Client Services PresentationSample Accession: Pre- to Post- Sale
What is Client Services?• A correspondent who provides information and resources on genetic testing – Performed or Scheduled to be Performed• A correspondent between the client and the remainder of the company – Operations – Financial – Executive – Medical Director
Client Services Goals1. Information Resource for Client2. Approachable and Friendly Attitude3. Exude Professionalism4. Information Resource for Company on Client Opinions and Comments
Client Services Needs• Client Services needs to have: – CRM system • Allow for tracking of all communication systems – Communication Tools • Landline Phone • E-mail • Fax – Access to LIMS system • Determine where samples are – Access to Financial Services • Determine costs and insurance claim resolutions• It would be nearly impossible to perform Client Services virtually without all of these capabilities
Who is a Client for Genetic Testing?• Genetic Counselor• Physician• Nurse Coordinator• Laboratory / Sendout Coordinator• PatientThe verbage for each client can be dramatically different depending on the situation.
World-Class Service• “World-Class Service” is a potential model for Client Services to utilize in their operations.• "World Class Service" is a term which means that you anticipate the needs of your customers before they actually have the need. In order to do this, you must intensely study your customers and employees to see where a) your employees fail your customers, b) your services or products fail your customers, and c) how your customers change over time.• Only by having this knowledge can you create a business plan that completes the prerequisites of world class service.
World-Class Service Example #1 – Action – Reaction• Nurse Coordinators and phlembotomists often call Client Services to ask about blood draw tube type – Reason: paperwork containing information is in doctor’s office, not with nurse – Created small adhesive on inside of specimen kit which indicates draw tube type
World-Class Service Example #2 – Action – Reaction• Preliminary report explanation – preliminary reports still lack several amplicons – Issue: Nurse / Doctor understanding may be difficult because genetic testing is different from other clinical testing – Use Scratch Ticket analogy – unable to change information on ticket – and information given will not change – more time needed to fill in gaps.
World-Class Service Example #3 – Action – Reaction• Physician requests a genetic test which is not currently offered by the facility• Issue: Testing selection is not offered by facility• Provide information of potentially where test can be performed even if direct competitor – Client will view you as a resource plus provide information of what customer desires are
Client Service Correspondence • Phone • Mail Correspondence • Fax • E-mailThe level and type of communication varies dramatically and differently depending on the medium used especially when considering sensitive client information
Client Services and HIPAA• A goal of Client Services is to be resourceful• A goal of Client Services is to protect patient’s PHI• The nature of genetic testing involves the understanding of parental information at times
Client Services Do’s & Don’ts• Do: – Provide a resource for understanding genetic testing – even in cases where it may not directly help the company – Answer questions before even asked by clients• Don’t: – Provide results to the client directly • Possible interpretation issues may occur – Sell
How does Client Services help the company?• Interact with the customer in a resourceful manner• Provide information of correspondence to track trending of samples and comments – typically through a CRM• Provide input into operations how to efficiently handle samples – Flag important samples: STAT samples, Business Objective Samples, etc. – Flag lagging samples to possible finish or provide feedback
High Call Volume versus Growing Sales Client Services Call Volume400 • Depending on ongoing350 interactions during the year, call volume can300 vary.250 • Particular actions200 performed one month can reverberate150 several months later100 • Oscillations in call volume should be 50 tracked, but not 0 misconstrued.
High Call Volume versus Growing Sales Client Services Call Volume400 • Depending on ongoing350 interactions during the year, call volume can300 vary.250 • Particular actions Is this growing sales or just a Client Services backlog?200 performed one month can reverberate150 several months later100 • Oscillations in call volume should be 50 tracked, but not 0 misconstrued.
