How to meet evolving expectations and needs: Reimagining the healthcare consumer service experience

Higher Consumer Expectations, Higher Organizational Onus

Digital and online channels are being adopted by healthcare systems and consumers at rates never seen before. However, in the race to get up to speed quickly and meet evolving consumer needs, many healthcare systems do not pay enough attention to their primary connection point: the phone.

And while they’ve been answering phones for decades, it’s only become more complicated to do so. Consumers’ expectations are higher. With more options for care and services comes more complexity that patients need help navigating. And as health systems ramp up outbound communications — whether as part of a consumer engagement strategy or not — the onus shifts to the people answering the phone or on the other side of electronic forms of communication to translate and coordinate on behalf of consumers.

Start with Your Consumer Experience and Engagement Vision

The answer is not to start consolidating all your front-end staff into a central building. A critical success factor is to start with a consumer experience and engagement strategy: decide what your organization aspires to be or offer now in the near-term and further into the future.

The vision and roadmap established during this step will help inform decisions throughout the journey and help to align stakeholders on what the organization is collectively trying to achieve. The vision needs to be balanced between the practical — what do we need to do to fix our current operations? — and aspirational, with openness to emerging solutions that can support your overall consumer engagement goals.

The Fundamental Enabler: An Advanced Engagement Center

We believe that a high-performing engagement center will be a required enabler of your consumer experience/engagement vision. First, it’s not a building, or a team, or a call center. We define it as a centrally managed, coordinated set of capabilities that connects healthcare consumers with the health system (consumers are defined as current patients/families, potential patients, and referring providers).

Ultimately, the engagement center is critical to building and maintaining longstanding, trusted relationships with these consumers. No matter what channels through which consumers chose to engage with the health system, the engagement center can play a role in navigating them to the appropriate service.

Covering a breadth of consumer-facing functions: Here we’ve listed a set of functions that are typically included and/or coordinated by an advanced engagement center. The set of services at each organization may be different, depending on organizational dynamics and ultimately their individualized consumer engagement and experience vision. These services may be expanded or added over time as the engagement center matures.

Appointment scheduling and support is typically the most obvious and one that many organizations have centralized to some extent — often with mixed success.

Under the clinical services and care navigation bucket, we see a variety of complementary services that include triage, care management, and associated outreach. In many ways, this function serves as the extension of the care team in the practices, helping with prescription renewals and responding to clinical inquiries.

Patient financial management is also increasingly integrated with appointment scheduling to enable streamlined interactions with consumers and ensure that they’re able to appropriately prepare patients clinically, logistically, and financially.

Lastly, inclusion of referral management services can facilitate a hassle-free experience for referring providers and support more timely care for patients. The integration of these services — organizing around patients’ needs vs. legacy functional departments — can enable a powerful, coordinated consumer experience.

3 Major Steps for Your Journey

As we think about embarking on the journey, we’ve broken it into three major steps: standardization, centralization, and digitization. I’ll briefly touch on each of these in the subsequent slides but wanted to make the point that this is often a more iterative process than is depicted here. You may progress through this cycle for a single function or capability and then restart for the next, or you may find, as many do, that for some services, you’ve jumped to centralization before standardizing and need to go back to standardizing before progressing toward further centralization or digitization.

1. Standardization is often a dirty word for clinicians in particular, but our experience indicates that standardization helps establish the foundation for consistent consumer experience. We think about standardization in several categories:

• First, establishing and disseminating a cohesive and compelling case for change and set of common goals across the organization.
• Next, taking inventory of your technology platforms and capabilities and working to create a more cohesive infrastructure across the key functions.
• Then, reporting. It’s amazing how many organizations have no data-backed understanding of the volume of and/or service levels associated with their phone-based and online consumer interactions across the health system. Getting a robust analytics system in place is critical to managing performance over time.
• Finally, identifying and seeking to eliminate variation and unsatisfactory consumer experience in the way staff interact with consumers. Anything from scripts for how to answer the phone, protocols for triage, scheduling and phone transfers, guidelines for outbound patient communication — all with the common goal of enhancing consumer experience and creating trusted, long-standing relationships.

2. Centralization enables organizations to capitalize on scale by consolidating operations. This does not necessarily mean moving staff into a central place, but often it does mean creating a consistent operating model and oversight structure — which also supports maintaining standardized technology, reporting, and processes.

In defining the new operating model, the design process is critically important. Ensuring that stakeholders, including providers, are engaged in the process and that decisions are made with long-term vision and goals in mind, helps mitigate challenges down the road. Additionally, spending the time and effort to adequately prepare the practices or departments to transition to the new model — making sure they understand the impact on their operations — is critically important and one that organizations often overlook. And lastly, as the operating model shifts, so too, will the relationships and interfaces with supporting functions and sites of care delivery. Therefore, it is important to put mechanisms in place to ensure that the engagement center is seen as a partner, with shared goals, rather than a distanced “corporate” function.

3. Digitization: Finally, stabilization and centralization efforts pave the way for effective digitization, whereby the organization is able to leverage self-service and automation capabilities to reduce cost and enhance convenience for consumers. During this phase, organizations will need to take a disciplined approach, whereby technology is selected and/or optimized based on business need and then fully adopted.

In order to generate value out of technology investments, processes must be redesigned and hard-wired to incorporate the appropriate use of technology to avoid redundancies and inefficiency. As more and more solutions emerge in this space, this step will be the most dynamic and will require active re-evaluation of current and potential technology to ensure that the engagement center is optimizing its resources and able to meet consumer needs and expectations.

The Business Case: Measuring Value

In the course of working with our clients, we’re often asked about the business case or the return on investment for an engagement center. That’s a difficult question to answer generally because: (a) most organizations don’t know what they’re spending on these functions today, and (b) the starting point is highly variable across organizations. However, our experience indicates that over time, value can be measured across several key drivers:

• Your ability to attract and retain consumers: as measured by new visit volumes, keepage/leakage, and even market share.
• Cost reduction: Though it takes time to realize, over time, the unit cost per encounter should decrease, supported by efficient operations and by the shift toward only the most complex interactions requiring live staff support. There’s also the potential to reduce staff attrition due to enhanced consistency, job aids, and tools for front-line associates.
• Capacity optimization: An enterprise-wide engagement center can enhance the ability to place patients in schedules that may have previously been unfilled due to lack of visibility or oversight. This can improve provider productivity and wait times for patient appointments.
• Population health management: Engagement centers can also support population health management through enhanced coordination of care and access.
• Increased revenue capture: Consistent, optimized processes can lead to more timely payments, registration, and authorizations and ultimately decreased initial denials, avoidable write-offs, and bad debt.

At the Heart of Improving Overall Consumer Experience and Engagement

This is an important topic for health systems seeking to improve overall consumer experience and engagement. More and more organizations are considering the value of an advanced engagement center from a strategic and operational perspective. We would welcome further discussion around where your organization is on its journey and how to accelerate or advance your efforts. Thanks for listening.