What is Driving Healthcare: The Patient Experience, Operations or Technology?

Transcription

1 WHITE PAPER What is Driving Healthcare: The Patient Experience, Operations or Technology? By Aspect Software and Healthcare Intelligence The days of business as usual in healthcare are over. Health systems struggle with cost containment, population health management and wellness of the individual. Health care leaders have tried numerous fixes with mixed results. So how do you maximize the value you provide for your patients? Do you focus on the patient experience, operational excellence or integration of new technology? At the core, it s about maximizing patient value. According to the Harvard Business Review, making this transformation is not a single step but an overarching strategy. We call it the value agenda. It will require restructuring how health care delivery is organized, measured, and reimbursed. Being successful will require taking a hard look at everything that impacts your patient. The New Affordable Care Act March 2010 marked a significant date in history for the American people. The Patient Protection and Affordable Care Act (PPACA) was passed and signed into law. According to the U.S. Department of Health and Human Services, the Affordable Care Act (ACA) allows patients to take charge of their own healthcare, and provides the stability and flexibility needed to make informed choices regarding their healthcare. Under the ACA, Americans are required to obtain or purchase healthcare or pay a penalty. As a result of the increased numbers of patients seeking medical assistance, health systems and contact centers are under increasing pressure to cut costs and control spending. The ACA is significantly changing the way health systems, healthcare contact centers, patients, clinical providers, and information technology personal approach and view medical care. As a Result 95%: Percentage of Americans who are expected to be covered by health insurance under the new law. 30 million: Number of currently uninsured Americans who would get coverage under the new law over the next ten years. $938 billion: Cost to implement provisions of the new health care law over the next decade, according to figures from the Congressional Budget Office. $143 billion: Reduction of the federal deficit that should be attributable to the new health care rules, according to estimates for 2010 to 2019 from the Congressional Budget Office (Goguen, 2015).

2 telephony systems for the facilitation of preventative and multidisciplinary care. The Congressional Budget Office (2015) believes the implementation of the ACA will lead to: Increased competition among hospital systems and insurance companies Declining sustainability of health systems, insurance companies, and medical services Reduced reimbursement/compensation rates Statistics gathered by Gallup illustrate the drastic 6.1% Y-O-Y decrease in the number of uninsured Americans who now have healthcare coverage due to the ACA (Levy, 2015) Imposition of new fees on health insurers, pharmaceutical companies, and medical device manufacturers scheduled to peak at more than $18 billion in annual fees in The Congressional Budget Office (2015) The ACA Effect While the Affordable Care Act is now providing affordable healthcare coverage options to the American people, implementing the new healthcare law will cost more than $900 billion by the year 2021 (Goguen, 2015). To describe the impact on the American healthcare consumer, the ACA is completely reshaping the healthcare industry and radically altering business models that have not changed in decades (Novack, 2014). America is transitioning to a new era. However during this disruptive paradigm shift, how are the technological, financial and operational implications that come with it being accounted for? Managing the Paradigm Shift Expanded health insurance coverage to the American people through the ACA is having a major impact on many of the nation s health systems and contact centers through increased demand for access, increased patient revenues, and lowered uncompensated care costs for the uninsured (Claxton, Levitt, Brodie, Garfield, & Damico, 2014). Increased access to care, as well as an enhanced and user friendly method for requesting care, equates to a need for additional providers, Information Technology Systems, and state of the art Gone are the days when hospital systems were generously compensated for the volume of patients filling their hospital beds. Clinical outcomes, along with efficiency in care coordination, will be the key determinants in a health system s longevity. Generating Ongoing Revenue We live in a data driven society. Patients are able to easily find statistics, data, and other value based decision-making information while shopping for an insurance policy, healthcare system, practice, physician or clinical provider. The ACA makes connectivity through the use of electric medical records commonplace. Due to the transparency required by the ACA, insurance companies, hospital systems, healthcare contact centers, physician practices, and medical personnel will be motivated to provide the best possible quality, service, and cost in order to compete within the shifting healthcare industry. The Healthcare Industry is shifting, and it requires technological advances to compete and survive.

