The most effective way to reduce the amount of money our country spends annually on healthcare – which now exceeds $4.1 trillion – is to help 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 driving down costs.
VBC is great in intent and theory, but many provider organizations today are struggling to meet the quality and financial metrics stipulated under these contracts. Under most VBC models, providers bear partial and even full risk for meeting quality and cost of care metrics.
What kinds of risks are we talking about? Last year, one health system cut a check to its payer for more than a million dollars because the provider organization failed to hit its metrics.
It’s no surprise, then, that many providers used to the fee-for-service payment model are leery of the financial risks they face under a typical VBC contract. In a survey of providers, payers and integrated “providers” by the Healthcare Financial Management Association (HFMA), 61% of respondents cited reluctance to assume downside risk as a significant factor in their failure to adopt VBC.
Democratizing data
For those health systems currently struggling under VBC, it’s imperative that they start meeting these metrics and become more proactive with them because what they’re doing today clearly isn’t working. The main obstacle to providers meeting the requirements of their VBC contracts is lack of data. The HFMA survey shows that 75% of respondents said gaps in data availability have negatively affected performance under their VBC programs.
One of the big selling points of EHRs was that when doctors are in the examination room with a patient for a checkup or a particular health concern, the EHR could tell them whether that patient is due for a flu shot. The key driver of value is not just the health system having the data but also surfacing it at the right moment to engage the patient and catalyze the desired action.
Providers have taken the same concept and brought it to population health, where the same data about a gap in care can be used to target outreach to segments of patients with reminders. But while these programs are important, outbound phone, text, mail, and email campaigns are limited in reach and can be costly. And these organizations already have interactions with patients every day that too often don’t have any value-based component. Those interactions are the inbound, reactive calls and chats fielded by their contact centers.
Healthcare organizations historically have viewed the contact center as a cost center, a way to communicate information to patients and members and handle their basic requests regarding appointments, coverage, billing questions, and more. But a modern, AI-enabled contact center can be a driver of value, especially in a VBC environment.
A natural shift vs transformation
When provider organizations consider shifting their contact centers into their VBC or population health strategies, there can be a tendency to view it as a major change or transformation project. After all, for most health systems it requires changes to the people, processes, and technology in play.
But the good news is that leading organizations incorporating proactive, value-driven processes into their contact centers are doing so without major disruption or extra resourcing. Modern customer experience (CX) technology is built to help other industries make customer service transactions more profitable, not just efficient. A retail brand will think about up-sell and cross-sell opportunities and tailoring experiences based on customer preferences to maximize loyalty by closely integrating their contact centers with their customer relationship management (CRM) systems.
The difference in healthcare is that a patient’s next best action is not as simple as buying a new product or service – it depends on what is best for the individual patient. Thankfully, integrating EHR systems with modern contact center platforms is becoming an industry standard. It enables providers to bring patient-specific recommendations to agents during conversations, as well as adapt self-service workflows to be more proactive and personalized. Agents can rely on EHR-based recommendations to close gaps in care without learning new software or being trained in totally new processes to find them.
Optimizing touchpoints
Self-help contact center automation streamlines interactions between patients/members and healthcare organizations and frees up contact center agents to focus on more complex challenges that require human assistance and intervention. AI-enabled contact centers also empower support agents with data and recommendations about the next-best actions.
Epic has integrated its EHR platform with an AI-enabled contact center to democratize data and better enable provider organizations to meet the VBC goals of improving patient outcomes and cutting costs – while also boosting revenue. As a patient calls in to an Epic-integrated contact center, agents view all of the caller’s clinical information and suggest the next-best actions highlighted by AI, whether to get a lab test, make an appointment with a specialist, or resubmit a claim.
To fully democratize that clinical data and eliminate gaps in care, providers must ensure it is available in every patient/member touchpoint, from the autopilot to the patient portal to the chatbot. This is vital because it 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), such as lack of transportation. These are the patients whose chronic conditions, left untreated, can lead to higher healthcare costs. So, providers need to have these touches.
Conclusion
If provider and payvider organizations want to get the most out of their VBC contracts (and avoid signing seven-figure checks for failing to meet performance metrics), they must fully leverage their patient and member data in both clinical settings and in the contact center. This can produce better outcomes, lower overall costs of care, and generate more revenue – all of which help get the most value from VBC contracts.
About Patty Hayward
Patty Hayward is the general manager of healthcare and life sciences at Talkdesk, a cloud-native, generative AI-powered CX platform empowering enterprises in the cloud and on premises to deliver exceptional customer experiences.
