Customer Experience Meets the Healthcare Journey
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Customer Experience Meets the Healthcare Journey Customer Experience Meets the Healthcare Journey Document Transcript

  • WHITE PAPER CUSTOMER EXPERIENCE MEETS THE HEALTHCARE JOURNEY HOW TO WIN TODAY’S HEALTHCARE CUSTOMER Executive SummaryTABLE OF CONTENTS Over the past decade multiple forces have caused the healthcare market in AmericaExecutive Summary .................. 1 to transition from that of managed care and capitation to integrated delivery1. Task Routing and WorkloadDistribution .............................. 5 (integration of health insurance with provider systems) to a vision in which2. Resource Management ...... 11 providers compete to improve care quality and control costs, and consumers choose the best providers. The only thing that is likely to remain constant is change,3. Facilities Management ....... 15 particularly as provisions of the Patient Protection and Affordable Care Act take4. Revenue CycleManagement.......................... 18 effect over the next few years aimed at improving healthcare outcomes and5. Compliance......................... 20 streamlining the delivery of health care.Summary ................................ 23 At the most fundamental level there are three perspectives on the discussion thatSolution Components ............. 24 need to be understood and accounted for if any meaningful discussion is to be held,Conclusion .............................. 24 here represented as the “Three Ps of Healthcare” which translates to Patient,About Genesys ....................... 24 Provider and Payor. Patient Payor Provider F IGURE 1: THREE P S OF H EALTHCARE
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 2 of 25You can see in this diagram that there are interaction points between all three; thetriangle in the center represents offerings that are integrated. Although each have acritical role to play in order to understand contact and medical history, the goal is tofind the right balance that delivers optimal patient health at a reasonable cost. In afully integrated environment – the triangle in Figure 1 – we would find a modelsolution operating as one contact system that provides the following for eachstakeholder: • Patients: Front-end solution, with the insurer or medical group, to view claims, bills, contact history, medical history, e-mail the doctor, look-up symptoms, and so on. • Provider: Task Routing, facilities management, revenue cycle management. • Payor (Insurer vs. Patient): o Insurer: system to pull Healthcare Effectiveness Data and Information Set (HEDIS), claims, costs reports, charts for case management, etc. o Patient: billing, collection, back office financials, etc.The Centers for Medicare and Medicaid Services (CMS) and Health & HumanServices (HHS) are especially keen on this idea of making sure their money goes along way, and they are asking insurers and providers to integrate systems, processesand the overall healthcare system so that focus is delivery to the patient. Theirmessage has always been: Don’t make healthcare difficult for the consumer, period!In lieu of this level of integration, the focus should be on the Provider deliverysystem. One way to understand how this plays out is to examine the patienthealthcare journey.Patient Healthcare JourneyJust as no two patients are the same, no two healthcare journeys are the same. Inorder to provide some framework, consider two common scenarios. The firstscenario involves the initial task every patient has of finding and visiting a primarycare physician for Routine/Preventative care.
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 3 of 25F IGURE 2: R OUTINE/P REVENTATIVE C ARE J OURNEYThe patient must first contact the physician referral service in order to find anappropriate provider. Then the patient must contact the provider’s office toschedule an appointment. After visiting the physician, the account needs to besettled. This could be covered by insurance, in which case a co-pay will likely needto be paid by the patient. In some situations the entire cost may be theresponsibility of the patient.Consider the level of coordination between The Three Ps for something as simple asa routine doctor visit. Apart from the actual visit, think of the legions of peopleworking behind the scenes to schedule the appointment, code services, file a claim,determine benefit eligibility, pay the bill and keep tabs on the status!The second scenario is for Acute/Emergency needs that involve wellness centers,physicians, hospitals and urgent care centers for the patient. This process is morecomplex as it can involve activities prior to the visit to identify financialresponsibility, and after the visit to speed recovery and minimize avoidable hospitalreadmissions.
