- CATEGORIES: Accountable Care Organizations (ACOs),Doctors and Hospitals,Improve Your Practice
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By Charu Raheja, PhD and Ravi Raheja, MD
The Centers for Medicare and Medicaid have taken a major step towards controlling soaring health care costs by starting the Accountable Care Organization ACO movement. These ACOs need to find the sources of inefficiency and poor care coordination and fix them. But where do you start? ACOs can start by looking at simple strategies: make sure that each person gets the care that they need at the right place and the right time.
Every patient encounter starts with a phone call. So the first step is to make sure that the people answering the phones triage patients efficiently and effectively. In order for ACOs to show cost savings, it is crucial that they invest in an effective nurse triage service or program. There are many clearly documented benefits of nurse triage including better patient access, coordinated care, and cost savings. For example, the March 2011 answer stat article written by C. Raheja shows that patients were 70% less likely to seek emergency care if they had access to nurse triage (http://www.triagelogicnurse.com/SurveyTriage). Nurse triage allows for more efficient use of health care resources. In addition, it gives patients better access to providers even if they are not seeking emergency care, which can improve patient satisfaction, prevent future complications, and allow providers to educate patients.
SO HOW DO YOU SET UP A NURSE TRIAGE SYSTEM?
The evolution of new technology has made several cost-effective options available. They are: (a) do it yourself in-house (and hire your own nurses), (b) outsource to a nurse triage center, (c) use a combination of in-house and outsourcing.
a) Do it yourself in-house: start your own call center
Starting your own call center involves setting up the call center infrastructure. The requirements include hiring an experienced call center manager, purchasing triage software for night-time protocols, and hiring clinical and non-clinical staff to answer the phones and handle patient phone calls. Having your own system also gives your staff the flexibility to perform multiple tasks in addition to triage such as physician referrals, scheduling, disease management, class registration and surveys.
The organizations most likely to succeed with this approach are larger organizations with high call volumes, who expect to handle over 50,000 triage calls a year. These companies are the right fit because they already have some call center infrastructure and they just need to add to it. The high call volume also allows the center to use nurses’ time efficiently.
b) Outsource to a nurse triage center
In this option, the organization outsources the nurse triage function to an outside vendor. The vendor provides access to a call center infrastructure that patients can call to have access to a nurse when they have clinical questions and concerns.
The advantage of this option is that it has a relatively low upfront start-up cost. The organization does not need to train its own nursing staff and there is no need for human resources and IT staff. Since the outside vendor is already taking calls, start up is quick and there is an immediate return on investment. In addition, vendors may have more experience and expertise in the niche area of triage, resulting in better care for your patients.
The disadvantages are also clear: first, you have less direct control over the nurses. Second, some nurse triage vendors cannot integrate with Electronic Medical Records. For the best outcome, you need to be very careful about interviewing and make sure that you are comfortable with your vendor. In addition, costs may vary significantly depending on the vendor and while you “get what you pay for” you get less from some than others. Still, assuming you have done your homework in interviewing and discussing costs, outsourcing can be a good option for small to medium size call centers
c) Use a combination of in-house and outsourced services
This is a model in which an organization uses its own nurse triage software and nurses during high call volumes and outsources the triage to a service during low call volumes. A combined model can prove to be a way to improve services and decrease costs. Most triage centers lose money when the call volume is very low because nurses are sitting idle waiting for phone calls. By outsourcing during those low volume times, the call center can continue to provide service at a reduced cost. This combination can be accomplished seamlessly with the call center technology, integration engines and communication platforms available today.
This model requires finding the right partner with the technology and service-level knowledge to implement a combined model. interview and discuss your software and services with your partner before making a commitment.
This model is best for organizations that have some existing nurse triage infrastructure and are being faced with budget cuts. Please see our blog for additional questions to ask if you are considering this model.
Soaring health care costs and increasing incentives from government organizations are making it crucial that we look for ways to improve the allocation of patient care. Nurse triage is a solution that can dramatically reduce medical calls by making sure that patients are getting the care that they need at the right time. Not only does it reduce costs, it also improves patient satisfaction because it gives patients access to a supportive and knowledgeable person who can help them.