Importance of CRM• CRM provides cataloging of all Client Services action on day-to-day basis• Importance to log all information, however banal, with understanding that message would be read 3-18 months later by another party.• Importance for Management to establish uniform tracking method for all Client Services members to adhere – very high “learning curve”• CRM provides “10,000 ft” view of operations through dashboards and other indicators – Importance of management to utilize and exploit CRM system to its fullest
CRM Primer• CRM is a tool which provides organization to the Client Services representative by logging every correspondence – e-mail, phone, fax into the system• Typically CRM is a shell program towards the e- mail system, so manual integration is crucial• Faxes should be scanned in, then attached and cataloged into the system• Every phone conversation must be logged in and a fair representation of time spent should be performed
How did that phone call take 10 minutes?• Scenario: Call received from nurse, unsure of ordering physician identity, needs report• Receive call: Identify nurse from particular hospital, identifies patient, identifies needs report sent to particular fax number – this is physically done on scratch paper• Post call: Using patient name, identify original ordering physician on order form, log information, print report, print appropriate cover sheet
How did that phone call take 10 minutes? continued• Phone call: 3 minutes• Post-phone call CRM activities: 4 minutes – Look at patient documents – Identify doctor – Find doctor entry in CRM – Log phone call into CRM• Post-phone call: 3 minutes – Print report – Print coversheet – Send fax – Confirm fax reception
Understanding Your Customer• Keeping with “World-Class Service”, understanding your customer is tantamount to anticipating their desires.• Although stereotyping may be considered crude, it helps follow a heuristic about what concerns a customer may have.• Currently, Client Services faces two types of customers Cardiologist and Immunologists which have stark contrasts in their interactions.• Understanding customer desires and worries and acting BEFORE it happens makes for good Client Services
Typical Suburban Cardiology Practice Appointed LeaderStaff Physicians(Decision Makers)Nurse Coordinators
Types of Questions answered in Client Services• Technical Background Questions – How is my sample processed?• Sample Completion Issues – Where is my sample?• Financial Issues – How much will this cost me?• Logistics Issues – How do I provide a sample for testing?• Report Interpretation Issues – What does this on the report mean?• Report Feedback Issues – How do I act accordingly with the results given?
Comparison of Customer type and typical questions Report InterpretationDoes not Completeunderstand Comprehension C a r d i o l o g i s t s Immunologists Financial Concerns to PatientsLittle Very ConcernedConcern Immunologists Cardiologists Beliefs in Genetic Testing and Clinical OutcomeNo Belief Strongest Belief Cardiologists Immunologists
Comparison of Customer type and typical questions Report InterpretationDoes not Completeunderstand Comprehension C a r d i o l o g i s t s Immunologists Even if an immunologist does not Patients Financial Concerns to completely understands the geneticsLittle Very ConcernedConcern an outcome, the physician behind knows to act in a very strong manner Immunologists Cardiologists Beliefs in Genetic Testing and Clinical OutcomeNo Belief Strongest Belief Cardiologists Immunologists
Case Study AA09001828• New Physician to ordering Genetic Testing• Consider ordering Wiskott-Aldrich Syndrome testing (Immunology)• Briefly mentioned extensive history treating patient – see as next step in determine best course of treatment• Using this example because somewhat good flow with few “hiccups”
Case Study AA09001828 – Initiation – CRM Log• 2/26/2009 11:13 AM 10 minutes• Call Received WAS Testing• Call received from Lab Tech Gerry Linden• understands needs 2-ml EDTA tube of blood• understands can pre-qualify patient from before• understands sending specimen kit to Alexandria office• confirmed location of alexandria office• works for Robert Dobrzynski• 17 yM WAS• needs kit on Monday• send specimen kit to 5226 Dawes Avenue, Alexandria, VA 22311