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 4 of 25F IGURE 3: ACUTE/E MERGENCY C ARE J OURNEYDuring a visit to the physician it is determined that it will be necessary to schedule aprocedure at the hospital. The provider works with the patient and the insurer toascertain financial responsibility. The patient visits the hospital, has the procedureperformed, and is discharged. A bill is sent to the insurer, and any unpaid balance isbilled to the patient.And just like with the Routine/Preventative example, the Acute/Emergencysituation relies on an even greater level of coordination between The Three Ps.There are lots of moving parts in both examples, yet each stakeholder needs toprotect their interest while providing for the patient’s optimal health. Areas inneed of examination include: 1. Task Routing and Workload Distribution 2. Resource Management 3. Facilities Management 4. Revenue Cycle Management 5. ComplianceThe remainder of this document explores the Provider delivery system in greaterdetail.
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 5 of 251. Task Routing and Workload DistributionMultiple interactions happen between all three parties as well as ancillaryparticipants and suppliers such as outpatient clinics, pharmacies and suppliers ofdurable medical equipment. If the contact is not face-to-face, theres a good chancethat the interaction will be handled by a contact center, acting as the intermediaryfor various business units.F IGURE 4: P ATIENT I NTERACTIONSThe primary source of work in most contact centers comes from inbound voice callsthat are handled by an Automated Call Director (ACD). In some cases there mayalso be outbound call activity that is either direct dial or handled by an outbounddialer. There could also be a range of digital channels available to facilitate email,chat, SMS and video interactions.Sometimes the interaction is short - simply answering a question; other times, itmay be an involved process spread out over time. Regardless of the interaction
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 6 of 25channel used, the goal is to connect the patient with the right resource to getinformation or assistance.F IGURE 5: I NTERACTION C HANNELSInteraction ChannelsPatients have become accustomed to interacting with most companies via inboundand outbound voice for decades, as well as fax for sending and receiving printedforms and documents. More recent digital channels include: • E-Mail for discussing symptoms, recommending a course of action and sending prescriptions, especially when the patient is out-of-town; submitting electronic documents such as out-of-network claims. • Chat and Video for interacting with nurse advice teams. • SMS/MMS for sending appointment reminders, receiving images from patients.Mobile devices enable applications that blend all of the self and assisted servicefunctions. One key benefit of mobile apps is that they require patient
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 7 of 25authentication, and they can provide location-based services like finding the nearestclinic.Case Management systems include appointment scheduling, facilities management,patient reminders, pharmacy services, claims processing, and business officefunctions like accounts receivables.Information areas include: • Locations and Services • Medical Encyclopedia • Health Guides • Disease and Symptom Information • Drugs and Medicine • Class Information and RegistrationSelf-Service functions include: • Locations and Services • Appointment scheduling and changes • Class Information and Registration • Prescription Refills • Business OfficeResource targets include: • Physician Referral • Appointment Scheduling • Class Information and Registration • Pre-Clearance • Nurse Advice • Physician • Pharmacy • Business OfficeMany organizations are now multi-channel in the contact center. Extendinginteraction routing beyond the contact center allows you to leverage investments intechnology and improve the patient experience across the enterprise.
