The relationship between health plans and providers has long been complicated and somewhat fractured. In their dealings, both parties have struggled with various inefficiencies leading to compounding frustration over the years. One of the largest contributing factors to this frustration is how health plans manage referrals into provider offices—a process that traditionally relies on a cumbersome three-way call between the patient, provider, and health plan.

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We recently attended Healthcare Call Center’s Annual Conference in Pittsburgh, and had the opportunity to discuss with business leaders and industry heads some of the biggest challenges and opportunities in the healthcare call center world. This year’s event hosted the largest number of physician practice call centers in attendance since the conference’s inception 30 years ago, and it’s no wonder. With call centers playing a critical role in the healthcare ecosystem, more executives are realizing that these centers are on the front line and critical to the patient experience.

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Ensuring patient populations are getting the care they need is a challenging task that many healthcare providers are struggling with today. We’ve discussed before some of the ways that consumer scheduling and referral coordination solutions are helping providers improve patient access. We also recently wrote about how we are specifically helping call centers. Now we would like to discuss how automated outreach combined with the ability to schedule appointments in real-time can help close gaps in care.

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As consumerism and value based initiatives continue to change the landscape of healthcare, access to care has become a key part of the new paradigm. However, opening access without a specific strategy or without the proper protections in place often creates more challenges than it solves.

What patients really need is access to the right care.

This means the goals of the provider organization must be aligned with their resources in an intentional way. Whether it’s a patient self-scheduling, a care coordinator scheduling a referral, or a call center agent helping a patient find a provider, care delivery must be mapped to the patient’s needs. In our experience, we’ve learned this doesn’t happen by chance. Instead it takes a concerted, strategic effort, complemented with smart technology, to bring the pieces together to provide a navigable care network.

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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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