit of a messy business. So, we knew we were going to have to customize things a lot.
We were already heavy users of AWS’ ecosystem. We leveraged a LOT of their HIPAA eligible services and had no intentions of moving away from them. Being able to customize our contact center and begin to leverage the AWS ecosystem was a REALLY big deal for us. We decided to try out Amazon Connect Contact Center.
Getting started in less than 30 mins
We decided to give Amazon Connect a shot. What’s to lose? They already had a free tier for us to play around with. It took us less than 30 mins to get started. We were floored – we didn’t need any training and we were up and running. Almost as easy as Skype! Next up, we tried some ACD and set up the IVR. Easy peasy.
We took the IVR a step further and decided to integrate with Lambda for some of the other custom things we were doing. Easy.
We tried to do automated dialing to leave voicemails and to allow patients to talk to an agent by pressing 1. Easy.
We went through various experiments one by one – they all seemed pretty easy.
We ended up choosing Amazon Connect Contact Center.
Adding no-shows re-appointments
Meanwhile, once we started calling for appointment reminders, a natural progression was to start calling for no-shows as well. Our client (like most others) didn’t really have a plan for recalling no-shows. They would, on a sporadic basis, create a list of no-show patients from CareCloud and hand them over to another offshore team to call.
We didn’t think that approach was regimented enough to improve patient visit volumes. Drawing from our experiences from other industries combined with our own marketing strategies, we figured no-shows should be part of a regimented program as well.
We added calling, dropping voicemails and texting no-shows to our team’s assignments. The team size also grew along with. Taking the route of voicemail drops was not a big deal at all – thanks to Amazon Pinpoint.
Taking on inbound call handling
At one point we were asked to produce KPIs for our customer’s front desk call handling. As it turned out, each patient had to wait for at least 15 mins for the front desk to get to the phone with them. That’s when we started handling inbound calls as well. Again, Amazon connect contact center came to the rescue. We were ready to do so within a day. All we had to do was to modify the sample contact flow that Amazon connect provides and we were good to go. The only thing that took a few days was porting the existing phone number of our customer into Amazon connect contact center. From day 1, we started handling approximately 250 inbound calls. Our patient CRM came to the rescue as well. For each inbound call, the screen pop would open up the patient record fetched by the patient CRM from the Carecloud EMR and our agents were ready to service the patient.
Amazon’s Spanish speech to text was fantastic (they’ve recently upgraded those features a lot as well, making it even easier).
Ability to do skills based routing helped a lot. We created Spanish, Bengali, Hindi and English queues. We also created quick connects to be able to forward billing and prescription requests to the technicians working in specific locations.
Hopefully this helps.