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By John Woerly, RHIA, MSA, CHAM
Manager, Cap Gemini Ernst & Young
Customer relationship management (CRM) is the access process of the future. It can be defined as "the alignment of people, process and technology to drive the acquisition of new customers and strengthen existing relationships by improving their duration and profitability." It is the glue that holds various systems and processes in place to enhance the customer experience.
CRM is the ultimate phase in a sequence that for many hospital systems might start with multiple call centers. (See graph, below.) With the traditional arrangement of work functions by care site, one group of employees at Hospital A might handle pre-arrival functions (preregistration, benefit verification, and precertification/ authorization), while another group does scheduling. At Hospital B in that system, yet another group would handle those functions. This arrangement does not fully allow consolidation of services, process standardization or deployment of resources.
The second phase would be to have a "cluster contact center," where a health system with five hospitals might have just two places where pre-arrival functions are done. The third phase is a consolidated contact center, where a greater variety of functions are pulled together into a work unit.
In the fourth phase, the health system has multiple channel access centers, with technologies added for decision support, CRM and Intranet services.
With CRM, the ultimate phase, two high-value, consumer-driven solution offerings — applications that support and enhance the customer access process and the web-enabled extension of care delivery — would be realized. The differentiating factor is the customer-centric approach, founded in the principles of CRM. This approach is particularly well suited to manage the complexity of business processes used by health care organizations.
Consumer-centric health delivery models must be able to accommodate all customer/patient interaction modes, including telephone, fax, web, or e-mail. However, there are currently no health care vendor applications that effectively combine automation of customer access process (scheduling, registration, and insurance verification, for example) with an integrated set of solutions to drive down transaction costs while improving customer satisfaction and quality of care.
At the core of the customer access solution is a robust set of CRM technologies that will allow health systems to strengthen existing customer relationships and to acquire new customers. These CRM applications will enhance customer access to business processes by facilitating the exchange of information, regardless of the medium (or channel) used to distribute the information.
Once the information is received from the disparate sources, workflow rules built into the CRM application will provide a structured mechanism for routing information or queries to the appropriate person and/or information system. CRM applications that support the front-end customer access process carry the potential to significantly improve efficiency, thereby reducing costs. For example, by tying the insurance verification activities to an enterprisewide scheduling function, a health care system will be able to identify and resolve insurance issues earlier in the access process. Additional efficiencies can be realized by the centralized nature of the scheduling process, which streamlines workflow through standardized processes. Customer satisfaction is similarly improved due to the personalized, "one-and-done" approach to interactions with the organization.
Components of the customer-centric customer access solution include a multichannel contact center serving as the hub for all customer interactions. Contact center processing can be centralized or distributed, based on provider preference. Through the use of telephony/IVR and unified messaging applications, effective consolidation and distribution of information becomes possible, regardless of whether the mode of contact is fax, telephone, e-mail, or something else.
The contact center will serve as the single contact source for all customer inquiries (account status or locators, for example) and service requests, such as appointment scheduling, referral requests or issue resolution. This functionality will be enabled by the integration of contact center applications to health system legacy systems.
Seamless integration of CRM application rules and routing with health system legacy systems will allow all customer interactions to be queued, logged, and resolved in an efficient manner. Processes supported by the customer access solution include:
Some of the terms being used in association with this operational level include:
This has to do with defining yourself through your customers, ensuring that they are aware of your name, your services, and your reputation for service. You want the customer to think of you, when they think of the products or services you offer. For example, in thinking of fast food and hamburgers, McDonald’s comes immediately to mind.
This is the process of continuously learning about customer needs and anticipating those needs, of giving them value. It is recognizing the customer as an individual and then tailoring your offerings to best meet his or her needs. An example of this is realizing that a couple in their 30s raising a family would seek and require pediatric care, and providing a pediatrics health care guidebook. A couple in their 70s, on the other hand, would not be interested in pediatric care but might benefit from geriatric care information.
• Customer empowerment.
A key part of patient access in the future will be empowering customers to serve themselves, when and how they wish to do so. A simple example is a person who wants to schedule an appointment and has the choice between making a telephone call and being put on hold for a period of time or scheduling the appointment on-line.
Among the things that CRM can provide for patient access are:
• Multiple service combinations.
You can have access to customers, and they to you, through e-mail, fax, regular mail, intranet, and inbound/outbound voice transactions (predictive dialing).
• Integration of voice and electronic transactions into a single workflow.
This will enable access managers to blend their work and balance their workloads. An employee working at a computer, for example, also has a headset on and is talking to a customer, instead of reaching over for the telephone. The work is blended on the computer for voice or electronic functionality.
• Computer telephony integration (CTI).
CTI allows users to pass data from one computer to the next, which facilitates such efficiencies as predictive dialing, automated call distribution, integrated voice response, and work queuing.
With skill-based work routing in place, an employee who speaks several languages, for example, can recognize what geographic area calls are coming from and what language a caller may need. Another use of skill-based work routing is to better utilize staff resources. An employee may be primarily assigned to preregistration functions, but can also be utilized in appointment scheduling.
Maybe 80% of the person’s job is to do pre-registration, but if the schedulers are busy, he or she can help there. The system will know to divert the calls to that employee automatically without the employee having to move work locations.
• Integration of all transactions into a comprehensive customer contact history.
You house all calls coming in to scheduling, so if down the road, someone says, "I called to make this appointment," we could go back and see that transaction, as well as listen to that call. This also would be beneficial to customer service areas. If there is a billing dispute, hospital employees could go back to the initial contact (fax, email, telephone call, etc.) and see the activities that took place.
The patient database and history that is established through this technology also can be used for marketing purposes. When a person has moved into town and called the hospital to ask for information, you could track down whether the person actually used any of the hospital’s physicians after you made that referral. If you put a million dollars into marketing, you can find out if it paid off, as well as what areas of service are being utilized.
Other uses of the technology include physician referral, "Ask-a-Nurse" programs, disease management, and medical records inquiries, as well as employee self-service regarding benefits and payroll information.
The same technology also facilitates productivity reports for each employee, for example, including the gathering of information on length of talk time and who is being served during a call.
(Editor’s note: Before joining the consulting firm of Cap Gemini Ernst & Young, John Woerly spent many years in hospital access management. He recently spoke on the subject of CRM at the annual National Association of Healthcare Access Management conference in Orlando, FL, and was to make a presentation on CRM in October at the American Association of Healthcare Administrative Management in Reno, NV.)