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 8 of 25Contact CenterThe primary purpose of the contact center is to provide assistance to patientsneeding a physician referral, scheduling appointments, claims processing, andbusiness office functions related to accounts receivable.F IGURE 6: I NBOUND R OUTINGImportant considerations include proper identification and authentication of thepatient to maintain HIPAA compliance, and placing each interaction in context tomore completely understand the immediate patient need.Nurse AdviceHealthcare providers offering Nurse Advice services can improve the quality of lifefor their patients by making nurses available 24x7 for those situations that do notrequire a visit to the doctor. When the needs go beyond allowable limits, thenursing team can act as a conduit to the PCP, or alert ER staff about a patient on theway. In addition, these teams may perform check-up calls on patients recentlydischarged from the hospital to ensure they are following doctor’s orders, andperform protocols related to ongoing chronic health maintenance.In addition to inbound and outbound voice channels, Nurse Advice teams areincreasingly turning to digital channels for communication. One of the mostimportant advances here is in the area of video, as research indicates that patientswho can see the nurse are more inclined to follow instructions. This is especiallyuseful for health maintenance issues like diabetes where prevention is critical.PhysicianIn the past, much of the interaction between physician and patient has been face-to-face or over the phone. More recently, some physicians have embraced email asan alternate form of interaction, particularly for those patients who don’t need to
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 9 of 25be seen in person for treatment. In addition, escalations from the Nurse Adviceteam enable physicians to keep abreast of patient needs.Workload DistributionHealthcare providers utilize various methods of workload management today.Some segments are automated, such as those for scheduling appointments. Othersare almost ad hoc, like the way email is processed. The goal should be to accuratelyinventory all work that needs to be done at any moment in time, assign a priority,and route to the most appropriate resource equipped with the most appropriatetools to respond.Each interaction type follows a standard triage process.F IGURE 7: TRIAGE P ROCESS
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 10 of 25Those conditions categorized as "Expectant" or "Immediate" are routed toemergency or urgent care. Those categorized as "Delayed" or "Minor" are handledby the primary care physician. Each interaction could further have a numeric valueattached to provide ranking within a category based on patient history and theseverity of the need. As interactions were created and categorized, the attendantworkload could be calculated. Then the interaction would be routed to the mostappropriate resource available. Face-to- Ask-A- Face Nurse Escalation e-Mail Most Available ResourceF IGURE 8: T ASK S OURCESNotification to the resource could be facilitated most easily by mobile device (e.g.,smart phone or tablet), with an option to "ignore" or "delay" response in the eventthat a more pressing issue needs attention. If that were to happen, the interactionwould be re-routed to the new most appropriate resource.Each event handled by workload management is tracked by interaction channel foraccurate classification, task duration and patient outcomes to ensure that the rightamount of time was allocated to future similar events. An accommodation could bemade for some number of "urgent, non-scheduled" events to be inserted each hour.
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 11 of 25All of the tasks handled by the physician are accounted for in order to provide amore complete picture of productivity by: • Channel: o Face-to-Face o Inbound/Outbound Voice o E-mail o Web o Chat o Video • Season (cold/flu, back-to-school, etc.) • Illness (chronic, health maintenance, etc.) • Demographic (age, ethnicity, etc.)Then the provider could: • Filter, prioritize and push ‘next most important patient’ to the most appropriate resource: o Physician o Physician Assistant o Nurse • Predict resource requirements by channel • Forecast, schedule and track events and resources • Link productivity to compensationAdditionally, healthcare delivery can develop pricing models based on accesschannel. For patients who triage to a point where treatment options are feasiblewithout seeing the doctor, plans could offer lower cost of access. These usuallyallow some number of escalations per year at no charge; then a fee for low-costplans that exceed triage limits.2. Resource ManagementOur research has found that for every front office worker there are three knowledgeworkers in the back office providing support. It can be quite a challenge foroperations leaders to manage back office workers in the same way that they have
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 12 of 25grown accustomed to for agents in the contact center, largely because much ofwhat goes on in the back office involves manual tasks that are off the radar.Along the same lines, managing resources that historically engaged with patientsface-to-face is equally challenging. The engagement models are notoriously difficultto expand to non-real-time tasks like e-mail, even though the medical servicesrendered are no less important. However, recent developments now make itpossible to identify back office and off-queue tasks and route just like a call. Thiscapability is especially interesting in multi-channel environments where resourceshave blended skills.Advanced workforce management tools make it possible for staff planners to juggleall of the activity that occurs on voice and non-voice channels, allowing resources toseamlessly move between tasks and channels throughout the day. These samecapabilities have been extended beyond the contact center to work-at-homeagents, nurses and physicians in order to optimize service and minimize costs.ToolsIn order for this to work properly, a range of performance management tools areneeded to understand what is happening in real-time as well as from a historicalperspective. Additional tools are needed to calculate workload, identify neededskills and training requirements, and manage the workforce performing the tasks.F IGURE 9: S UPPORTING E LEMENTSPERFORMANCE MANAGEMENTThe reporting tools used for performance management present information inhistorical and real-time format for all resources involved in direct patientinteractions, regardless of location.
