How the Contact Center Can Be a Driver of VBC Success

The U.S. spends $4.5 trillion annually on healthcare, with a large portion going towards treating Americans with chronic diseases and mental health issues. Imagine how much our country could save on healthcare spending if we could help a portion of those people avoid becoming sick in the first place.

That’s the fundamental premise of value-based care (VBC), which focuses on improving patient outcomes and quality of care while reducing costs.

Hayward

Though VBC is great in intent and theory, many provider organizations struggle to meet the quality and financial metrics stipulated in value-based contracts under which providers assume partial or full risk for meeting quality and cost of care metrics.

Failing to meet VBC performance requirements can be costly. Some provider organizations have even had to make large payments back to insurers when they fell short of metrics on at-risk contracts.

For provider organizations used to the fee-for-service payment model, the financial risks they face under a typical VBC contract can be a barrier. In a survey of providers, payers and integrated “payviders” by the Healthcare Financial Management Association (HFMA), 61% of respondents said a reluctance to assume downside risk was a “significant factor” in their organizations’ decisions not to adopt VBC.

The right data at the right time

The main obstacle to providers meeting the requirements of their VBC contracts is lack of data. Seventy-five percent of respondents to the HFMA survey said gaps in data availability have negatively affected their organization’s performance under VBC programs.

A major selling point of EHRs was that they enabled doctors in the examination room with a patient to know whether that individual was overdue for a flu shot or other preventive measure. The key driver of value, therefore, is not the health system having the data, but that the data is surfaced at the right moment to engage the patient and inform a patient and care team’s decisions and overall journey.

Providers have applied this concept to population health. That same data revealing a gap in care in an exam room can also be used for targeting outreach to patients with reminders. While these programs are important, outbound phone, text, mail and email campaigns are limited in reach and can be expensive. Further, provider organizations already have interactions with patients every day – the inbound, reactive calls and chats fielded by their contact centers – that too often lack a value-based component.

Historically, healthcare organizations have considered the contact center to be a cost center, a communications platform for conveying information to patients and plan members, facilitating basic needs such as making and canceling appointments, answering questions about coverage for a procedure or billing, and more. Today, however, AI-enabled contact centers can be drivers of value, especially in a VBC environment.

In a “cost center” contact center, handling a patient’s inbound call or chat as quickly and efficiently as possible is the primary (and often only) goal. For most patient interactions, that will be enough to maximize the impact of the conversation. But if a high-risk patient with a gap in their care, such as a cancer screening or blood test, is chatting or calling in to pay a copay, the best outcome for all parties is to proactively engage the patient about that gap, instead of just handling their stated request. That conversation moves from maximizing efficiency and convenience to driving better health outcomes and value.

Evolving, not disrupting

The prospect of adapting their contact centers to support VBC or population health strategies can be daunting to provider organizations leery about a major change or transformation project. Yet leading organizations today are incorporating proactive, value-driven processes into their contact centers without major disruption or costly extra resourcing.

Modern customer experience technology is designed to make customer service interactions not just efficient, but profitable. Think about how digitally savvy retail brands create up-sell and cross-sell opportunities and tailor experiences based on customer preferences by integrating their contact centers with their customer relationship management systems.

A patient’s next best action, of course, is not as straightforward as buying a new lamp or adjustable desk from an online retailer. Rather, the next best action is dependent on what is best for the individual patient at that moment.

Integrating EHR systems with modern contact center platforms enables providers to bring patient-specific recommendations to agents during conversations, as well as adapt self-service workflows to be more proactive and personalized. Support agents can rely on EHR-based recommendations to close gaps in care without learning new software or being trained in totally new processes.

Leveraging each touchpoint

Self-help contact center automation streamlines interactions between patients/members and healthcare organizations, allowing contact center agents to focus on more complex tasks that require human assistance. AI-enabled contact centers also empower support agents with data and real-time recommendations during patient/member encounters.

To fully democratize that clinical data and eliminate gaps in care, providers must ensure it is available across every patient/member touchpoint, from the voice autopilot or “virtual agent” to the patient portal to the chatbot. This allows providers to reach people disengaged from managing their health, whether it’s because of cultural or language barriers or social determinants of health (SDoH) issues, such as lack of transportation. It is these patients whose chronic conditions, left untreated, can lead to higher healthcare costs. Thus, frequent and strategic patient “touches” can pay off in better patient outcomes and better provider performance under VBC contracts.

Conclusion

Provider and payvider — an integrated healthcare entity that combines the role of a healthcare payer and a provider — organizations seeking the most value from their VBC contracts must fully leverage patient and member data in both clinical settings and in the contact center.

This integrated approach will result in better patient and population health outcomes and lower overall costs of care while driving additional revenue — all of which help make risk-based contracts work for providers and payviders.

Patty Hayward is the general manager of healthcare and life sciences at Talkdesk.