Technology lends a hand
Automated systems help cut costs, improve efficiencies
The year 2008 was a tough one for disease management (DM). The Centers for Medicare & Medicaid Services (CMS) ended DM’s Medicare Health Support (MHS) project, claiming that it didn’t effectively improve quality or save money. In addition, there has been a growing drumbeat from experts questioning the effectiveness of DM programs such as the nurse call center. In response, the industry is asking how to make call centers more efficient. One answer is automated communication programs, which can effectively reach members without the labor costs associated with trained nurses making the calls. The automated system makes the phone calls, questions patients on their status, and collects medical data, such as blood pressure and blood sugar levels. The technology frees up the nurses to counsel and coach at-risk members, who have been contacted and triaged to the call center. The automated network also helps pharmacy benefit managers and health plans reach members with a clear, consistent message.
Automation saves money because an insurer or DM company doesn’t have to manage mail or employ skilled staff members to spend countless hours trying to find members with out-of-date or incorrect contact information, says Stan Nowak, founder, president, and CEO of Silverlink Communications, a Burlington, MA–based healthcare communications company.
“[Automated systems are] more cost-effective than letters, much more cost-effective than humans … If you want to proactively engage people in wellness, this is the most effective way to do that in large populations,” Nowak says.
Not getting much in return
DM companies spend about $18 per member on patient communication, which equals about 30% of their revenues, says S. Michael Ross, MD, MHA, vice president of healthcare at Varolii, a healthcare messaging company based in Seattle. They’re not getting much in return for the money. DM companies find only 12%–15% of at-risk members through nurse phone calls, Ross says.
Part of the problem is that DM companies often have wrong or out-of-order member phone numbers (40%–60% are not correct). But automated communication systems can transform outbound call centers into inbound call centers with at-risk patients getting triaged to the nurses, says Ross. “One of the biggest attractions in this program is that no longer do you have an engagement specialist or nurse dialing for dollars and getting busy signals, looking up phone numbers, getting answering machines, and all the rest,” he says. “Those nurses are now taking inbound calls from people who know about the program, are prequalified, and are ready and able to talk to that individual.”
Varolii starts the process by making a welcome call to a member to check whether the phone number is correct and then introduces the at-risk person to the program. The outbound call may also provide incentive information, reinforce privacy issues, and offer the member the opportunity to transfer to a nurse.
That first call also provides the necessary information to patients so they understand why they are receiving the call. “What we do is combine the employer’s name and/or the health plan’s name with the DM company that is doing the outreach. We are starting to develop that association,” Ross says.
The rest of the communication varies depending on the person’s disease state and communication preferences.
An individual’s health status plays a role in engagement success. For example, depression often complicates communication outreach, but Varolii has found that an automated system can make a difference.
Ross points to a case study in which a client enjoyed a 218% increase in enrollment in depression DM programs after being contacted by the Varolii system. The outreach included the following four steps:
1. An automated call before sending a mailing to the member about the program
2. An automated call after the mailing
3. Appointment reminders
4. Reengagement calls for those who dropped out of the program
For incorrect phone numbers, which totaled 60% of the depression DM program phone list, Varolii hired a third-party lookup service to find individuals’ contact information.
“That is huge savings in terms of time nurses spent looking up phone numbers … The work flow reductions from that were very substantial indeed,” Ross says.
Nurses’ productivity increased by an estimated 68%–70% in the case study because they were able to spend their time talking with patients rather than searching for phone numbers and leaving messages on voice mail, Ross says.
Supporters point to this as proof that automated systems are a cost-effective alternative for DM companies. For example, the companies that participated in the MHS project could have used automated systems.
Instead, the project included a heavy dose of nurse call centers that were not cost-effective, Ross says. “When CMS decided that MHS did not deliver value to offset costs, it was very clear. It wasn’t that [nurse call centers] are not high touch or not a great thing—it’s not affordable,” he says.
Personalization is key
Silverlink provides member communication to myriad patient populations, including Medicare, Medicaid, commercial health insurers, pharmacy benefit managers, and DM/population health companies.
Personalization is essential for member involvement in a program, says Nowak. Taking a page from consumer-based industries, Silverlink combines decision science methodologies with technology and marketing expertise to create a system that connects and engages.
Silverlink’s Adaptive HealthComm Science and SAVS 5.0 Technology Platform craft a system that delivers personalized, HIPAA-compliant, and interactive communication programs. Using decision science methodologies, Silverlink can track call times to determine when a customer is usually home.
It also follows a person’s health status by using such methods as collecting clinical data over a set amount of time and changes the message according to the member’s age, sex, location, or other subgroup.
“We routinely observe relatively dramatic differences in responses by taking different approaches in these different subpopulations,” says Nowak. “One of the great benefits of using an automated system rather than using nurses is it actually allows us to advance the science of what motivates behavior change, because technology takes the variability of the human out of the equation.”
The offerings combine healthcare with the best consumer engagement sciences, says Nowak, adding that healthcare communication needs integration, coherence, and consistent messages.
The first step in the personalization process is inputting an individual’s claims data into the computer system or entering a person’s health risk assessment to develop a profile. Through future outreaches, Silverlink’s technology platform can figure out an individual’s preferences.
In addition to the individual level, Silverlink uses applied analytic principles to segment populations and measure behaviors. Every important communication is part of an end-to-end process that allows the customers to manage the outreach.
The data used go beyond a person’s credit score or income level, which are not as predictive as data found through the outreach. “What we find is that when you are actually trying to specifically move behavior of large numbers of individuals, you must be more granular than that and you have to be able to experiment,” says Nowak.
The automated system makes the outreach, but if the technology finds a potential problem—such as a diabetic with high blood sugar—or if a patient seeks help, Silverlink forwards the call and patient information to a nurse call center.
Although companies are looking for options other than large nurse call centers, that doesn’t mean those skilled specialists are not needed. The idea is to use nurses more productively, Nowak says, adding that technology helps locate and communicate with members, but it does not replace the human touch.