Case Study AA09001828 – Initiation – continued• Goal is to understand situation – New Physician possibly ordering WAS test• Determine who is calling – Gerry Linden• Determine what is role of person calling – Lab Tech / Nurse Coordinator• Determine next action items to work on – Send specimen kit to confirmed address
Case Study AA09001828 – Website Snapshot – continued• Based in Northern Virginia area• Three practices• Four Physicians• Not accustomed to ordering genetic testing• Not a “Center of Excellence” location
Case Study AA09001828 – Pre-sale – follow-through – CRM Log• 3/4/2009 3:27 PM 5 minutes Call Received WAS Testing• Call received from Gerry• indicated that will be sending paperwork with patients• will draw patient on Tuesday
Case Study AA09001828 – Pre-sale – follow-through - financials – CRM Log• 3/4/2009 4:17 PM 10 minutes• Call Received WAS testing• Call received from mother of patient name given• 703-815-3561• Patient name given• DOB: 4/23/1991• AETNA ID: W1201 43172• Group: 630891-10000• Providers # 888-802-3862• PO Box 9612804 El Paso, TX• will call back mother
Case Study AA09001828 – Pre-sale –follow-through – financials – Insurance Determination
Case Study AA09001828 – Pre-sale – financials – Insurance Determination – follow-up• 3/4/2009 5:06 PM 10 minutes• Call Completed WAS Testing• Spoke with Mother name given• send pre-auth info to Home Fax• Fax 703-815-5441Sample received on 3/18/2009
Case Study AA09001828 – Pre-sale – financials – Final Issue• 3/23/2009 1:21 PM 10 minutes• Call Completed• AA09001828 - billing issue Spoke with mother of patient• took CC information• VISA XXXX 1548 exp 02/12After accession has been provided refer to FULL accession only in ALL transactions
Case Study AA09001828 – Report Release• Report released on 4/26/2009• 1 Disease-causing published variant found• Need to provide list of references in relation to disease variant
Case Study AA09001828 – Report Release – follow-up• 4/27/2009 2:48 PM 10 minutes• Call Completed AA09001828 - report - follow-up• Spoke with receptionist• transferred to Dr. Dobrzynski receptionist• Spoke to receptionist• possibly speak with Dr. Dobrzynski• spoke with Dr. Dobrzynski• BPDobrzynski@hotmail.com
Case Study AA09001828 – Report Release – follow-up - continued• Goal is to follow-up with Doctor• Provide Medical Director direct line to physician directly – Indicated to Doctor that Medical Director can follow- up with any questions• Provide list of variants which have been published – Direct links to Pubmed• There is never a discussion about the results of the report
Case Study AA09001828 – Report Release – follow-up - continued• 4/28/2009 10:56 AM 10 minutes• Call Completed• AA09001828 - report - follow-up• Spoke to receptionist• transferred to Gerry Linden• << on hold for some time >>• spoke with Gerry• asked to send results to patient immediately.
Case Study AA09001828 – Timeline• Took 44 days from initial inquiry to final follow-up• Not continuous work – need to take diligent notes to ensure continuity in process
Case Study - AA09001711• Experienced Cardiologist with prior ordering history of genetic testing – Robert Bonow• Physician is in Chicago area• Cardiologist works closely with Nurse Coordinator Edith and Administrative Assistant Angela• Cardiologist’s group utilizes e-mail extensively• Example of Index and Respective Family Testing
AA09001711 – Physician Practice Hierarchy Physician Important that all members be informed of all on-going actions Nurse Coordinator Administrative Assistant
AA09001711 – Physician Practice Hierarchy Client Services ViewNurse Coordinator Physician Administrative AssistantIn terms of Client Services, all members are equal
AA09001711 – Physician Practice Hierarchy Client Services ViewNurse Coordinator Physician Administrative Assistant1. Partial-to-Full Decision 1. Full decision maker 1. Limited Decision Maker Maker 2. Extreme Time 2. No Time Restraints2. Limited Time Restraints Restraints 3. No understanding of clinical3. Decent understanding 3. Decent-to-Full versus genetic diagnosis of clinical versus genetic understanding of diagnosis clinical versus genetic diagnosisClient Services exploits each office member to their fullest
Case Study – AA09001711• Index Patient is located some distance from physician’s office• Patient has several clinical issues to warrant genetic testing for greater understanding• Patient’s mother recently passed away
