Centralized contact center 101

Frequently asked questions about setting up contact centers. If you don’t want these headaches, reach out to our contact center team.

What is a contact center

A contact center handles multiple channels of communications – email, text messages, phone calls, WhatsApp, Google My Business messaging, Facebook messaging, Twitter messages, faxes, website chats etc.

Many businesses have multiple locations and each location typically has its own local phone number. The contact center team or the front desk at each location handles new appointments, recalls, rescheduling, cancellations, follow up appointments etc. This includes both inbound and outbound communications.

What’s a centralized contact center

A centralized healthcare call center essentially just centralizes these functions to a single team, at a single location, typically off-site. The team in itself doesn’t necessarily have to be co-located. It is, however, important that the same processes and workflows are followed by the entire centralized call center team.

In a centralized healthcare call center, you are centralizing
– the technology and the infrastructure into one
– the management and oversight of the contact center into a single space
– the call types that your contact center will handle
– the training, security protocols, management into one place
– telecom costs

How a healthcare centralized contact center helps

A centralized healthcare call center helps
– Increased patient access
– Higher patient access leads to more patient acquisition
– More acquisition can lead to higher patient retention
– Higher patient retention often leads to higher patient satisfaction
– Higher patient satisfaction leads to better patient reviews (i.e reputation scores improve)
– Higher reputation scores leads to higher patient appointment requests (patient acquisition)

MGMA had done a pretty good study on centralized call centers (read here).
Today’s healthcare consumers are seeking out care that is convenient and easily accessible at a date and time they want to be seen. If today’s patients (new or existing to the system) do not get the appointment date and time requested, they will continue to search for a provider that meets their expectations.

How about decentralized healthcare call center model?

In this situation, you have multiple sites servicing your patient communications.
– Your contact center agents are geographically distributed.
– Your real estate footprint at each location / site could also be a lot smaller.
– The telecom, call center technology and infrastructure costs are also now spread across the multiple locations / sites
– You are not limited to the talent pool of a centralized contact center location
– Your training and hiring will also be spread across those decentralized sites
– Your disaster recovery risks per location are lower as well

Centralized or decentralized contact center

One general rule of thumb that we’d like to point out – a centralized call center brings in economies of scale and all the benefits from achieving economies of scale.

If your contact center is going to be staffed with only a handful of staff, there would be no economies of scale to achieve.

This means that you don’t have the need to scale.

Total costs of ownership of a contact center

Operating costs of a location would generally break down into a few well known categories. You’re going to have:
– Real estate costs
– Infrastructure costs
– Utilities costs
– Hiring costs
– Training costs
– Payroll expenses 

With a centralized contact center these are items that you achieve economies of scale with.
In a decentralized healthcare call center, you’ll have to incur those same costs at each location.

However, a decentralized contact enter model allows you to leverage several benefits as well.
– Labor arbitrage across locations wherein certain locations might be significantly cheaper than other locations. 
– Real estate costs across locations might also vary significantly.
– Having multiple locations allows you to have a backup site in case of natural disasters in one of your other call center sites.
– In certain businesses, customers might simply prefer being served in their local languages.

How contact center helps the front desk staff

– Checkin patients at home or even when they’re at the office
– Ensure capturing correct demographics
– If in healthcare, capture correct insurance details
– If in healthcare, capture the patient’s insurance cards, driver’s license for identity verification
– Update your back office records with customer / patient information
– Handle surgery counseling
– Handle surgery pre-operative signatures needed from patients
– Triage with PCP office for surgery medical clearance appointment
– Triage with other provider office to handle pre-admission testing (PAT)
– Provide follow up appointments
– Ask COVID screening questions before patient comes in for their appointment
– Answer all incoming calls
– Answer questions about services provided, insurances accepted
– Answer billing related questions
– Answer pharmacy related questions
– Make outbound calls for appointment reminders
– Make calls for customer / patient recalls
– Make outbound calls for reactivating patients that have fallen out of care
– Handle all faxes for medical record requests
– Handle outbound faxes for pharmacies
– Handle outbound faxes for consult notes
– Handle COVID results faxes

Are contact centers needed?