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 13 of 25F IGURE 10: P ERFORMANCE MANAGEMENTBeyond the contact center, reporting tools also consider patient interactionshandled in clinics and hospitals for phone, e-mail, Web, chat, SMS, video and workitems. The information possibilities are endless, but include: • Interactions by: channel, patient, facility • Duration of interactions and end-to-end processes • Outcomes • Trends • Patient SatisfactionAll are critical for sustainability and long-term growth.WORKFORCE OPTIMIZATIONRegardless of staff location or interaction channel, workforce optimization tools aimto forecast, schedule and track activities. In the contact center this is most oftendriven by inbound and outbound call activity handled by the phone system. But asoutlined here, off-queue activities are equally important. The real challenge comesin when patients use multiple channels to engage, and when staff are capable ofaccepting work from all of the channels used by the patient.
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 14 of 25F IGURE 11: W ORKFORCE O PTIMIZATIONWhere all tasks (calls, e-mail, face-to-face appointments, etc.) are handled by asingle routing platform, this makes it easy to: • Calculate staff utilization by channel. • Forecast staffing needs by channel, season, illness, demographic, etc. • Tie productivity to compensation.This becomes especially important in determining compensation rates for highlypaid staff interacting with patients across multiple channels throughout the day.Some providers are considering compensation models that differentiate betweeninteraction types, volume, response time and outcomes to reward top performers.The idea is to encourage doctors to meet with patients for more than a few minutesduring an office visit and to also compensate them, or nurse coordinators, forcommunicating with patients by phone and e-mail even when it may be outside ofnormal office hours. Doctors would also be compensated for helping patients
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 15 of 25manage chronic conditions - like reminding diabetic people to take their insulin--and would be encouraged to transmit prescriptions electronically.3. Facilities ManagementHospitals make money when beds are occupied. This poses at least two bigchallenges to hospital administrators: managing the pipeline to achieve optimaloccupancy levels while reducing avoidable hospital readmissions.Pipeline ControlThe first issue involves real-time knowledge of beds available, as well as those likelyto become available within the next 24-hours. One way to accomplish this is tounderstand all of the events linked to discharge, and ensure they are actioned in atimely manner.F IGURE 12: D ISCHARGE P ROCEDUREEven when the answer to any decision point is “yes,” there must be a link to therelated activity to ensure the ultimate goal of ‘discharge’ for the patient. Forexample, it’s one thing to ask “is transport available” to take the patient home or toan outpatient care facility; it’s quite another to know that the transportation has
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 16 of 25been scheduled. If the transportation fails to show up on time, the patient cannotbe discharged and the bed will thus not be available for the next patient.F IGURE 13: T ASK D ETAILEach of these decision points will likely spawn a series of activities involving multipleentities as well as the patient and their family. The only way to ensure that eachstakeholder is aware of their responsibility is to utilize a workload distributionsystem – the same system described earlier in Section 1 for tracking, prioritizing androuting tasks or work items.F IGURE 14: W ORKLOAD D ISTRIBUTION
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 17 of 25ReadmissionsApproximately three-quarters of hospitalized patients are able to return to theirhome environment following discharge. However, among Medicare patients,almost 20 percent who are discharged from a hospital are readmitted within 30days. This represents a significant risk for hospitals, who now have a financialmotivation to cut readmissions as Medicare recently began penalizing those withhigher-than-expected rates of readmission within 30 days of patients original stay.There are many contributing factors to avoidable hospital readmissions, includingthe effectiveness of the discharge process outlined above, and effective monitoringof the patient after discharge. Specific insurance benefits and availability ofservices in the community may also influence whether or not the patient may besafely discharged home.Along the same lines as managing discharge planning, proper patient care afterdischarge can dramatically reduce the odds of readmission. Proper scheduling andmonitoring of home services, such as visiting nurses or infusion providers toadminister intravenous infusions, may allow selected patients, who would otherwiseneed non-acute residential care, to manage their transitional care needs at home.F IGURE 15: P OST D ISCHARGE T ASKSFor discharge home, patients, with help from family or other caregivers if available,should be able to: • Obtain and self-administer medications • Perform self-care activities • Eat an appropriate diet or otherwise manage nutritional needs • Follow-up with designated providers
