IBM and Cincom: Guiding Smarter Interactions in Healthcare Reform

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  • 1. Cincom® Synchrony™Guiding Smarter Interactionsin Healthcare ReformIBM and Cincom Systems Address the Challenges of CustomerExperience in the New Healthcare ReformCommentary by Harry Reynolds, IBM
  • 2. United States healthcare reform legislation is a subject of considerable debate and confusion. Pundits on the right and left continue to argue about the potential implications and whether or not parts and pieces of the legislation should be repealed altogether. Uncertainty abounds, but most agree that whatever the outcome, new reform legislation will inevitably change the business of healthcare as we know it. What will be the impact to health insurance providers when the dust settles? No one knows for sure, but it is clear that insurers must be prepared for significant changes in the way they do business. This paper explores three of the most important aspects to consider—Medical Home, Accountable Care and Global Payments—and suggests steps to bolster information systems using Cincom Synchrony in order to adequately respond to evolving legislative and market demands.Guiding Smarter Interactions in Healthcare Reform 1/18
  • 3. Change Is Coming “We’ve got standards, policies, technologies and The concepts of patient-centered Medical Home, Accountable processes that never before Care and Global Payments are three key areas that will have a have converged into this powerful impact on the healthcare industry, says Harry Reynolds, industry at a time when all the Director of Health Industry Transformation for IBM. Reynolds, these regulations and the a respected industry veteran who knows the health insurance rising cost of healthcare business inside and out and spent over 30 years with Blue Cross have forced people to listen Blue Shield of North Carolina before joining IBM as Chairman of and react.” the Council for Affordable Quality Healthcare initiative. He currently - Harry Reynolds, the serves on the National Committee on Vital and Health Statistics. Director of Health Industry Transformation for IBM “I spend a lot of time with payers and providers, and whether or not you are on this side or that side of the debate, change is going to happen,” says Reynolds. “Medical Home is one example of that change. The focus is on providing care holistically and all the incentives are built to encourage that the information flows seamlessly amongst the professionals involved. Providers and organizations will be expected to work proactively together to ensure that the patient has a more unified experience.”Guiding Smarter Interactions in Healthcare Reform 2/18
  • 4. According to Reynolds, the concept of Accountable Care is another important aspect of new legislation to consider. “If you go one step past Medical Home, you start having an entire organization being held accountable for all the patients that they see. Proposed legislation stipulates seamless delivery of high-quality care for Medicare beneficiaries and the scope includes group practices, hospitals and hospitals in partnership with those practices. The activities of hospitals, doctors and insurers will be viewed together; whereas today they are most often regarded separately.” Hear Harry Reynolds live on Expert Access Radio Reform legislation is also poised to change the current payment structure for hospitals and providers and, according to Reynolds, this will be a significant change from the status quo. “Going forward, there will be one payment, usually to the hospital, that will be split amongst the practitioners and organizations involved,” says Reynolds. “The new legislation also stipulates that if a patient leaves a hospital and is readmitted for that same reason within 30 days it will be the responsibility of the hospital to cover that additional expense; the government won’t pay for it again.”Guiding Smarter Interactions in Healthcare Reform 3/18
  • 5. Improving Care, Reducing Costs Healthcare reform legislation is focused on improving care and reducing costs. Insurance and healthcare companies can respond to the implications in two ways: with great efficiency or with great inefficiency. Understanding the following will have a direct bearing on your ability to navigate the transition. Medical Home The concept of the patient-centered Medical Home model is an approach to providing comprehensive primary care that facilitates partnerships between patients and medical providers. The aim of the Medical Home model is to improve access to care, increase patient satisfaction with the care received and ultimately, improve the health of patients. The idea behind legislation is that every American should have a “personal Medical Home” through which to receive services and that those services should be “accessible, accountable, comprehensive, integrated, patient-centered and satisfying to both patients and their physicians.”Guiding Smarter Interactions in Healthcare Reform 4/18
  • 6. With the current economic challenges facing the United States, it is easy to see why the move to a patient-centered Medical Home approach has become a cornerstone to new legislation. One study estimated that if recommendations were followed, healthcare costs would likely decrease by 5.6%, resulting in a national savings of $67 billion dollars per year. Indeed, in 2006—before healthcare reform stepped into the national spotlight—industry leaders including IBM and others started the Patient-Centered Primary Care Collaborative to promote the Medical Home model. Membership includes some 500 large employers, insurers, consumer groups and doctors. Accountable Care On March 31, 2011, the Department of Health and Human Services released proposed rules to help doctors, hospitals and other providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). The goal of an ACO is to deliver seamless, high-quality care for Medicare beneficiaries, and incentives are designed to encourage healthcare providers to work together to treat an individual patient across care settings—including doctors’ offices, hospitals and long-term care facilities.Guiding Smarter Interactions in Healthcare Reform 5/18