Advisory board had published an article “Must-Have Upgrades for the Consumer-Focused Health System” that shows the current state of patient access and makes a case of why health systems, primary care and specialists need to make patient access a high priority. They go on to explain why patient consumerism is forcing providers to change the way they do business. 

According to that report “Access a Major Decision Factor 6 of the top 10 decision drivers are related to access and convenience, when choosing a primary care Physician“.

Also, “42% of consumers report “short travel distance” as a top-three driver when choosing a specialty care provider”

KPIs for your contact center

Before you get started, try to gather at least the following metrics / business intelligence (current state)
– Scheduling correct appointment
– Average speed to answer
– Duration of call
– Call hold times
– Total or % abandoned calls
– Call volumes per week/month
– Call volume trends by day of week
– Patient satisfaction
– No show rates of appointments that were scheduled more than 2-3 weeks before appointment date

People needed for a contact center

Make sure you identify a steering committee that will take on this initiative and will guide/coach the team. If possible, include the following:
– Office manager(s)
– Site supervisors
– Patient access director (if you have one)
– Front desk/receptionists
– Billing department

How to roll out a centralized contact center

You could take one of these approaches
All locations and all doctors / service providers in one shot
– Opted-in doctors / service providers only
Opted-in locations only

All practice locations and all doctors / service providers

In this approach you decide on a cut over date and transition your entire practice and all its providers to your centralized contact center. There are several pros and cons to this approach.

Pros – Planning tends to be very thorough in this case and the committee tends to view this a lot more seriously (as there’s no rolling back). Standards are made quite stringent due to the same reason. Participation is a lot more active from all stakeholders as they realize that all functions are being transitioned over the call center. Various scheduling gaps are identified in this process because all locations come together towards the same goal. A centralized scheduling workflow is developed that is consistent with best practices and does not allow for variations based on doctors’ / service providers’ personal preferences

Cons – This is a big bang approach and investments are made up front, in one shot. The risks are higher in this approach as this could lead to larger disruptions, should the roll out not work perfectly from the get-go. Providers are hesitant because of their perception of loss of control over their own schedules. Planning requires more time – hence, executive management tends to view this as analysis-paralysis.

Opted–in of doctors  / service providers only

In this approach, your providers / doctors make the decision whether they want to participate / open up their schedules to a centralized call center or not. For the providers that do accept to participate, all their locations are made available for scheduling. 

Pros – This has the biggest provider buy in from the get go. It is a lot easier to handle as the staff has to manage only those providers’ preferences. It also allows patients to “follow” a doctor / provider of their choice. This allows us to test the waters and iron out the kinks in the transition process before bringing other providers onboard.

Cons – This is only a stop gap solution. If the end goal is to transition to a full fledged centralized call center, then this does add a bit to the confusions during the interim. Staff typically get confused about which schedules are available to the centralized call center vs which ones are not. There are also several dependencies between provider schedules (based on visit types) that are not accounted for in this approach. 

Opted–in of locations only

In this approach, you start a trial / pilot with only a few locations (or even a single location). 

Pros – This allows you to start with locations that have a lower call volume. This also allows you to start this “trial”, iron out the issues in call handling/scheduling before transitioning the entire practice / health system to using the centralized call center.

Cons – These are very similar to the issues you will face with the option above (opt in providers)

Location planning for a centralized contact center

You need to segment the languages your contact center *absolutely has to support*. This helps in planning your contact center location(s).

Once the centralized call center starts providing tangible benefits, this would increase the volumes of inbound calls for appointments.

That will increase team size needed and will increase the customers / patients serviced at each location.

This in turn would also improve the practice reputation, which will contribute to increased patient visits and appointment calls. 

What does a director of patient access do

Initially, this might not seem as very important, but having a single coordinator / director of all patient access challenges is crucial.
This person is directly responsible for patient access, satisfaction, maintaining KPIs related to patient AND provider satisfaction.

