Evolving Health Care Contact Centers Into Drivers of Value-Based Care

Patty Hayward, General Manager of Healthcare and Life Sciences, Talkdesk

My name is Patty Hayward, and I'm the general manager of health care here at Talkdesk. I have been here for almost 4 years now and joined when Talkdesk really wanted to very specifically look at some verticals that were important. So I joined it at the very beginning and formed sort of the health care vertical and helped us build the product, came up with concepts, kind of have been working on all the thought leadership and different things like that.

Historically, I've worked for quite a few different companies across both health care and life sciences, started out my professional career in the life sciences, actually started as a bench scientist and sort of went into working with those organizations, scaling up, doing things like drug discovery, looking at the Human Genome Project, et cetera, then made the leap over to health care via McKesson. And I worked at McKesson for 15 years. That was two separate stints. In between the two separate stints I worked in some population health companies. I worked at Aetna for a couple of years when they were first standing up ACOs. So I have been all over the industry from both the life sciences to the provider organizations as well as working on the payer side for a little bit before I came here.

How can health care contact centers shift from a traditional cost-center model to becoming drivers of value-based care? 

As we think about where folks are today, you know, contact center in general has been making this shift in a lot of other industries, right? So thinking about retail, thinking about banking, during the pandemic, they really realized that they were missing some opportunities to do additional things for revenue generation inside of the contact center, right? Add on sales, different sorts of opportunities and things like that, depending on what they were services they were providing. And in health care, we really haven't done that yet. We have really looked at things as an ask answer.

You know, they're the least trained, the lowest paid, the highest turnover rate of any piece of the care team, right, as you think about health care. And a lot of that has to do with the fact that when you think about health care, we really put clinical work at the center. We don't put consumer experience in the center. So what the job is really to just direct traffic answers, you know, the questions that are easy to answer, everything else sort of gets escalated and is sent back to them. So it's a very reactive system. It's also very siloed. Different organizations within a health care system, like revenue cycle might own, I'm going to call in and pay my bill. And it's a separate group from, say, patient access, which is typically run by the physician organizations. And that's different from maybe even the ologies, right, as you go into specialty and different things like that. So it's a very fragmented system. So it hasn't been unified. And it certainly hasn't been attached to how do we then turn it into something more value-based? So we're sort of in the infancy stage when we think about health care. 

Really, a lot of it is getting from on-prem to the cloud, a step one. Second is how do we start to integrate into the EHRs and bring people a better satisfying, hey, we know you when you first call versus I'm new every time someone calls. So a lot of this is thinking about what is the higher value work that they need to do. So I always encourage organizations to think about what are the things that you guys need to do? Because there's going to be a step process of going from these different aspects.
But it's important to identify what those higher-value workpieces are and how are you treating them today? Today, the way we deal with value-based care and contact centers is we run reports and then we do outbound campaigns and dialing, right? You have usually a care team, a higher trained care team that's making phone calls to get patients to do things that they need to do to take better care of themselves. So we often put it into clinicians, maybe it's nurse call centers, oftentimes it's just marketing, sending out text campaigns, things like that, but it's all outbound. And we all know that outbound is minimally effective, right? Your hit rates on outbound are much smaller than if you're calling in and someone says, hey, I'm calling to take an action on my health. And if you bring something up in the moment that you need them to do, your ability to get them to do that is much higher than if you're outbound. 

So a lot of this is just really thinking very differently about what we even think about for contact center because it's today thought about as a cost center and nobody wants to own it, right? So many people own it. It's not unified. And so thinking about these things really has to change. And I think part of that is this whole concept of it could be a value center for us, right? As we think about the increase in number of value-based care contracts that we have out there. They're not only Medicare contracts now. They're private contracts. Different Medicaid has a lot of value-based aspects to it. How do we think about how we deal with our patients and our patients' families as they're contacting us? And what information do we have available in the EHR that we can mine and we can use? Because I think we have to give people different journeys as they call in, too.

