Influencing policy (training slides from Fast Track Impact)
Client services overview
1. Client Services
Presentation
Sample Accession: Pre- to Post- Sale
2. 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
3. Client Services Goals
1. Information Resource for Client
2. Approachable and Friendly Attitude
3. Exude Professionalism
4. Information Resource for Company on Client
Opinions and Comments
4. 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
5. Who is a Client for Genetic Testing?
• Genetic Counselor
• Physician
• Nurse Coordinator
• Laboratory / Sendout Coordinator
• Patient
The verbage for each client can be
dramatically different depending on
the situation.
7. 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.
8. 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
9. 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.
10. 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
11. Client Service Correspondence
• Phone
• Mail Correspondence
• Fax
• E-mail
The level and type of communication varies
dramatically and differently depending on
the medium used especially when
considering sensitive client information
12. 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
13. 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
14. 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
15. High Call Volume versus Growing Sales
Client Services Call Volume
400 • Depending on ongoing
350
interactions during the
year, call volume can
300 vary.
250 • Particular actions
200
performed one month
can reverberate
150 several months later
100 • Oscillations in call
volume should be
50
tracked, but not
0 misconstrued.
16. High Call Volume versus Growing Sales
Client Services Call Volume
400 • Depending on ongoing
350
interactions during the
year, call volume can
300 vary.
250 • Particular actions
Is this growing sales or just
a Client Services backlog?
200
performed one month
can reverberate
150 several months later
100 • Oscillations in call
volume should be
50
tracked, but not
0 misconstrued.
17. 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
18. 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
19. 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
20. 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
21. 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
27. 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?
28. Comparison of Customer type and
typical questions
Report Interpretation
Does not Complete
understand Comprehension
C a r d i o l o g i s t s Immunologists
Financial Concerns to Patients
Little Very Concerned
Concern
Immunologists Cardiologists
Beliefs in Genetic Testing and Clinical Outcome
No Belief Strongest Belief
Cardiologists Immunologists
29. Comparison of Customer type and
typical questions
Report Interpretation
Does not Complete
understand 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 genetics
Little Very Concerned
Concern an outcome, the physician
behind
knows to act in a very strong manner
Immunologists Cardiologists
Beliefs in Genetic Testing and Clinical Outcome
No Belief Strongest Belief
Cardiologists Immunologists
30. 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”
31. 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
32. 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
34. 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
35. 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
36. 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
37. Case Study AA09001828 – Pre-sale –
follow-through – financials – Insurance
Determination
38. 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 703-815-5441
Sample received on 3/18/2009
39. 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 02/12
After accession has been provided refer to
FULL accession only in ALL transactions
41. 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
42. 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
43. 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
44. 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.
45. 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
46. 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
47. AA09001711 – Physician Practice Hierarchy
Physician
Important that all
members be informed
of all on-going actions
Nurse Coordinator
Administrative Assistant
48. AA09001711 – Physician Practice Hierarchy
Client Services View
Nurse Coordinator Physician Administrative Assistant
In terms of Client Services, all members are equal
49. AA09001711 – Physician Practice Hierarchy
Client Services View
Nurse Coordinator Physician Administrative Assistant
1. Partial-to-Full Decision 1. Full decision maker 1. Limited Decision Maker
Maker 2. Extreme Time 2. No Time Restraints
2. Limited Time Restraints Restraints 3. No understanding of clinical
3. Decent understanding 3. Decent-to-Full versus genetic diagnosis
of clinical versus genetic understanding of
diagnosis clinical versus genetic
diagnosis
Client Services exploits each office member to their fullest
50. 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
52. AA09001711 – Sample Reception
- operation communications
• 2/9/2009 3:55 PM 0 minutes E-mail Attachment
Subject: Sample rec'd 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
53. 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
54. 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 name's 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
55. 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
56. AA09001711 – Sample Status Inquiries
• Patient’s health situation critical
• Numerous inquiries both by telephone and e-
mail about status of patient’s sample
57. AA09001711 – Sample Inquiry continued
• 2/24/2009 1:54 PM 0 minutes E-mail Sent
Subject: Correlagen Diagnostics: AA09001711
status
Hello 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
58. AA09001711 – Sample Inquiry continued
3/6/2009 12:05 PM 0 minutes E-mail
Attachment Subject: Correlagen Diagnostics:
AA09001711 status anything yet?? Edie
Edith A. Pacheco, RN
Lead Cardiology Nurse
Bluhm Cardiovascular Institute of Northwestern
Tel 312.695.1796
59. 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.
60. AA09001711 –
Preliminary Report e-mail
• 3/6/2009 1:20 PM 0 minutes E-mail Sent
Subject: Correlagen Diagnostics: AA09001711
status
Hello 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
61. 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 for
your review. The reference sheet has dynamic hyperlinks to the
respective PUBMED publications for your access.
Please feel free to contact me with any additional questions or
requests.
Sincerely,
-Al
63. 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
64. 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.
65. AA09001711 – family testing logistics
• 3/16/2009 4:02 PM 5 minutes Call Received
AA09001711 - family testing
• Call received from Lake County Coroner's 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
66. 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 genetics
laboratory service provider.
This e mail is confirmation that we have received your specimen(s) dated
3/18/09, 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 AA09001829.
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.
67. AA09001711 – report inquiry
• 3/26/2009 12:22 PM 0 minutes E-mail Attachment
Subject: Accession #: AA09001711
• Hi Al
We 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 the
patient's deceased mother or more results for the patient himself?
Thanks
AD
Angelene Delk
Administrative Assistant to Robert Bonow, MD
Bluhm Cardiovascular Institute of Northwestern
68. 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 patient
partial patient name. The initial report sent on March 9th, 2009 was the preliminary
report sent by the Medical Director due to the significance of the
variant found.
The sample of the patient’s mother is accession #AA09001829.
Please feel free to contact me if you have any additional questions.
Sincerely,
-Al
Al Gunduz | Manager, Immunology and Client Services | Correlagen
Diagnostics, Inc. | 781-647-0604 x261
69. 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
70. 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
71. 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
72. 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
73. 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
74. 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 given
13215 Hawkshead Court
St. Louis, MO 63131
• DOB date given
• UHC
• ID: 903631475
• Group: 714084
Subscriber: patient
• # 877-842-3210
• Providers Address: SLC, UT
75. 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 the
special forms specific to this family. I have provided insurance
coverage information to you for the first family member scheduled to
visit your office next week.
If you could please attach the following forms with her paperwork, this
will make the process smoother.
Please feel free to contact me if you have any additional questions or
requests.
Sincerely,
-All
76. 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.
77. 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
78. 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.
79. 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
80. AA09001829 – family testing
• 4/30/2009 9:53 AM 10 minutes Call Received
AA09001829 - family testing
• Call received with Gerri
• gburke@im.wustl.edui
• 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
81. 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
82. 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 patient
Sample received on 5/8/2009 for second sister
83. 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
87. 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