Automated system reminds members of screenings 

Telephone calls work better than mailings 

An automated calling system reminding members to get preventive health care services has paid off for Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ).

Instead of receiving a postcard reminding them to go for immunizations, cancer screenings, prenatal and postnatal care, and other preventive health care services, members who are eligible for the services receive a computer-generated telephone call.

"Through focus groups, we discovered that people don’t usually take action on mailed reminders. Telephone calls have a higher success rate in getting people to take action on recommended tests and procedures and are about a third of the cost of mailed reminders," says Richard Popiel, MD, MBA, vice president and chief medical officer of the Newark-based health plan.

The program has produced dramatic increases in the number of members obtaining preventive health care services.

For instance, in 2003, Horizon BCBSNJ’s HEDIS score for breast cancer screening was 78%, the highest in its market. It has increased to 83% this year.

Cervical cancer screening rates, at 78% in 2003 — about average relative to other health plans — improved by 12% in 2004 to 88%.

Outcomes have improved in the other targeted areas as well, Popiel adds.

The preventive health care call program has won a BlueWorks recognition award, which honors initiatives shown to be effective in improving the quality and affordability of health care among Blue Cross and Blue Shield plans throughout the country.

The call program is part of Horizon BCBSNJ’s World Class Clinical Quality initiative that focuses on preventive disease management.

Early recognition of members’ health risks and programs that advocate prevention are critical parts of Horizon BCBSNJ’s corporate strategy, Popiel says.

"We looked at what we were doing as a health plan and determined its effectiveness. We were spending a lot of money doing written reminders, but we weren’t getting the bang for our buck. This led us to adopt an innovative technology-driven outbound call system to targeted members. We’re into our third year, and we’re still getting dramatic, but indirect, results from our outbound calls," Popiel says.

The company partners with Eliza Corporation, a Boston-based provider of speech recognition technology, on the preventive call program.

Horizon BCBSNJ staff collaborated with Eliza representatives to create scripts that the technology company turned into spiels by digitized voices.

The health plan uses its member data to compile lists of members who are appropriate for the services.

The reminder program is broad-based and goes out to the entire eligible population at targeted times during the year.

If an analysis of claims data shows that the members have not gotten the recommended screening examinations after a certain interval, the system calls them with another reminder.

"We are mindful of the fact that while these telephone calls are a third of the cost of a written reminder, we’re making a lot of them. We want to make sure that each time we do call a member, the call produces the result we want," he says.

During the call, the system asks the member to answer a series of questions about why he or she hasn’t gone for the screening exam.

For instance, the member can indicate if he or she was too busy or didn’t think the services were important.

"We’re not just sending reminders. We’re collecting information about barriers to preventive care. The computer is collecting this information and putting it into a database, and we’re able to do process improvement using the information," he says.

For instance, if the members indicate that their physicians have not recommended the preventive procedures, the health plan may develop an education program for its physician network.

When someone has not gotten a test, such as a mammogram, and indicates that they intend to do so, the system can do a warm transfer to a radiology scheduling line to help them schedule an appointment.

About 16% of people who are called have not gotten the test and want to be connected to a scheduling line so they can immediately make an appointment. Many ask for the number so they can call it at a later time, Popiel adds.

The health plan has begun using the interactive calls in its disease management programs and is exploring other applications of the technology.

"We know that we can collect information using a computer and voice technology, and given the early success with these programs, we are looking at new ways to improve patient care using this technology," Popiel says.