• July 1, 2006
  • By Marshall Lager, founder and managing principal, Third Idea Consulting; contributor, CRM magazine

Market Focus: Healthcare: CRM Says ''Ahhh...''

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It's hard to imagine a more customer-centric industry than healthcare. While most businesses sell products or services, healthcare providers like hospitals and private practices keep customers--the patients--alive and well. Healthcare payers, the other part of the industry, enable those patients to afford the ever-increasing cost of medical attention. Yet most people would report negative experiences with those organizations, centered on lack of understanding of individual patient issues. Scott Schumacher, senior vice president and chief scientist of Initiate Systems, spells out the need. "The most important part of [healthcare] CRM is integrated patient records," Schumacher says. He relates the oft-quoted hassle of filling out a medical history and insurance information, and then waiting. "Electronic medical records get rid of all that--it makes the check-in process more palatable. "Currently, all patient data is stovepiped; lab work, imaging, and history are kept in separate systems. One of the things we do is enable communication between these siloed systems," Schumacher says. There's good reason for this. "If you don't match two records that you should have put together, such as with drug allergies, you will have more than just a dissatisfied customer." CaseStudy: Speedy Intake for Hospitals Patient billing is the part of healthcare where CRM is most in use, but it's still complex, frustrating, and time-consuming. Errors at the beginning of the intake process create slow payments, improper billings, and denied claims at the end. Not in Cincinnati's TriHealth hospital system though--now that they're working with Cincom to streamline the registration process. TriHealth, a partnership between Bethesda and Good Samaritan Hospitals, performs over 2,000 patient intake registrations a day. The process includes creation of the patient's medical record, which must be accurate for appropriate treatment and care, according to Yvonne Focke, director of access and care management for TriHealth. "The issue was how to help my registrars remember all the different and changing rules that weren't in our registration system and couldn't be made part of it," Focke says. "Inefficiency can make us too late on a claim, or fail to get authorization before tests and procedures." What TriHealth needed was a new way of doing intake, one based on business rules that could be updated quickly. "We discovered that Cincom had a product, then called Socrates, that was a rules-based overlay to guide registrars through a series of questions to get the right result," Focke says. TriHealth contracted Cincom to provide a solution, and that has since become Cincom IGR, a product produced in partnership. "Insurance codes have lots of numbers and very complex rules," explains Mike Greenwald, Cincom industry consultant. "Socrates was originally used in manufacturing for quote-to-order automation, and we expanded it to health. Let's provide something to registrars so the information is at their fingertips and guides them through the registration and collection process." Another part of Cincom IGR's value is the ease of update. "It doesn't need to be maintained by IT; insurance professionals can go in and update it. This negates the need of retraining and sending endless memos about new rules." In just six months TriHealth has realized exceptional benefits from Cincom IGR. Initial orientation time was reduced 15 percent, and continuing education training is down 50 percent. Employee retention has improved 25 percent due to reduced complexity, and satisfaction is up a like amount. Medicare and HIPAA compliance are 50 percent better than before, resulting in a one-third reduction in auditing and a 20 percent reduction in eligibility rejections. Just as important, Greenwald says, is patient care. "We keep the patient experience as pleasant as possible. They don't want to be barraged with questions while they're sitting in an emergency room waiting for care." "Most mainstream CRM technology is found in billing and accounts," says John Quinn, a senior executive and CTO of Accenture's Health & Life Sciences provider practice. Even in actual patient care, most CRM is focused on lower level activities. "Home health and elder care are where most of the classic CRM can be found. It's care management--not charts and medical histories, but reminders and simple upkeep." The issue, Quinn says, is integration. "Integration to clinical CRM is not an off-the-shelf thing," Quinn says. "The federal government has tried several initiatives to integrate health info. The first requirement is having that info in structured, coded electronic form, something 80 percent of providers don't have." That will change out of necessity, according to Jocelyn Young, research director at Datamonitor. The payers are used to dealing with employers, but the scope of relationships has expanded to individuals, increasing competition for customers. "Consumers are much more involved with their own healthcare and management because they are receiving more of the financial burden," Young says. "As they play a bigger role in selecting providers and payers, there's a growing need to cater to them." Hospitals advertising their services and expertise are one symptom of this trend. Eric Brown, research director for healthcare with Forrester Research, explains that another effect will be the repackaging of consumer healthcare options as friendly and interactive tools. "The complexity of healthcare is a big barrier to members getting full value. The trend is to give them more input and control, making them market drivers. But especially in HMOs, issues like cost and quality are taken off the table." Good CRM will help change people's perception of the system. "In a consumer-directed world, the consumer is given more control but it's more complex," Brown says. "The goal is to have the plan be viewed as a decision-making advocate, not part of the problem. Patients should think, 'It's me and my plan against the world,' not 'me and my doctor against the plan.'"
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