3 On both local and national levels, the old pay-for-service framework is giving way to a pay-for-performance model creating new revenue streams for companies that previously weren t directly involved in care delivery. - (Novack 2014) The Chicken or the Egg Operational Needs or Technological Offerings? With the changes brought about by healthcare reform, health systems require new technology and operational efficiencies designed to handle a higher volume of interactions. Decisions on design and implementation must be carefully evaluated and implemented. According to the Donella Meadows Institute, there are 3 ways for a health system to influence their patient interaction outcomes: 1. Adjust current models of operations to be in line with the existing system s functionality. a. This is the least effective methodology; stopgaps are placed to circumvent the system to allow clinics to maintain their previous model of operations. Vanilla deployment of this kind creates havoc within the health system and within the clinical teams. Not accounting for their needs and nuances of the operations causes the end users to lose confidence in the product. Future optimization and deployments are treated with major apprehension. b. This implementation method has the shortest deployment timeline. Hospitals that have yet to undergo major technological upgrades choose this method at the behest of the vendor to get the system online expediently. They are not aware of the fall out that occurs due to the inattention to details, the waste, the lack of productivity and the dissatisfaction that ensues. 2. Create a custom design to capture the nuances of the culture and the operations of the organization. a. This is a costly and time-consuming approach. It has the least impact on the clinics and the change management facilitators. There are instances where the system cannot accommodate the workflow that is being proposed due to the amount of the custom design that is being proposed. This option propagates and promotes inefficient processes. Designers and clinicians are not encouraged to think outside of the box. This is also a nightmare for information systems technicians to maintain once the deployment and stabilization periods are complete. b. This approach takes a substantial period of time to design, validate and test. Vendors and designers are often assessing one another s work to ensure that they have captured the details behind day-to-day operations. Rather than questioning certain practices, they manufacture and promote processes that favor one party rather than the end users and or the patient population. Contingencies are often factored into these proforma project plans. Often times, the return on investment is never realized during the forecasted fiscal cycle. 3. Leverage all functions within the health system to discover new efficiencies. a. Concurrently, clinicians, change managers and operational business owners must identify highly efficient in-house processes along with patient and operational needs that cannot be compromised. These aforementioned needs must translate into the system or must be custom built. It is imperative that the operational business owners and the clinicians be exposed to demonstrations of the system and be provided with sample work-plans prior to the beginning of their design period. This is the ideal method to enable retention of key success practices, and the ability to innovate by leveraging successes from the technology s capabilities. b. Deployment timelines that take on this hybrid approach often factor in the time that it takes for the end users and change management facilitators to understand the capability and limitations of the software. Throughout the course of the design and implementation, efficiencies are realized as rework loops are eliminated. Healthcare reform has mandated that transformation occur at a rapid pace. Aspect Healthcare solutions are purpose built for healthcare to efficiently and costeffectively address the evolving needs of patients and providers.

4 Aspect Can Help Aspect s innovative solutions can help health systems create their value agenda by more efficiently organizing and measuring everything that impacts the patient interaction experience. Aspect Healthcare Workforce Optimization helps health system leadership determine if they have proper staffing to handle interactions with their patients. In addition to determining staffing levels, quality monitoring and performance feedback ensures that each and every patient receives the care they deserve. Elevate operations to the next level of performance through detailed root cause and effect analysis, actionable reports, and recommended steps to decrease inefficiencies through enhanced service levels, decreased errors and increased patient satisfaction. Aspect Healthcare Unified IP plays a key role in the operations of a healthcare contact center. Organize agents based on their level of expertise and eliminate wasted opportunities to create superior patient experiences by reducing patient abandonment rates. As part of the Aspect Healthcare Unified IP solution, Unified Director makes it easy for supervisors to create detailed time studies to promote the use of DMAIC problem solving methodologies. Process improvement is more effective with real-time data. Aspect Healthcare - Patient Connect is purpose built to streamline patient interactions and experiences. Starting with their first call, patients have access to physicians at any location within your healthcare network. During interactions, employees are empowered with a 360-degree patient view that makes for an informed and productive conversation. Notes can be easily entered within the same patient record that is visible on their screen for capturing important information shared on the call. If your patient needs to be transferred to another clinician or specialist no problem. Easily view who is available before transferring the call (complete with notes), without needing to manually search directories for the correct extension. Confidently transfer the call to the right person with the right skill set who can efficiently handle the situation. Stop creating stress with your patients and perpetuating costly inefficiencies with lengthy wait times to transfer calls often to the wrong person or location. So Which Is It, The Chicken or the Egg? Healthcare contact centers must evolve to survive. Factors like the Affordable Care Act, operational improvements, and patient satisfaction will continually be key to maintaining a completive edge. Each of the three components operational workflows, technological innovations, and patient experiences are intricately intertwined. Operational workflows and technological innovations allow patients better access through efficient and engaged clinical practice. Patient satisfaction provides revenue, which in turn, supports operational and technological growth. Building a solid healthcare contact center doesn t have to be challenging. Aspect Healthcare solutions create an efficient, user-friendly way to build and maintain the competitive edge needed in today s healthcare marketplace. References Claxton, G., Levitt, L., Brodie, M., Garfield, R., & Damico, A. (2014, April 30). Measuring Changes in Insurance Coverage Under the Affordable Care Act. Retrieved June 3, 2015, from Effects of the Affordable Care Act on Health Insurance Coverage - Baseline Projections. (2015, March 9). Retrieved June 4, 2015, from Goguen, D. (2015). The Health Care Reform Bill: 10 Things to Know. Retrieved June 1, 2015, from Key Features of the Affordable Care Act By Year. (2015). Retrieved June 2, 2015, from timeline-text.html Levy, J. (2015). In U.S., Uninsured Rate Dips to 11.9% in First Quarter. Retrieved June 2, 2015, from poll/182348/uninsured-rate-dips-first-quarter.aspx Novack, J. (2014, October 7). Like It Or Not, Obamacare Is Reshaping The Healthcare Industry. Retrieved June 2, 2015, from

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