Pay attention to details in access center plans

Centralizing calls a boon - if it works

Improving access to appointments is a major focus in today's health care industry. That's the conclusion of a study, "New Models for Access to Care: Integrated Delivery Systems of the 21st Century," by First Consulting Group (FCG) of Boston. Call centers - or access centers, as the consulting group calls them - are a key part of that process, says Jane Metzger, FCG vice president.

At the high end of the models included in the FCG research, in both scope and covered population, are regional or enterprise access centers for making appointments and seeking triage or medical advice. Regional or enterprise models, the report states, usually are implemented in a stand-alone, 24-hour access center equipped with advanced telecommunications integrated with contact management software and computer-based triage/medical advice software.

Redesign needed at all levels

New front-end processes that are truly customer-friendly, the report contends, will be achieved only through redesigning - or retuning - processes at all levels and all access points within the care system. However, there's room for variance in designing an access center, Metzger says, as well as some guidelines to keep in mind.

With access centers or any of the access initiatives mentioned in the report, an important principle is that the new process must make sense. It wouldn't, for example, "if there was a new access center for patients to call, but they could only call that number for a certain type of service and had to revert to the old process for other services," Metzger explains.

For physicians to benefit from access centers, the organization "has to be sure that whatever's happening translates into clinic schedules they can work from and billing procedures that still work," she points out. "You don't want to create more steps for physicians and their staffs."

Because they've had "core control" of the scheduling process in the past, physicians are skeptical of any system that seems to take away that control, she says. A health care organization must ensure it has the process right and "obsess about all the details" if it is to combat skepticism.

Routing those physician calls through a centralized function can be a boon to the physician's office by removing a source of disruption, assuming the process works and patients find their way to the right place, she says. Physicians are concerned about the ability of a scheduler to make appropriate appointments and understand the complexity of the process, Metzger points out.

They also dislike the idea that their patients likely will deal with a different person each time they call, but there are ways to assuage those concerns. Several of the organizations FCG has studied have used call routing, for example. Call routing sends calls for a particular physician's practice to a small number of customer service representatives, Metzger says. With the calls routed to two or three reps, there is a high likelihood those patients will deal with the same few people each time they call while the organization still meets its standards for call pick-up.

Of course, the exception would be made only as long as it doesn't interfere with performance requirements. "If those people are tied up, the call will go to someone else," she says.

Another way to accommodate physician concerns is to have certain kinds of calls, such as those for routine appointments, go to the access center operators. Calls about acute cases that need to be seen that day continue to go to the physician's office. "I've seen that [arrangement] several times."

When it comes to access centers, as well as other components of a high-end integrated delivery system, there is room for variance, she emphasizes. For example, it's not necessarily preferable that an access center be centralized for the entire health system. "A large, complex health system may have several scheduling centers. If one goes down, it can switch to another."

There's also room for flexibility in the way a health system handles different facilities within its own purview, she notes. Many health care organizations have completely redesigned the front end of the care system, for instance, which spills over into various practice sites or clinics, Metzger says. "The question is, 'Is it necessary to mandate exactly how the front desk functions, or is there a certain part that can be done differently?'"

One difference might be in the way patient registration is handled. "At some sites, it might be centralized and in others, distributed. Is there an important reason to make all of these standardized?"