Limited Family PedigreeAA09001966 AA09001963 AA09001829 AA09001711 (index)
AA09001711 – Sample Reception - operation communications• 2/9/2009 3:55 PM 0 minutes E-mail Attachment Subject: Sample recd today• Hi Al,• Please contact Dr. Bonow’s office regarding index patient name , DOB: 6/12/76.• Dr. B. checked off reflexive test, 190350, and kinda marked the PRKAG2 and LAMP2 genes (so perhaps he also wants the metabolic panel?).• Please confirm by phone or e-mail.• Thanks!• Liz
AA09001711 – Sample Reception• Sample received from Dr. Bonow on 2/9/2009• Communication received from operations during in-processing procedure• Needed to verify testing information before entered into LIMS system• Critical information (verify test code) otherwise problems for LIMS system• Client Services can inquire about issue directly or provide information to salesperson to provide scenario for more sales and client interaction
AA09001711 - Payment Issue – Salesperson notes• 2/12/2009 11:54 AM• Dr. Bonow will speak with the family name family about the $2000 deductible and he or they will call me back. Dr. Bonow indicates the family is particularly concerned with young patient names sister and assumes they will pay if needed. Also, the test code Dr. Bonow wants for patient name is 190350. Bonow is very happy with CRLG
AA09001711 – Payment Issues• Salesperson spoke with patient on 2/12/2009• Communicated with Client Services that patient understands payment responsibilities• Sample initiated by Client Services on 2/12/2009• Turn-Around Time Clock initiated by LIMS system
AA09001711 – Sample Status Inquiries• Patient’s health situation critical• Numerous inquiries both by telephone and e- mail about status of patient’s sample
AA09001711 – Sample Inquiry continued• 2/24/2009 1:54 PM 0 minutes E-mail Sent Subject: Correlagen Diagnostics: AA09001711 statusHello Edith-In regards to patient blinded patient name, there are seven remaining amplicons of the 113 performed. I anticipate the report should be released to you by the beginning of next week.Please feel free to contact me with any additional questions.Sincerely,-Al
AA09001711 – Sample Inquiry continued3/6/2009 12:05 PM 0 minutes E-mail Attachment Subject: Correlagen Diagnostics: AA09001711 status anything yet?? EdieEdith A. Pacheco, RNLead Cardiology NurseBluhm Cardiovascular Institute of NorthwesternTel 312.695.1796
AA09001711 – Preliminary Report Release• In process of sample analysis, critical mutation found in gene analysis to warrant early preliminary report to raise caution to ordering physician.• Understanding must be provided to all that final report to add to preliminary report, but will not change outcome most likely.
AA09001711 – Preliminary Report e-mail• 3/6/2009 1:20 PM 0 minutes E-mail Sent Subject: Correlagen Diagnostics: AA09001711 statusHello Edith-I have a preliminary report today which I will send to you immediately to your (312) 695-1434 number. I anticipate the remainder should be available next week.Sincerely,-Al• Same e-mail sent to all three members of physician team
AA09001711 – preliminary report – related references• 3/9/2009 2:44 PM 0 minutes E-mail Sent Subject: Correlagen Diagnostics: AA09001711: TNNT2 c.487 References Dear Dr. Bonow-As per request of Edith Pacheco, please find enclosed references foryour review. The reference sheet has dynamic hyperlinks to therespective PUBMED publications for your access.Please feel free to contact me with any additional questions orrequests.Sincerely,-Al
AA09001711 – related references - comments• Acrobat document which has list of references which have direct access to Hyperlinked PUBMED references per variant found• Provides a higher lever of understanding for physicians to instantly research publically available literature• Document is not specific to patient• Document is specific to references in literature only – no internal data (blinded or not blinded) is provided
AA09001711 – preliminary report – Action-Reaction• 3/9/2009 1:14 PM 10 minutes Call Received AA09001711 - family testing• Call received from Edith Pacheco• indicated mother of patient has deceased from possible HCM - however unsure• needs to know if perform testing on deceased human tissue or blood• will provide blood from deceased• Salesperson will provide special family pricing to all members• Edith to make several photocopies of requisition forms for family distribution.