  • 7. The Medicare Shared Savings Program will reward ACOs that Improving coordination lower growth in healthcare costs while meeting performance and communication standards on quality of care and putting patients first. through Accountable Care Organizations will help Experts estimate that more than 50% of Medicare beneficiaries have improve the care Medicare multiple chronic conditions such as diabetes, arthritis, hypertension beneficiaries receive, while and kidney disease. As a result, these patients often receive care also helping to lower costs; from multiple physicians. A failure to coordinate care can often Medicare could potentially lead to patients not getting the care they need, duplicative care save as much as $960 million and increased risk of medical errors. Improving coordination and over three years. communication through ACOs will help improve the care Medicare beneficiaries receive while also helping to lower costs; Medicare could potentially save as much as $960 million over three years. Global Payments Healthcare-reform legislation calls for a Global Payment system with significant incentives to encourage more holistic patient care. The idea is to encourage more careful coordination and collaboration between a patient’s physicians, nurses, hospitalsGuiding Smarter Interactions in Healthcare Reform 6/18
  • 8. and other care providers. Section 2705 of the Patient Protection Experts say that an emphasis and Affordable Care Act is intended to further states’ efforts to on patient-centered medicine, shift from the current Medicaid fee-for-service payment structure with doctors and other to a global, capitated payment model. providers providing better coordination of information Experts say that an emphasis on patient-centered medicine, and services, will help to with doctors and other providers providing better coordination reduce healthcare costs of information and services, will help to reduce healthcare costs while providing more while providing more effective care for patients. Providers would effective care for patients. receive payment that is adjusted for patients’ health statuses and it would be based on meeting common core performance measures to ensure high-quality care. Legislation calls for a careful transition to global payment within five years, during which “shared savings” would serve as an interim payment model to help providers become more familiar with global payment with reduced exposure to risk.Guiding Smarter Interactions in Healthcare Reform 7/18
  • 9. Cincom Synchrony—Optimize Interactions with Unified Information Healthcare reform is quickly changing the industry. The concepts of Medical Home, Accountable Care and Global Payments will require that companies foster more seamless and personalized interactions across patients, providers and payers while adhering to an incentive-based mandate to reduce costs and improve care. Cincom Synchrony offers an innovative, cost-efficient way to overcome the challenges of healthcare reform. It guides smarter interactions with patients, providers and payers, and leverages the insight a company has about each patient or member in the context of each interaction. Supported by a robust and highly flexible platform of IBM technologies, Synchrony is a powerful software application specifically designed to help customer care centers in healthcare provide smarter, streamlined experiences across complex, cross-channel interactions that utilize multiple back-end applications. The centerpiece of the solution is real-time Intelligent Guidance that automatically displays the information you need no matter the activity or the application.Guiding Smarter Interactions in Healthcare Reform 8/18
  • 10. By combining real-time Intelligent Guidance, Synchrony allows Cincom Synchrony offers an you to focus on the patient or member experience instead of innovative, cost-efficient way spending time on labor-intensive internal processes such as to overcome the challenges customer look-ups, interaction history or content research. It of healthcare reform. has also been developed to work with the healthcare-specific components of the IBM Health Integration Framework, so you can expect high reliability. Depending on the type of interaction, Synchrony retrieves and presents critical information, pulling it from any back-end source. You can see the patient or member’s entire interaction history. After every customer response, Synchrony identifies the next step in the process, providing context-specific language and interaction guidance. This is critical in standardizing interactions across departments.Guiding Smarter Interactions in Healthcare Reform 9/18
