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.
Here’s how we built out a centralized healthcare call center for an ophthalmology group based out of NYC.
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.
Gather the baseline numbers / KPIs before you get started
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 centralized call center initiative
This is a disruptive and transformative change in 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.
Determine the locations and providers participating in the centralized 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).
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 / 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.
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 for appointments scheduling, rescheduling, cancellations
- – inbound calls for surgical coordinations
- – inbound calls for pharmacy / medication related issues
- – inbound calls for billing related issues
- – inbound calls for insurance / eligibility related issues
- – inbound calls for patient balances
- – outbound calls for patient reminders
- – outbound calls for no show patients
- – outbound calls for reactivation of patients that have fallen out of care
- – outbound calls for patients that made an appointment and never showed up (no-encounter patients)
- – outbound calls for community outreach
- – outbound calls for 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 http://www.tollfreenumber.com/ – 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
- 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
- New patients acquired per agent
- Call source (“where did you hear about us”) per agent
- Agent utilization per day