AA09001711 – family testing logistics• 3/16/2009 4:02 PM 5 minutes Call Received AA09001711 - family testing• Call received from Lake County Coroners Office Deputy officer name• 847-377-2200• mentioned had whole blood - frozen blood - collected in plastic vial - sodium fluoride as preservative –• prevent clotting• has multiple DNA standard cards• would be able to provide some blood
AA09001711 – family sample reception• 3/18/2009 2:50 PM 0 minutes E-mail Sent Subject: Correlagen Diagnostics: partial patient name Dear Dr. Bonow-Thank you for choosing Correlagen Diagnostics as your geneticslaboratory service provider.This e mail is confirmation that we have received your specimen(s) dated3/18/09, and we are in the process of reviewing the documentation andspecimen as instructed. We will contact you immediately in the event weare missing any required documentation or if the sample provided is notadequate for testing. The corresponding accession number given to yourblood sample is AA09001829.Please feel free to call our Client Services Manager, Al Gunduz, at781-647-0604 x261 with any additional information you may need orquestions you might have.
AA09001711 – report inquiry• 3/26/2009 12:22 PM 0 minutes E-mail Attachment Subject: Accession #: AA09001711• Hi AlWe received a fax copy of the genetic report for accession # AA09001711.Dr. Bonow would like to know if this result really is the result of thepatients deceased mother or more results for the patient himself?ThanksADAngelene DelkAdministrative Assistant to Robert Bonow, MDBluhm Cardiovascular Institute of Northwestern
AA09001711 – report inquiry - response• 3/26/2009 12:33 PM 0 minutes E-mail Sent Subject: Accession #: AA09001711• Good Morning Angelene-The patient report that arrived yesterday is the final report to patientpartial patient name. The initial report sent on March 9th, 2009 was the preliminaryreport sent by the Medical Director due to the significance of thevariant found.The sample of the patient’s mother is accession #AA09001829.Please feel free to contact me if you have any additional questions.Sincerely,-AlAl Gunduz | Manager, Immunology and Client Services | CorrelagenDiagnostics, Inc. | 781-647-0604 x261
AA09001829 – logistics background• Patient AA09001829 is deceased and does not have effective insurance coverage• Issue of sample testing payment is in question• Initially determine from insurance of deceased that if coverage possible• Learned coverage termed at date of death
AA09001829 – payment inquiry• 4/13/2009 1:04 PM 10 minutes Call Received• AA09001829 - payment issue• Received call from son of patient (AA09001711)indicated no coverage for patient• offered $100.00 deal• provided M/C XXXX 2973 exp
AA09001829 – family testing• 4/28/2009 9:19 AM 10 minutes• AA09001829 - family testing• Call received from patient name given• sister of AA09001829• left VM• provided phone 847-212-5166
AA09001829 – family testing – further inquiry• 4/28/2009 9:56 AM 15 minutes• Call Received AA09001829 - family testing• Call received from patient full name given• sister of AA09001828• DOB date given• BC/BS NY• ID EQP80090655• Group 294572A11• # 800-582-4489• PO Box 5009, Middletown, Ny• Husband name with different surname given
AA09001829 – testing logistics• Call received from Nurse Edith• Indicated wanted to simplify paperwork• Indicated to Edith will provide specialized paperwork specific to this family’s variant only.• Sent 3 Specimen Kits with specialized paperwork
AA09001829 – family testing – other sister• 4/28/2009 12:48 PM 15 minutes Call Received AA09001892 - family testing• Call received from patient ‘s sister• 314-469-5922• not aware of results for AA09001892 - DOE 1/31/2009• provided address• Patient name given13215 Hawkshead CourtSt. Louis, MO 63131• DOB date given• UHC• ID: 903631475• Group: 714084Subscriber: patient• # 877-842-3210• Providers Address: SLC, UT