  • 11. Respond to Legislative Demands IBM ISV & Developer Relations Healthcare Solution Brief Cincom and IBM: guiding smarter interactions Enabling provider and payer customer care centers to optimize interactions with real-time intelligent guidance and a dynamic, unified information view Synchrony helps you respond and adapt to the new legislative Highlights: In an increasingly competitive and quickly changing industry, providers and payers face a stark new reality – today’s customers expect an efficient, personalized, high-quality experience every time they connect with a healthcare organization. At the same models brought about by the transition to Medical Home, time, providers and payers have an ongoing mandate to manage costs, improve productivity and increase revenue. Cincom Synchrony offers an innovative, cost-efficient way to overcome this challenge. Supported by a robust and highly flexible platform of IBM technologies, Synchrony is a powerful software application specifically designed to help customer care centers in healthcare Accountable Care and Global Payments systems. Some of the provide smarter, streamlined experiences that deliver intended results, even for complex, cross-channel interactions that utilize multiple back-end applications. The centerpiece of the solution is real-time intelligent guidance that automatically displays the information employees need and directs them to give every customer individual attention. capabilities of Cincom Synchrony include: Solution overview Healthcare providers and payers are working hard to improve the industry’s customer experience rankings, but the obstacles are considerable. Hiring, training and supervising customer-facing employees are costly. At the desktop level, agents and other customer care representatives are dealing with unprecedented complexity, from the technology they use, to the processes they follow, to the issues they are expected to resolve. Synchrony is a smarter solution. Combining real-time intelligent guidance, a customer-centric desktop and interaction automation, Synchrony allows employees to focus on the patient or member Real-time Intelligent Guidance – This is a key feature of Synchrony experience instead of spending time on labor-intensive internal processes such as customer look-ups, interaction history or content research. It has also been developed to work with the healthcare- specific components of the IBM Health Integration Framework, so users can expect high reliability. that will help you respond to the demands of seamless data access and communication across channels and data repositories. Cincom and IBM Solutions Brief (PDF) Intelligent Guidance easily surpasses conventional scripting and walks you through every step of even the most complicated interactions based on the context of the interaction. All of this happens automatically in real time, insulating personnel from the mundane tasks that can compromise the flow of information and the quality of the experience. This enables multi-tiered interactions where non-medical personnel are now able to provide triage-level interactions, such as reminding a patient to take medicine. Single, holistic customer view – Medical Home, Accountable Care and Global Payments all require a holistic and unified view of patient and member information. The Synchrony unified desktop isGuiding Smarter Interactions in Healthcare Reform 10/18
  • 12. a web-based interface that instantly presents the right information and resources for a specific patient or member. It provides a single view of data from multiple information systems, including CRM, HIM, patient management, billing, EMR/EHR and other supporting applications. Information is presented in a clean, tab-driven format that adjusts dynamically so you never have to toggle back and forth among multiple windows. Seamless, cross-channel continuity – Today’s hyperlinked business environment combined with the demands of healthcare reform will require companies to have more continuity across multiple channels of communication. The Synchrony desktop offers a single interface for all customer interaction channels, including phone, e-mail, IM/chat, fax and the web. During every interaction, you can see the patient or member’s complete contact history. Synchrony uses this history to guide the current interaction and ensures a seamless, continuous experience no matter what touch points are used.Guiding Smarter Interactions in Healthcare Reform 11/18
  • 13. Personalized, success-based routing – Synchrony tracks the results of every interaction, prompts and escalates follow-up actions and automatically generates personalized correspondence and documents. It can be configured to route incoming calls based on the success rates of individual employees in handling the type of call, the patient or member’s demographic information and the employee’s previous outcomes with similar customers. “Decisions are not going to get easier,” says Reynolds. “More complex decisions are going to need to be guided through to a resolution. This guidance will need to be personalized and across all channels.” Meet Healthcare Reform Goals U.S. healthcare reform is all about improving care while reducing costs. Synchrony allows you to do both while strengthening patient, provider and payer relationships.Guiding Smarter Interactions in Healthcare Reform 12/18
  • 14. Higher-quality care – With Synchrony, healthcare providers can A Complex Care Case “As customer service increasingly becomes a differentiating factor between healthcare facilities, Industry Profile: Healthcare ensure that patients receive the right care, whether they are calling consumers expect a more customer-centric experience or likely will take their business elsewhere.” – The Beryl Institute The healthcare industry is Guiding Smarter Interactions undergoing massive transformation in Healthcare to schedule an appointment or to inquire about test results. around the globe. From a customer-care perspective, consumers are demanding more control over their own health, and there is a growing awareness of risks and adverse events with higher expectations of care and service quality. But while expectations are Synchrony also enables patients to take a more proactive role rising, the industry lags in “customer service.” Addressing the Balancing Act While understanding the need to deliver better patient experiences, healthcare organizations from both the provider and payer sides are in their own care, which can help identify serious conditions also challenged to manage operational costs and