• by Daniella Koren , May 22, 2015

Healthcare is evolving from a fee-for-service and volume-driven model to one that is value based. The Centers for Medicare & Medicaid Services has stepped up its timeline for shifting Medicare to a value-based system so that by the end of 2016, at least 30% of fee-for-service Medicare payments will be tied to value through accountable care organizations or bundled payment arrangements. By the end of 2018, that number will increase to 50%.

Patient outreach and communication are a key component of population health management. To reduce the need for interventions such as emergency department visits, X-rays, or costly diagnostic procedures, population health management requires proactive care for all patients during and between office/hospital visits. This is where using a nurse-staffed call center can really impact a provider’s bottom line. Following are three needs that can best be met by call centers.

Chronic illness. According to the CDC’s Chronic Disease Prevention System, half of all US adults have at least one chronic condition, and almost one in three has multiple chronic conditions. Research from the Agency for Healthcare Research and Quality found that 86% of healthcare spending was for people with one or more chronic medical conditions. Nurses can help patients manage their chronic conditions more efficiently and effectively, and can also play a central role in helping patients stay healthy at home, by educating both patients and their caregivers about their condition and management strategies.

Adherence to treatment plans. An article by the department of Health and Human Services noted that the number of chronic conditions in an individual is directly related to risks of poor outcomes such as adverse drug events from having multiple prescriptions, duplicative tests, and conflicting medical advice. Not surprisingly, patients with multiple chronic conditions often have a hard time keeping track of medications and adhering to their prescribed treatment plans. According to a 2014 McKesson Patient Relationship Solutions survey, 31% of patients wanted their doctor to spend more time explaining their condition and its treatment. 80% responded that they were compliant and took their medications as directed—but since 2011, an increasing number claimed to be more forgetful about taking medication or stopped taking it when they felt better. Nurse call centers can clarify doctors’ instructions and provide counseling to patients who may not understand why they need to continue their treatment. They can also help patients sort out conflicting medical advice and keep track of prescriptions with potential interactions.

Follow-up care. Post-visit follow-up is becoming increasingly important as providers coordinate care and responsibility for patients’ health. The McKesson survey showed that patients are less interested in general information about their condition and more interested in personal communication from providers regarding missed prescription alerts (89%), refill reminders (87%), and live phone support (86%). Call centers can be used on behalf of providers to integrate efforts to manage and optimize patient outcomes by following up with patients after an emergency department visit, a hospital admission, or even a routine office visit. According to an article by Stericycle Communication Solutions, benefits of follow-up calls include: 

• Increased patient compliance and satisfaction

• More efficient coordination of care

• Fewer unnecessary readmissions

The fundamental goal of population health management is to keep patients as healthy as possible. Used within this context, nurse-staffed call centers can help reduce healthcare expenses while optimizing outcomes and ensuring maximum engagement and satisfaction for patients.