How to translate current scheduling system to a centralized scheduling system

Each location and service provider has several scheduling rules.
During this process of creating a centralized contact center, you will have to document the scheduling rules across various offices. This alone is a huge benefit and you will find areas of improvement + consolidation. Once you have centralized the scheduling rules, you can even use the same logic on your website to handle scheduling.

Contact center software needed

Call centers are run using one of many call center software available in the market (e.g. VicidialFive9, Amazon Connect etc).

However, none of the call center software is really integrated with your practice management software. That’s where most of the challenges crop up.

In healthcare, for a call center customer service representative to be effective, they need to have easy access to your EMR / EPM.

Their access needs to be up-to-date in real time, as changes to your appointment calendar occurs, as patients flow in and out of the system.

This step is crucial for success and should not be overlooked.

Determine the right staffing for your call center

Calculate the total number of inbound calls handled per week/month and also understand the seasonality of call volumes. Find out which days of a week, the call volumes are highest and staff accordingly.

Typical call durations are around 5-7 mins.

Next, use Erlang C model to calculate the staffing needs (e.g. here’s one).

Contact center supervisor and agents mix needed

Do not to skimp on hiring a supervisor. A general recommendation is that one manager should have no more than 10 direct reports. You need to hire call center agents with empathy.

You can have remote agents working from home. However, make sure that you are prepared for HIPAA and SOC2 compliance. Make sure your contact center staff understand compliance challenges + requirements.

HIPAA security and SOC2 compliance of your call center

One of the primary items in getting your call center to be SOC 2 compliant is the integration between your patient relationship management software / tool and your existing systems (EMR, EPM etc).

You need to follow a SOC 2 compliance checklist that guides you through these processes and includes measures like firewalls and malware protection.

You need to be able to demonstrate SOC2 compliance thus:
– Security protocols around how patient data is handled, how patient data access is tracked, time of access etc.
– Demonstrate training of employees to ensure that each customer service representative, supervisor, MIS personnel involved know security risks, procedures, and protocols
– Prove your compliance via extensive real-time and historical auditing of adherence to procedures and processes. 

HIPAA compliance is not very far away from SOC2 compliance in the sense that access, transmittal, mode of transmittal of ePHI is to be managed, monitored, audited and reported on. There are some excellent guidelines for enabling HIPAA compliance in your call center (e.g. read here).

Training needed for contact centers

Establish a training program – do not skip this. Contact center agents need to understand the importance of security, how you want your brand represented, data crucial for smooth back office operations etc.

Accuracy of appointments scheduled ends up being a sticking point for most of these transitions. While the ability to handle more patient calls is great , customer experience and appropriate / accurate appointment scheduling takes priority over volume of calls.

There are several items to train on. These are also the same measures that your quality assurance staff would monitor.
examples are below
– Correct spelling of caller’s name
– 1 or more patient phone numbers (mobile preferred), 
– Correct DOB of patient / customer 
– Whether doctor’s “desired” schedule was matched or not, 
– Was the right doctor selected for the visit type,  
– Was the appointment selected as per Nature Of Visit,
– Was the appointment booked as Per call notes,
– Was the call documented correctly (chief complaint, reason for visit etc)
– Referring provider / PCP info – was that collected or not
– Did we collect the source of patient appt (e.g. “where did they hear about us”)
– Was the correct payer name, plan name, member ID collected
– Was the patient advised on whether you accept that insurance

Try to have agents participate in mock calls before they take live calls from callers.

Call recordings for supervision and training

Call recordings are a must have – you are going to need them for quality audit purposes and you are also going to need it for training purposes.

Most call center software have the ability to record all calls. Keep in mind that medical call recordings have to be stored in a HIPAA compliant manner. 

Auditing call recordings for supervisory purposes is mandatory. While it is never going to be possible for your supervisor to audit all call recordings, a random sampling of 10% of call recordings every day is more than enough.

