Another Kind of Tele-Home Health: Medical Call Centers

Robert M. Johnston, M.D., Richard L. Nevins, M.D., and Michael L. Weaver, M.D.

The authors are co-founders of FONEMED, LLC.

Written for the August 1997 issue of Telemedicine Today

    Patients today are increasingly proactive about seeking health information and participating in decisions about their medical care. Much of healthcare, perhaps 40%, consists of the simple exchange of information between experts (physicians and nurses) and patients. Until recently, the surest way to assure this exchange was to see a physician in his office. This can be a time consuming, expensive, and highly inefficient way to address symptoms that simply do not require face-to-face assessment. This is especially true in the after-hours setting, when what would have been a simple office visit during the day becomes a very expensive emergency room visit at night or on the weekend.

    There is a simple, inexpensive way for patients to "see" a qualified healthcare worker after hours - for reassurance, for advice, for education, or for triage to a care center as necessary. That is by establishing a "medical call center" staffed by trained nurses. A study published in 1993 (see Reference) reported the 4-year experience of a call center that took after-hours phone calls for 56 pediatricians in the Denver metropolitan area. During the study period over 100,000 calls were managed without any adverse clinical outcomes. Just over half the patients were managed with home care advice only, and 28% were given home care advice after-hours and seen the next day in the primary physician’s office. Of all patients directed by the triage nurses to a care facility to be seen after hours, 78% were determined to have a condition necessitating after-hours care. Satisfaction among subscribing pediatricians was 100%, and among parents it was greater than 96%. Our experience with a wide range of patients (not just pediatric) confirms that these findings apply also to adults.

Role in managed care

    Increasingly, medical call centers are seen as a way of short-circuiting the expensive, doleful process that sends so many anxious patients to the emergency room late at night for what turns out to be a trivial or "delayable" condition. Call centers, coupled with other low-tech approaches to patient education, have evolved into what is called "personal healthcare management." This is becoming an important way for managed-care entities to reduce the cost of covering lives while maintaining or improving quality of care. Personal Health Management Programs, an umbrella term that includes medical call centers as a key constituent, covered about 8 million lives/year in 1994. Currently, call centers respond to almost 100 million calls/year from about 35 million covered lives in the US, with virtually no incidence of litigation. At current growth rates they could cover 100 million lives by 2000. (Source: Merrill Lynch & Co. See chart p.23).

What happens when the patient dials the call center?

    Medical Call Centers connect patients by phone, 24 hours/day and 365 days/year, to the health information they seek. When patients in need of medical assistance call a Medical Call Center, they will typically hear a custom greeting designed for the organization to which they belong. The caller will have the option of being connecting to the audio health library or speaking immediately with a Registered Nurse. If the caller selects to talk with a nurse, the nurse works through the patient's symptoms and recommends an appropriate course of action. In our system, 90% of all calls are answered by a nurse within 20 seconds of going into the call queue. With proprietary software, triage nurses have at their fingertips the patient’s recent call history and their doctor and coverage information. Members will know immediately if their visit to a provider will be covered by their insurance because callers are matched against the system’s knowledge base of health plan requirements. Member satisfaction is increased, and claims adjudication costs decreased because the approval process for many visits will occur up front.

    For the actual triage process, the nurse uses medical algorithms that serve as a guide for appropriate management for the situation at hand. This could mean telling the patient to go to the Emergency Room immediately, helping the patient in self-care, or recommending an appointment with the appropriate medical provider. If the patient is told to go to the Emergency Room, a record of the patient's call is immediately sent to the ER to expedite the emergency care process. If a doctor's visit is suggested, the nurse tells the patient how soon to see the doctor, and the patient's call record is transferred directly to the doctor's office.

    Other Medical Call Center services include 24-hour access to audio text health libraries for patient self-education. The system we use consists of over 1,800 topics. These reduce the amount of time nurses need to spend giving out basic health information, and they allow the calls that are subsequently transferred back to the nurses to be handled more efficiently, as the members are now more educated about their topic of concern.

Cost and savings

    The cost of enrolling subscribers in a medical call center service varies depending on the size of the contracting insurer and other factors. The cost/ year for a family of four for basic medical call center coverage ranges from $15 to $107.40. A recent study from the Center for Corporate Health showed that for every $1 dollar invested in a telephone-based health management system, $4.75 was saved through better self-selection and use of resources.

    We believe that a Medical Call Center is the single best strategy to deliver the right care at the right time in the right setting with the right resources. Medical Call Center activities are measurable, manageable and actionable, and can form the core of a highly efficient health care structure with very high patient and practitioner acceptance.

Source: Equitable Securities

Reference