So there's a lot of work that has to be done to kind of set the stage for a lot of these things that I believe we have this great opportunity to accomplish in health care. It's not like, hey, just turn on a switch over here and all of a sudden we'll be able to do things because we don't even, I don't even know if we have the right talent to start with. So you have to think through how do you level up the talent that you have? So I think one of the big challenges I hear over and over again is, hey, it takes me 3 months before I even allow a contact center agent to answer a call because of the complexity of a health system, right? And then the average tenure is 18 months for a lot of these organizations. I mean, imagine that. That's crazy, right? So you have a lot of this high turnover, lower, you know, skilled people that you're hiring in and they don't really have a good route to improve. You know, there's not a career path associated with contact center oftentimes.

So you get low satisfaction and people move on to do other jobs. So I think there's a fundamental reimagining of that whole sector of what can we do to have a career path that allows people to level up, that allows them to do more things, to give them the training. But that requires investing in your people, which is going to inherently cost you more money, which is why we need to make sure there's a good return there around the things that we can do in the contact center, which means we also need to give them better tools to do those things.

What are some key considerations for health care organizations looking to leverage AI and automation in their contact centers to improve patient outcomes? 

I think there's a couple of things that are really important. I think choosing a partner that is really knowledgeable, both about the call center as well as health care, right? Because health care is different, right? You're not talking about retail. You're not talking about banking. You're not talking about something that's a little simpler, a lot simpler, let's just say it, right? Making an appointment to get your hair done is very different than, you know, going and getting an interventional CAT scan, right? There's a lot more considerations that you have to put into that. So I think it's really important that you work with a partner that understands both. I would love to see, I think it's important, that the partner also has a partnership with your EHR vendor because outside of provider world, everybody uses a CRM and the CRM is the source of truth. Inside of provider land, it tends to be your EHR, which is a different kind of system. And it really needs to have a rich mining of that information to be able to elucidate this kind of information and distill it into a next best action type of a scenario.

So I think those are really important things. Someone who's got some really great knowledge of AI, I think as we move forward, these large language models are going to allow us to really do some cool things that we can't necessarily do today. But with that comes some caution of, hey, we've got to make sure that we've got self-contained models. They're not out there giving our PHI to the world, you know, all of those different things that you need to think about from a privacy perspective, as well as from a security perspective. So I think there's a lot of considerations there. 

I also would say, don't be hesitant to employ a business transformation consulting partner because this stuff is not just about choosing the right tech vendor. Tech is one piece. You're going to also have people in process that you need to evaluate and figure out how that all comes together. Because this doesn't come together with just putting in a solution. I wish it did. 

How can contact center agents be upskilled and equipped with the necessary tools to provide a superior customer experience? 

So I think you need to, first of all, think about that career path. I think that's an important aspect, right? You may, it may look differently with someone who's coming in and, you know, it's just starting new to their career, and it maybe doesn't have sort of the skill set that you want to be engaging in a higher level of conversation. So I think you need to have career paths and competencies. 

I think then you need to also have products that can guide and help, right, co-pilots that can sit alongside, listen to the conversation and offer up things in real-time so that you can then move those people up that career path more quickly and can help them supplement things like it's one thing to speak versus right. So like do you have agents that are, you know, skill set it to do a chat versus a discussion via voice, right? It's, it is different. So you want to be able to make sure that you have technology that can help supplement that and maybe someone's writing skills aren't that great, but you have a product that can go in and rewrite it for you in a way that's acceptable to your organization and put it into the chat. That's, you know, we're seeing that with chat GPT today. So the ability for people to be able to write better than they ever have because they can put it in there and then go at it.

So that's the kinds of things I think you're going to see becoming really, really prevalent. They're already there today. So how do you go ahead and enable that and empower that? But again, you need to have the health care literacy in those tools so that they can understand the medical terminologies.

I think it's going to be really important as we think about retention efforts, right? You don't want to put all this effort in and then have people sort of skill set out and move on. So I think retention strategy, and I was, I'm really keen on this idea of a career path for, for agents so that you can better retain. That's something I hear constantly. How do I retain? Do you have anything to help us retain our talent better? Because, you know, as we skill them up more and ask them to do more things, they're going to want to stay more because I think you're going to get more job satisfaction out of helping people. If you think about health care, people join because they want to help people. And if you give them more opportunity to help people and they come out feeling better about how they've been helping and guiding, you're going to get better retention, too.
So I think there's a real focus that needs to happen on just how all of that looks so that as they move up in the career path and you're doing more things, patients are being better guided, patients are staying healthier, they get better satisfaction. I think there's a lot of back and forth with that. And by the way, then the organization gets better payment tiers for their contracts because as they're hitting these metrics and taking better care of their populations, they hit the tiers that they need to.