increase productivity and/or revenue. In reality, you don’t have to sacrifice one of these objectives for another. Cincom® Synchrony™ is a flexible technology platform for contact earlier. Synchrony enables providers to acquire and retain the centers that enables healthcare organizations to deliver better experiences; drive up productivity, efficiency and revenue while also lowering costs and training. Cincom Synchrony and IBM for the Healthcare Industry Some of Life’s Most Memorable Moments Happen best patients and reduce errors that can delay reimbursement. IBM’s Healthcare Industry Framework in a Healthcare Setting provides healthcare-specific software, solution accelerators and best Some of these moments are joyful, while some may be extraordinarily practices to help you reduce costs painful. How can you make each experience the best it can be? For and manage risk while delivering an healthcare contact centers, the people you place on the end of every outstanding customer experience. telephone call, e-mail or web chat—and the quality of the technology Cincom Synchrony is validated in this they rely on—are instrumental in delivering patient/member framework to guide customer-facing experiences that are compassionate, personal, private and accurate. employees to deliver smarter interactions and experiences. “A phone call is often the first point of contact and thus, can be the most important.” Reduce the cost of care – By increasing member accountability – Paul Spiegelman, executive director of The Beryl Institute and facilitating proactive care, Synchrony helps reduce claims View Guiding Smarter Interactions in Healthcare (PDF) and patient re-admittance. Synchrony also reduces the cost of employee training and streamlines the entire process to reduce the total cost of claim processing and payment. Insurers and other payers can use Synchrony to turn high-quality member service into a differentiating competitive advantage.Guiding Smarter Interactions in Healthcare Reform 13/18
  • 15. Moving Forward with Cincom Synchrony The cost of doing nothing could be great, and now Clearly, healthcare reform will have a number of major impacts in is the time to react in order the health insurance industry, not least of which will be the impacts to be prepared for the of Medical Home, Accountable Care and Global Payments. many changes on the According to IBM’s Harry Reynolds, now is the time to move legislative horizon. forward regardless of the debates and pending repeals on Capital Hill. “Eighty percent of what should happen is going to happen whether or not the whole thing gets turned upside down or inside out,” says Reynolds. “We’ve got standards, policies, technologies and processes that never before have converged into this industry at a time when all these regulations and the rising cost of healthcare have forced people to listen and react.”Guiding Smarter Interactions in Healthcare Reform 14/18
  • 16. Indeed, the cost of doing nothing could be great, and now is the time to react in order to be prepared for the many changes on the legislative horizon. Contact us today to learn more about how Cincom Synchrony can help you implement a well-planned and holistic approach to managing member and patient information across multitude channels and repositories in order to be prepared for the changing regulatory and market demands resulting from healthcare reform. Brian Flagg, Account Executive 55 Merchant Street Cincinnati, OH 45246 bflagg@cincom.com www.synchrony.cincom.comGuiding Smarter Interactions in Healthcare Reform 15/18
  • 17. About Cincom Share This: Cincom recognizes that it is your people—your customer-facing Email employees—who represent your brand. And in each interaction, it LinkedIn is the experience that they deliver to your customers that either Twitter builds value for your brand or destroys it. It is a powerful role to play. Facebook Cincoms Customer Experience Management initiative is focused on helping companies and their employees consistently deliver experiences that not only build your brand, but are valuable to both your customers and your organization. Cincom does this through its Synchrony offering that guides employees to deliver smarter interactions. Since 1968, Cincom has helped thousands of clients worldwide by solving complex business problems with its software and services. Cincom is an IBM Premier Business Partner and has been integrating IBM technologies and leveraging IBM services for over 40 years.Guiding Smarter Interactions in Healthcare Reform 16/18
  • 18. Will she build your brand or destroy it? Every customer touch with the contact center is a test of your brand and your promise to the customer—and the stakes are high. A recent study shows that 87% of customers stopped doing business with a company after a bad customer experience. When a customer picks up the phone, your agent is the brand and possibly the only human voice that customer will experience with your business. It pays to make that experience great. Learn the seven categories to consider when evaluating an effective agent desktop—and who ranked as a “hot vendor”—in the Ventana Research Value Index for Customer Experience Manage- ment: Agent Desktop 2011. Download your FREE summary of this independent report at www.cincom.com/agentdesktop http://smarterinteractions.cincom.com © 2011 Cincom Systems, Inc. All Rights ReservedGuiding Smarter Interactions in Healthcare Reform 17/18
  • 19. © 2011, 2012 Cincom Systems, Inc. All Rights Reserved Developed in the U.S.A. FORM CMUS1201003-1 12/11 CINCOM, the Quadrant Logo and Synchrony are trademarks or registered trademarks of Cincom Systems, Inc. All other trademarks belong to International Business Machines Corporation or to their respective companies.Guiding Smarter Interactions in Healthcare Reform 18/18