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Dec 26 2011   12:00AM GMT

The debut of health care CRM



Posted by: Jenny Laurello
ACOs, CRM, Customer relationship management, Enterprise resource planning, ERP, health information exchange, HIE, Patient data, Patient engagement, Patient portals, PHR

Guest post by: Ruby Raley, Director, Healthcare Solutions, Axway

Today’s health care industry for the most part doesn’t offer patients and their families a one-stop shop where they can schedule an appointment, discuss a bill, learn about hours of operation, find out about emergency-room wait times and stay apprised of upcoming events that may interest them. ┬áHealth plans and/or providers often have websites where you can do some things — like obtain an explanation of benefits, learn about a deductible or even view emergency room wait times — but I believe those avenues aren’t top of mind for most people, and certainly aren’t the one-stop shop most people need. And even though more and more plans and providers are offering online services, that doesn’t mean those services are supported by a commercial CRM they may simply be exposing some collaborative services via a portal.

Because of this, I expect more providers will soon adopt customer relationship management (CRM) tools that offer a modern way to better engage patients and their families.

Consider the following scenarios:

  • A patient needs quick access to their health records or lab results, but doesn’t have time to endure endless interactions with receptionists, nurse practitioners, doctors and admissions. CRM tools will offer a central coordination point to help minimize those interactions.
  • A health care provider needs to interact regularly with a health information exchange (HIE), furnishing provider certification and attestations that support an up-to-date provider directory. The HIE also needs to collaborate with providers for general outreach and new-provider solicitations for joining the HIE. CRM tools will provide the health care provider with collaborative options beyond simple email or technical support for interacting with the HIE.
  • An accountable care organization (ACO) — an organization that provides a higher level of care for certain chronic or acute conditions that need a managed care approach — needs to simultaneously report a diabetic patient’s blood sugar levels to a specialist, endocrinologist, primary care physician and ophthalmologist in order to come to a consensus about how the patient is progressing. CRM tools will enable the ACO to connect with all of them efficiently.
  • A self-employed consumer using a health insurance exchange (HIX) wants a variety of insurance options and needs a host of questions answered. That HIX’s call center, using CRM tools, will serve that consumer by providing customer service representatives (CSRs) to explain options and co-insurance choices, as well as answer ad hoc questions.

What can an organization do today to ensure their infrastructure is ready to support these new applications of CRM?

First and foremost, they can:

  • Become familiar with the idea of integrating classic CRM systems with enterprise resource planning (ERP). A CSR’s degree of access to sensitive information, the time sensitivity of a response and other issues can completely shift how information flows across a health care organization and how that information is coordinated and controlled. Integrating classic CRM systems with EMR/EHR systems will facilitate this shift.
  • Build stronger CSR capabilities. Most importantly, investing in up-leveling CSR skills will ensure that they know how to resource technical support and provide real-time service to the consumer, provider, health plan and others. For example, healthcare CSR positions may require nursing-related skill sets and training. They can improve CSR responsiveness by investing in the right technologies, such as high-speed data lines for CSRs not local to the data center.
  • Ensure that their core systems can provide visibility to external users. EMR/EHR systems aren’t necessarily architected to provide interfaces to CRM systems out of the gate, so organizations may need to make policy and governance decisions regarding what data can be shared with whom. But once policy is in place, providers can enable patients to receive updates through the patient’s EHR or hospital-provided EMR, routing any resulting questions directly to the CRM, for “custom” CSR follow-up.

Many organizations have not yet built out a “single face” for their patient community – that is, one that integrates billing, procedures and proactive health services. But for those of us thinking through emerging health care IT challenges, it’s already apparent that the rise of CRM is going to have a marked impact on IT infrastructures everywhere. Savvy companies that plan for and act upon this forward-looking strategic view now will build the infrastructure and culture for future health care CRM success.

For more information, please visit www.axway.com.

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