AA09001829 – family testing e-mail• 4/28/2009 5:28 PM 0 minutes E-mail Sent Subject: Correlagen Diagnostics: AA09001829 - family testing• Hello Edith-The first two family members have contacted me about family testing.You should received the package I sent tomorrow (if not today) with thespecial forms specific to this family. I have provided insurancecoverage information to you for the first family member scheduled tovisit your office next week.If you could please attach the following forms with her paperwork, thiswill make the process smoother.Please feel free to contact me if you have any additional questions orrequests.Sincerely,-All
AA09001966 family testing – – receipt e-mail• 5/12/2009 2:55 PM 0 minutes E-mail Sent Subject: Correlagen Diagnostics: Jan R. sample received Dear Ms. Pacheco-• Thank you for choosing Correlagen Diagnostics as your genetics• laboratory service provider.• This e mail is confirmation that we have received your specimen(s) dated• 5/12/2009, and we are in the process of reviewing the documentation and• specimen as instructed. We will contact you immediately in the event we• are missing any required documentation or if the sample provided is not• adequate for testing. The corresponding accession number given to your• blood sample is AA09001966.• Please feel free to call our Client Services Manager, Al Gunduz, at• 781-647-0604 x261 with any additional information you may need or• questions you might have.
AA09001829 – family testing• 4/28/2009 12:48 PM 15 minutes Call Received AA09001892 - family testing• Call received from patient other sister• Home phone number• not aware of results for AA09001892 - DOE 1/31/2009• provided address• provided insurance information• Indicated will be going to physician not in Chicago area
AA09001829 – family testing• 4/29/2009 3:22 PM 10 minutes Call Completed• AA09001829 - request to share information• Spoke to Angie Delk (coordinator of Chicago physician)• indicated okay to share results with patient• will send e-mail confirming this.
AA09001829 – family testing• 4/29/2009 3:28 PM 10 minutes Call Completed AA09001829 - family test• Spoke to receptionist Laurie• indicated nurse to contact me• fax send to 314-996-3268• ATTN: Dr. Mankowitz - nurse Gerri / Lisa
AA09001829 – family testing• 4/30/2009 9:53 AM 10 minutes Call Received AA09001829 - family testing• Call received with Gerri• email@example.com• ndicated to send list of references• indicated that patient has specimen kit & pre- paid mailer• provided contact information• send list of references to Dr. Mankowitz and Gerri Burke
AA09001829 – family testing• 4/30/2009 10:10 AM 0 minutes E-mail Attachment Subject: Correlagen Diagnostics: AA09001829 / AA09001711 - related references• Good Morning Gerri-• It was excellent speaking with you this morning about your patient Second sister . Please find attached references in regards to this variant.• The references are interactive in that they automatically link to the• corresponding PUBMED webpage to review each publication independently.• Please feel free to contact me with any additional questions or requests• on this matter.• Sincerely,• -Al
AA09001829 – family testing• 4/30/2009 3:40 PM 0 minutes E-mail Attachment Subject: Correlagen Diagnostics: AA09001829 / AA09001711 - related references Thanks• The sister, my patient will be coming in for a gene study.• I would like to test her for the same gene.• Can you please send us the paperwork and tell us how much it will cost the patientSample received on 5/8/2009 for second sister
AA09001963 – family testing• 5/12/2009 10:30 AM 10 minutes Call Completed AA09001963 - family testing - 314-469-5922• Spoke to patient• not to be billed to insurance• VISA XXXX 6812 exp 07/11• final $100.00
Limited Family PedigreeAA09001966 AA09001963 AA09001829 AA09001711 (index)
Correspondence Count• Number of Correspondences (phone, e- mail, fax) with each particular accession – AA09001711 (index): 97 – AA09001829: 158 – AA09001963: 11+ – AA09001963: 18+• Total as of 5/21/2009 for this family: 284