Contact Center professionals in all industries must understand the marketplace in which they operate . For Healthcare , the landscape is changing and it is important to stay informed . Consider the fact that Walmart recently announced that it would close all 51 of its Health Centers and Virtual Health Services . The company said that after just five years , “ a challenging reimbursement environment and increasing operating costs make the ( ambulatory care ) business model unsustainable .” 1 Walmart also states that it will remain in the pharmaceutical and eye care business ( I guess because they must be … profitable ).
THE COVID-19 PANDEMIC HIGHLIGHTED THE VALUE AND IMPORTANCE OF CONTACT CENTERS IN KEEPING INDUSTRIES OPERATIONAL DURING THE SHUTDOWN .
Essentially , a company focused on generating profits has informed the market that providing actual patient facing care is simply not profitable . This highlights the challenges that all Healthcare providers face : “ a challenging reimbursement environment ” ( insurance companies ) and “ increasing operating costs ” ( providers at all levels , admins , lab techs , facilities , tools , etc .).
This situation makes the recent years of systems ’ growth in Healthcare and massive consolidation easier to understand ; it also positions Access Centers for growth in order to support ongoing efficiency gains and improve the Patient Experience .
Access Centers have an organizational and operational environment well-suited to handle additional services currently provided by overburdened practice personnel . Access Centers have systems , processes , analysts , trainers , quality assurance , and workforce management all in place and if they were built right … all are SCALABLE !
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https :// corporate . walmart . com / news / 2024 / 04 / 30 / walmarthealth-is-closing
Access Centers are well-positioned to contribute to both financial wellbeing and the Patient Experience by working with executives and Practice Administrators to identify additional activities and tasks suitable for centralization .
I will focus on three areas to consider for Contact Center centralization . ( There are many others .) These are Physician Referrals , Prior Authorizations , and Radiology Scheduling . Each is part of the Patient Access journey as they represent pre-appointment tasks and significant revenue improvement opportunities .
PHYSICIAN REFERRALS
Physician referrals are a clear revenue stream as they result in a patient requesting an appointment . Primary Care providers generate a huge percentage of referrals to specialists and have various processes to follow depending on specialists ’ widely-varied scheduling protocols .
For many Healthcare systems , the handling of Physician Referrals is a decentralized activity ( handled in the provider ’ s office ) and in many cases as informal as it is inefficient . When admins in provider offices are assigned to handle referrals , among their many other tasks , it is largely because they have always done it that way . This might have started 20 years ago !
Referrals are often paper driven , arrive by fax , and are “ distributed ” by hand to whomever is responsible that day . This “ shared ” responsibility model is fraught with risk . Limited tracking and reporting minimizes management ’ s ability to understand the demand level . The lack of systematic processes and documented procedures may cause confusion / chaos within the practice , delay patient care , and negatively impact revenue .
The Access Center has greater capabilities to manage this important revenue stream by providing a more centralized , seamless , and user-friendly experience for patients and providers .
IDIOM INSIGHTS
CONTACT CENTER PROFESSIONALS IN ALL INDUSTRIES MUST UNDERSTAND THE MARKETPLACE IN WHICH THEY OPERATE .
PRIOR AUTHORIZATION
Prior Authorization ( PA ) is one of the most frustrating and inefficient aspects of today ' s Healthcare system for patients , providers , and staff . According to the American Medical Association ( AMA ) provider practices complete an average of 43 prior authorizations per physician per week ; this takes about 12 hours of physician and staff time . 2 Typically , securing prior authorizations falls to the already overburdened physician ’ s office staff where training , standardization , and analytics are often lacking . Poor handling of PAs leads to administrative frustration , delays in patient care , unexpected bills due to PA denials , and financial losses to the enterprise . These conditions also significantly impact telephone calls to the practice .
The Access Center has greater capabilities to manage this important revenue stream as it provides a more seamless and user-friendly experience for patients . Centralization to an Access Center improves efficiency , streamlines the process , reduces redundancy , and ensures that requests are handled promptly and accurately . This helps minimize delays in patient care and optimizes the use of resources . Access Centers are also equipped to develop teams specifically trained to handle PAs . These teams stay up-to-date on the latest requirements and best practices . This adds to more effective and accurate PA submissions .
Overall , centralization improves communication and coordination among different departments and stakeholders . Centralizing PAs in the Access Center also provides clearer career paths for staff ; this offers opportunities for growth and specialization within the organization .
SEPTEMBER 2024 15
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https :// www . ama-assn . org / press-center / press-releases / ama-survey-indicates-prior-authorization-wreaks-havoc-patient-care