Healthcare call centers play an important role in the healthcare ecosystem. Some are performing outreach to close gaps in care, others are receiving inbound calls from patients trying to book appointments, and so on. Whether the focus is inbound or outbound, one issue remains, identifying the right provider and booking the appointment is difficult.
Typically, massive spreadsheets and/or three-ring binders full of provider information and scheduling rules must be combed through by agents to find the right provider. Once the provider is located a three-way call must be initiated so the call center agent can find a time that works for both the patient and the provider for an appointment. Many times, these three-way calls are unsuccessful, and even when they are successful, they are always tedious and time-consuming.
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Humana was looking for a way to enhance access to specialists and improve clinical outcomes across their provider network with a digital solution. Typically, coordinating referrals across a disparate provider network has many challenges: long delays between referral order and actual appointment, identifying appropriate specialists, inefficient appointment coordination and scheduling, and inability to track data in real time.
These challenges lead to poor patient experience, diminished access to care, wasted time, negative clinical outcomes, and increased medical costs.
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Pay-for-performance incentives are impacting health plans’ bottom lines. To maximize these incentives, health plans need to improve quality scores by closing more gaps in care. Population health vendors have come a long way in identifying those gaps and then taking action to close them, but often times it all falls apart on the last step.
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