And that's where that ROI comes in, right? Because if you say you're at your lowest tier, say, $120 per patient per month on your contract because of whatever metrics. If you can get that up to, say, 420, that's a big return, right, depending on the population set that you have. But that requires us to be able to identify who those patients are that are part of those contract cohorts.

What are the metrics that they need to be hitting? Where are they currently? And what are the recommendations then to the agent? Because you can't just hit them with a wall of, hey, here's all the things and expect them to then know what to do next. There has to be very clear, this is the next, this is the thing you need to say next and where you need to go. And then be able, of course, to report back on that so that you can attribute what those agents are doing to the return that you're getting.

And those are all really, really important as you think about migrating from what you typically think of as a cost center to a value center because you've got to understand your metrics, you've got to be able to hit them and then you've got to be able to attribute that you did that to that contract so that you can say, okay, you know what, this is, this investment has been worth it. We are seeing a big return from upskilling our agents, investing in them, et cetera. I don't think anyone would argue the point at that point.

Today, it's more like, how can I cut, right? How can I just not have people talk to people? And how can I make things everything self-contained and automated? And I would say you need to do both, right? There's definitely need to self-contain. A lot of these conversations that can be easy conversations that aren't going to add value. Let's answer those via virtual agents, whether they be digital or voice. But let's also identify red flags, let's say. Let's say we've got a patient who just recently discharged from the hospital, right? And that patient is a diabetic. And we know that the best chance of keeping that patient from readmitting or having another acute episode is to get them back to their primary care doc in the next 7 days after discharge. And they call in to cancel their appointment. Well, we probably don't want to automate that. We want to escalate that to a live agent to inquire as to why they're, you know, canceling and do what they can to help them. Maybe they don't have a ride, right? Maybe they're not feeling well or whatever, right? You've got to understand what's happening and then offer solution sets. Maybe it's just they need to come the next day, but you can get them still in the window. So you need to free up some, you know, emergency appointments for those patients. 

You're not going to be able to self-contain that. There's too many decision points there. So we need to know that diffraction of like, okay, this is an easy one, right? This one's more complicated. How do we deal with that and move on? So there's a lot of development work and integration work that has to happen. This isn't a, hey, we're doing this at 12 hospitals. This is definitely like this is where we need to go. And there's a lot of work being done currently on it, but it is definitely, it is definitely where the puck's going. So it's a, it's an interesting topic. It's definitely one I think we can do. 

What are some examples of successful strategies for contact centers to use patient interactions as opportunities to drive preventative care and improve population health? 

You know, I think that we've been chasing the golden moment for a while here, you know, which is that patients calling in to take action on their health or they're standing in front of you. How do we bring more information to bear so that we're not just answering the question that they have? So, you know, they call in to say, look, I'm out of my statin refills. I need a new refill from my doc. Can you please take care of that? And today, what we would do is, okay, I'm going to send a note to your doc, and then we'll send it to the, you know, the pharmacy of your choice and that's it now we should know that in that case that this this patient also hasn't had her A1C checked in a while right or hey this this patient needs to have her eye exam right there's a lot of metrics around diabetic patients and what we need to make sure that we do because we know that if we do certain things, foot and eye exams, right, because of the circulatory system degradation, things like we need to make sure they're on a satin.
So this patient, I just said, is on a satin. That's good. Do they have enough patient days covered? So like if they're only refilling their satin every 60 days, that's a problem. We need them, we're giving them a 30-day supply. They're only picking it up every 60 days, we should be able to see that from claims data and information there. So how do we, how do we, you know, ask the question what's happening with this and, and offer maybe something like, hey, can I send you this? Can we put this on a mail order and send it to you every 30 days? So we know that they have their, or is there something else that's going on? Because maybe they just can't get to the pharmacy to pick it up.