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 18 of 25If discharge to the outpatient setting is not appropriate, the discharge team mustarrange transfer to another inpatient facility for ongoing care. Determining themost appropriate inpatient setting of care for ongoing treatment involvesdetermining the patients needs and matching needs with the capabilities ofpotential sites of care.As with Pipeline Control, the only way to ensure that each stakeholder is aware oftheir responsibility after the patient has been discharged is to utilize a workloaddistribution system – the same system described earlier in Section 1 for tracking,prioritizing and routing tasks or work items. Service Level Agreements (SLAs) needto be established at each juncture to measure performance against the goal ofminimizing readmissions.SLA management will in turn shape operational procedures. For example,scheduling and making regular outbound calls to determine if the patient is takingthe proper amount of medication at the right time, performing self-care, eatingproperly and following up with providers. Failure to aggressively do this onschedule greatly increases the likelihood of an avoidable readmission. SLAmonitoring will feed the closed-loop process improvement, and provide earlywarning of patients at high risk of readmission.4. Revenue Cycle ManagementLike all businesses, hospitals need to be paid for services rendered. Many patientsprovide a co-pay and rely on some form of insurance to pay for medical needs. Insome situations the patient is uninsured, or seeks services that are not covered bytheir plan. When that happens, the patient has a financial obligation that must bemet.Healthcare providers can create strategies to improve debt collection cycles bysetting the right expectations up front, confirming benefit eligibility and accountresponsibilities before any services are rendered. Presuming accurate charges havebeen captured and coded, timely claim submission is critical to reimbursement.For unpaid balances, additional work is needed. This includes proactively remindingpatients that payment is due in a few days, highlighting patients who have a highprobability of missing payments, and improving patient loyalty by shaping paymentbehaviors through regular communication.
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 19 of 25F IGURE 16: R EVENUE C YCLE M ANAGEMENTPatients are diverse and pretty clever when it comes to avoiding calls fromcollections. They are pretty adept at using caller ID, call blocking and voicemail.They also change mobile phone numbers easily and frequently. This makes themmore difficult to contact with a much higher contact failure rate.But compensating for this is the bigger range of communication means nowavailable. Some debtors may be easier to reach in the morning rather than theafternoon or may answer their mobile phone in preference to their home phone.All this information can be used to customize the treatment of specific contacts. Aswell as home phones, work phones and mobile phones, debtors can now becontacted by e-mail and SMS as well. All of these channels can be used as a meansof improving contact, taking into account regional compliance rules.Using an outbound dialer allows healthcare providers to operate more efficiently.They can decide when to use live agents for calls that require the unique skills of alive agent. Or, they can determine which contacts should be made without an agentpre-recorded voice messages for things like payment reminders, e-mail or SMS.Other efficiencies can be achieved by call blending in the contact center. Blendinguses outbound/blended agents to smooth out inbound calling peaks during hightraffic times. When these peaks return to normal call volumes, the blended agentresume outbound calling. Outbound is all about achieving more productivity andgreater efficiencies.Collections StrategyCreative and innovative strategies can optimize collection success and/or enhancepatient relationships, while keeping costs to a minimum.