There are several factors to audit recordings on – here are suggestions.
– Call opening
– Call probing
– Empathy displayed during the call
– Call resolution
– Script adherence
– Call closing
– Call compliance

Scripts for your contact center agents

Sometimes it is better to not have all calls scripted – but we recommend preparing scripts for agents as you begin this journey.

Having these scripts created helps immensely with training and onboarding of contact center staff.

At a minimum, you need to have scripts for the following workflows:
– Inbound calls related
– Outbound calls related
– Appointments scheduling, rescheduling, cancellations
– Surgical coordination
– Pharmacy / medication related issues
– Patient balances collections
– Insurance / eligibility related issues
– Billing related issues
– Patient reminders
– Reactivating no-show patients
– Reactivating patients that have fallen out of care
– Appointing no-encounter patients
– Community outreach
– Patient balance reminders and collections
– Getting new patient referrals from existing patients
– Past due collections. Here, do keep in mind that if you are calling on behalf of your own practice, you are a first party collector and do not have to handle Miranda rights to the extent that a third party collector has to handle.

Get a single number for the entire practice

You can choose to continue with your per office phone numbers. To ensure smooth contact center operations, forward calls received at each of these numbers to a central number.

This central number should be the one connected to your contact center software.

Contact center metrics

You can decide on your contact center metrics. Here are examples:
– Inbound calls handled per agent
– Inbound calls response time
– Abandoned calls per day
– Longest call hold times
– No shows reappointed per agent
– Patients reactivated per agent
– Patient balances collected per agent
– Average call handle time
– Call source (“where did you hear about us”) per agent
– Agent utilization per day
– New patients acquired per agent 
– After call work time per agent
– % calls answered within the first 20 seconds.
– Calls resolved on first contact
– Appointment reminders made successfully per agent
– New patients acquired per agent via community outreach
– New patients acquired per agent via patient referrals
– New referrals received per agent via inbound calls
– New referrals processed per agent via outbound calls

Technology list for a contact center

At a minimum, you are going to need to plan for:
– Inbound phone numbers that you provision via your carrier or a VOIP provider.
– Extension set ups or direct inward dial (DID) numbers for each team member.
– Computers,
– Headsets
– Physical phones if that’s how your call center will operate
– Voicemail set up if you need it
– Web based chat software if you support that channel at your call center
– Software to enable patients to text your call center
– Soft phones (not all soft phones are alike)
– A reliable, reputable call center software
– Automated call distribution capabilities
– Skill based routing capabilities
– Call queues and routing profiles capabilities
– Call recordings – Audio file storage facility
– IVR set up
– Reporting and analytics software
– Whatsapp support software
– Facebook chat if you support that channel
– iMessage software if your call center supports it as a channel

– HIPAA controls and audit software
– SOC2 compliance controls and audit software

Costs of various call center software

From our research, here’s what we gathered
Vicidial – $400 per server per month hosting fee (after first month) plus cost of minutes. 1.5 cents per minute for outbound calls as well as inbound toll calls. 2.8 cents per minute for inbound toll-free calls
Talkdesk – Talkdesk starts at $65 per seat per month. Talkdesk also provides telephony (using Twilio) and charges a price per minute starting at $0.02 per minute for inbound calls and $0.03 per minute for outbound calls.
Bright Pattern – Bright Pattern pricing starts at $70.00 per month, per user. They do not have a free version.
NICE inContact – NICE inContact pricing starts at $100.00/month/user, 
Five9 – Five9 pricing starts at $100.00 per month, per user. They do not have a free version.
FluentStream – FluentStream’s “Essential” package starts at $20 per user per month. However, for access to more advanced features, such as integration and SMS capabilities, you might have to upgrade to their “Advanced” ($30 per user per month) or “Complete” ($45 per user per month) package. 
All of the above didn’t include the pricing for dial minutes.. Which adds to the costs even more so.
So, doing some basic math.. With the lowest of around $ Our small call center of 6 people would cost a bare minimum of $200/- for seat costs plus the dialing charges. If our team grew to 50, seat costs would be a minimum of $1,500/- per month