Or is it, hey, the statin makes me feel bad and I feel better if I only take half a pill. Well, we probably need to have that discussion with your physician. So do you like schedule time for that discussion to occur? So there's just different things that we need to be able to bring up and elucidate and then help them navigate what they need to be doing in order to make sure that they're hitting and taking things as prescribed. They're doing the things like getting their A1C's checked, having their foot, eye exams, just different things like that. The nice thing about the population health metrics that we're looking at in these contracts is they're pretty black and white. We know what we need to do, and we know whether patients are doing them or not. So we should be able to make suggestions about making sure that they do things to best keep them healthy from escalating. 

How can contact center workflows, technologies, and metrics be rethought in order to better align with value-based care goals? 

So I think, you know, I'll give you guys an example of, you know, we obviously, we have a great partnership with Epic. And one of the things that Epic does is they actually have a product inside their EHR called Healthy Planet, which is, it does exactly this. It tracks the metrics and key goals for population health. So being able to tap into those APIs and be able to, you know, generate express actions based on those sorts of things and where a patient is going to be really important and key. So that's where I kind of go into that, hey, you need to have a couple things. We need to make sure you have a good relationship with the EHR vendor so you can tap into these bits of information that they hold. Two, you need to have the AI capabilities to be able to understand and generate the co-pilot along with it, because these are not things that you're going to expect a contact center agent to be able to generate in their own head. You're going to need to generate those next best actions in real time.
And, you know, they need to understand. So that means your vendor needs to understand health care enough to build those models. So I think those are all really important aspects of just what you need in order to accomplish kind of that next level of contact center that we're talking about building here.

What are some challenges that health care organizations may face in transitioning their contact centers to focus on maximizing population health and preventative care? 

The silos of communication are probably the areas that are the most difficult to overcome because I think building a career ladder is not that difficult. Like you can, if you reimagine that, like we imagine that, like we can build a ladder, right? Knowing, again, identifying those needs, those skill sets that you need to have, building a ladder for those folks, that shouldn't be that difficult. You just got to get consensus across sort of the silos.

And what does that mean for each piece of the contact? Could you say contact center? It sounds like it's one thing. But it's really not, right? There's different contact centers across health care that do very different things. So what does that look like in revenue cycle versus what does that look like there? And does it need to be different, right? Maybe, maybe not. I think each organization has to make that decision about how they go about looking that. But then you need a CCAS system that can then navigate that and bring people to the right place so that you're not creating additional silos of like, oh my God, I got to be transferred 12 times before I get to the right person that can answer my question or help me. So that's really important. 

You've got to have that advanced technology that can navigate these organizations recognize that a patient is part of a certain cohort and should be treated differently versus someone who doesn't have a chronic disease, isn't on a value-based care contract, and probably can just self-service a lot of things because it's pretty simple. They're having their annual physical. That's good. Getting my annual like check check check I do 3 things a year and I’m good right and that's the only in you know time I really engage with health care. That's fine. Let them self-serve that takes time away from those agents that are suspending there and are able to work more with our more complex patients that do need more guidance and do need more help and should be attended to in a different way so we've got to be able to separate that today, people call in and they're expected to know what they need to do, right? That's the first question they ask you. Where do you want to go? What do you want to do? Well, sometimes they don't know. I need an appointment with a doctor, Smith, and, you know, there's 12 of those. I'm not sure. This is just what my doctor handed me, right? Because when you discharge from the ER today, they hand you a piece of paper or they tell you to go to your portal and here's all the stuff, right? You go do that.

So that becomes a really challenging thing. We don't do any proactive follow-up to say, hey, look, we got your referral, call us, or here's a link that you can go in and you can make an appointment, here's some opportunities, things like that. We don't tend to do a lot of those types of follow-ups when it comes to discharging from hospitals and things like that. You know who does do that, though, are the payers because they're the ones that pay the bill. So they tend to call you and see what's going on. But that should be more unified, right? I mean, I think that's an important aspect of caregiving is helping navigate through these things. But people have made entire businesses out of care navigation because we're so hard to navigate.