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 20 of 25 • Reach the responsible party as early as possible after their account becomes delinquent in order to present the widest range of options. • Reach out to the responsible party even before they are in trouble, particularly those who are uninsured and pay for services with credit cards. A single missed payment on the credit card can dramatically increase the interest rate on the unpaid balance, thereby reducing the likelihood of timely payment. That starts a domino effect, and all creditors are at risk. • Segment responsible parties based on collection effort, and design campaign strategies tailored to the unique requirements of each group.5. ComplianceHealthcare is quite possibly the most regulated industry of all, regardless oflocation. Although there are many angles on compliance, the focus here is on twoareas: 1. Task Validation. 2. Medical Loss Ratios (MLRs).Task ValidationMany of the processes used in the Provider delivery system have actions that areregulated. For example, HIPAA requires authentication prior to release of sensitivepatient information. Failure to follow regulations could lead to fines and penalties – at the time of failure, or for the lack of proof during an audit.We actually observe the following behaviors and conditions in many healthcareenvironments: • Prioritization of tasks including compliance steps are self-selected by employees. They decide what tasks are important, or what order tasks should be accomplished. • Employees may mark a compliance task as complete, but actually don’t do the task.
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 21 of 25 • The fail to update the system so the audit trail is lost. • While workflow systems are wonderful at HOW something should be done, they fail to identify WHO is the best skilled person to perform a task. • Managers have little insight to what tasks have been completed, or if they have been completed in the right order.Instead, avoid problems and the resulting fines by addressing how employeesengage with regulated work items to: • Prove that tasks were actioned and provide an audit trail • Prioritize, assign and push tasks to the most appropriately skilled and available employee • Optimize resource utilization to control costsThere are four main components required to make this work: 1. Task Validation proves that a task was auctioned and provides an audit trail. It does this by controlling and tagging all of the interactions patients have with you – inbound and outbound. The tags are the links that allow tracing so that you can prove things actually happened. 2. Prioritization and Push of tasks to employees based on regulatory requirements, business rules, SLAs and employee skill. 3. Employee Process Improvement provides reporting tools to provide insight into performance, task completion and workload. Knowing what happened is important; using that information to continually improve what you are doing is critical. 4. Resource Optimization to forecast, train, schedule and track all resources for activities.For patient interactions using inbound/outbound voice it may also be advisable toapply business rules that would identify call types or segments that are subject tocompliance, and configure the rules to trigger the call recording platform. Thiscould be done for patient authentication, authorizing surrogate decision-makers,confirming acknowledgment of transfer to a wellness center and so on.Taken together, these manage the risk and cost associated with Task Validation.
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 22 of 25Medical Loss Ratios (MLRs)The Affordable Care Act requires health insurance issuers to submit data on theproportion of premium revenues spent on clinical services and qualityimprovement, also known as the Medical Loss Ratio (MLR). It also requires them toissue rebates to enrollees if this percentage does not meet minimum standards.MLR requires insurance companies to spend at least 80% or 85% of premium dollarson medical care, with the review provisions imposing tighter limits on healthinsurance rate increases. If they fail to meet these standards, the insurancecompanies will be required to provide a rebate to their customers starting in 2012.Insurance companies that issue policies to individuals, small employers, and largeemployers will have to report the following information in each State it doesbusiness: • Total earned premiums; • Total reimbursement for clinical services; • Total spending on activities to improve quality; and • Total spending on all other non-claims costs excluding federal and State taxes and fees.The regulation imposes civil monetary penalties if an insurer fails to comply with thereporting and rebate requirements set forth in the regulation. Although the lawallows HHS to develop separate monetary penalties for medical loss ratio non-compliance, HHS has adopted the HIPAA penalties in this regulation. Theregulation’s penalty for each violation is $100 per entity, per day, per individualaffected by the violation.CONSIDERATIONSThere are at least two key things healthcare insurance companies need to focus onfor MLR compliance: 1. Accurate and timely reporting to HHS. 2. Identification of the types of “activities to improve quality” and amount spent.Following NAIC recommendations, this regulation specifies a comprehensive set of“quality improving activities” that allows for future innovations and may be counted
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 23 of 25toward the 80 or 85 percent standard. Quality improving activities must begrounded in evidence-based practices, take into account the specific needs ofpatients and be designed to increase the likelihood of desired health outcomes inways that can be objectively measured.In order to maintain incentives for innovation, insurers will not be required topresent initial evidence in order to designate an activity as “quality improving” whenthey first begin implementing it. However, to ensure value, the insurer will have toshow measurable results stemming from the quality improvement activity in orderto continue claiming that it does in fact improve quality.On further examination, it may be possible to attribute some of the technologyoverhead costs to the 85% side of the equation as “quality improving activities”instead of the 15% side for overhead. For example, integrated providers may beable to implement technology on the delivery side that could be leveraged by theinsurance side at minimal cost.Alternatively, insurers may need to more closely examine CAPEX v. OPEX models fortechnology, or consider moving technology responsibilities to a wholly-ownedsubsidiary.SummaryThis document has provided a closer examination of five key areas in the Providerdelivery system: 1. Task Routing and Workload Distribution 2. Resource Management 3. Facilities Management 4. Revenue Cycle Management 5. ComplianceTaken together, all of these work together to deliver optimal results for the Three Psof Healthcare – Patient, Provider and Payor. Integration of key systems andcomprehensive analytical tools are essential for understanding and managing thepatient experience end-to-end. This includes streamlining operational throughput,controlling costs and ensuring compliance.
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 24 of 25Solution ComponentsGenesys Customer Interaction Management (CIM) platform is the framework usedfor routing and reporting on customer interactions.Genesys Workload Management consists of four main components: • intelligent Workload Distribution (iWD) - Supports customer service delivery beyond the contact center by tracking, prioritizing and routing tasks or work items. • Workforce Optimization - Reduces staffing costs, improves productivity and protects service levels with accurate forecasting and scheduling for all interaction channels. • Skills Management - Proactively assesses and maintains employee skills so they have the right skill sets to handle work streams across all interaction channels. • Interactive Insights – Historical reporting that delivers a complete picture of employee performance and work streams across multiple operations and channels.These components work together to provide visibility to all patient interactions,which can then be tracked and used for forecasting and scheduling resources.Genesys Quality Management software gives you the three tools you’ll need tohelp you meet your customer service objectives: Call Recording, Quality Managerand Screen Capture.ConclusionIf a healthcare delivery organization has a contact center in place for physicianreferrals, appointment scheduling, pre-clearance, business office and accountsreceivable, they are likely to utilize multi-channel, utilizing inbound/outbound voice,e-Mail and chat. Extending the contact center infrastructure to the providers willdeliver similar benefits and higher cost savings to the enterprise.About GenesysGenesys is driven by our cause to save the world from bad customer service. We doit by applying a relentless focus on the consumer perspective of the customerexperience — and the impact it has on your business. Genesys works with its
  • WHITE PAPER WHITE PAPER Customer Experience Meets the Healthcare Journey / Page 25 of 25 customers and partners world-wide to deliver the experience that today’s digital consumers want. It all adds up to one seamless customer conversation. Great customer service extends beyond the contact center to the processes and work streams involved in meeting your commitments. Genesys products give you insight into and control over these processes, so you can truly track the customer experience from end to end.Corporate Headquarters Genesys is a leading provider of contact center and customer service software — with more than 2,200 customers inGenesys 80 countries. With over 20 years of contact center innovation and experience, Genesys software directs more than2001 Junipero Serra Blvd. 100 million interactions every day, maximizing the value of customer engagement and differentiating the experience by driving personalization and multichannel customer service — as well as extending customer service across theDaly City, CA 94014 enterprise to optimize processes and the performance of customer-facing employees.USA For more information visit:, or call +1 888 GENESYS.Worldwide Inquiries:Tel: +1 650 466 1100 Genesys and the Genesys logo are registered trademarks of Genesys Telecommunications Laboratories, Inc. All otherFax: +1 650 466 1260 company names and logos may be trademarks or registered trademarks of their respective holders. © 2013 GenesysE-mail: Telecommunications Laboratories, Inc. All rights