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AS SEEN IN
Hospitals
& Health Networks
IT SERVES
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YOU RIGHT
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Hassle-free health care builds loyalty, volume--and the bottom line.
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Article by Howard D. Larkin
Imagine promising your patients they'll see a primary care doctor within a day of phoning for an appointment-or a specialist within two days. Imagine
promising a breast cancer diagnosis two days after a worried patient's first call, with surgery and chemotherapy starting in a week.
In fact, these strides are already happening. The cutting edge of customer service just got sharper. "We're talking about zero barriers, zero wait
time," says Jayne Oliva, a health care consultant with Croes-Oliva Group in Burlington, Mass. Packaging especially counts: Services previously
scattered are being coordinated. Others centralized at hospitals are getting farmed out to local clinics where they're handier. "Instead of making the
patient traverse the system," she says, "the system will come to the patient."
All this raises the service bar for doctors, hospitals, and health plans striving to stay competitive. Most of all, it means learning to be more flexible. "It can be done, but not in the box you live in now," says Oliva. "It's not a change in the services that are delivered: It's a change in the way they're being delivered."
A QUICK TURNAROUND TAKES AIM AT ANXIETY
Since opening its doors in May, the Women's Pavilion at Milford Whitinsville
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For Ciak, faster service is a personal crusade: She has breast cancer. It's also a mission that Milford administrators are backing with $2.5 million in new construction and equipment, including the first advanced breast biopsy instrumentation system, or ABBI, in central Massachusetts. Using computers to locate and sample abnormal tissue, ABBI performs biopsies in an hour or less in 80 percent of cases-versus up
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Regional Hospital has cut the typical waiting time between a positive mammogram and a biopsy from two weeks to less than 48 hours. "If we can get the primary care physician and the patient to sign off," says medical director Barbara Ciak, "we can do it in under 24 hours." In one recent case at the Massachusetts facility, a woman who discovered a lump had a mammogram and biopsy the same day. She met with a breast surgeon the following day--and was in the OR on the third.
Reduced wait times cut patient anxiety and improve cure rates. "It's hard to pin down because cancer's progress varies so much from woman to woman," says Ciak. "But we can't be so ignorant as to say that there's no clinical advantage."
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to six hours with standard techniques. A separate computer system tracks lab and radiology reports, as well as risk factors based on family history.
Milford's ABBI system is on the same floor as primary care exam rooms, with a full arsenal of ultrasound, bone densitometry, and urodynamic testing situated nearby. The setup lets patients move from exam room to mammography to ultrasound, and even to biopsy, without making new appointments. Patients who receive bad news wait in private areas and can leave the center without passing through the waiting room.
Even this well-oiled machine would grind to a halt without support from doctors. Beyond those who staff the center,
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hospital radiologists and surgeons have agreed to be accessible for consults, says Ciak. "It's not perfect, but we have a good group of physicians who are very interested in breast care and have bought into the [service] concept."
It's too soon to tell whether the pavilion has helped Milford's finances, says CEO Frank Saba, but the hospital's reputation for service is spreading. He expects the center will help boost admissions for other hospital services, including cardiac care, lab work, and birthing. "We're already seeing new patients coming into the hospital," he says. "Ancillary services are picking up."
EASIER ACCESS = LOYAL PATIENTS
Renown for good service has done wonders at Sharp Mission Park Medical Group in Oceanside, Calif. A service improvement program launched four years ago not only reversed a loss of Medicare HMO patients, but helped put the 60-doctor group near the top in terms of access in Southern California. That's according to a 1997 survey of regional medical groups by the Pacific Business Group on Health in San Francisco and the Medical Quality Commission in Seal Beach. "It's nice to have the confirmation," says marketing manager Lorraine Ybarra.
Once the area's only medical group accepting Medicare BA40 patients, Mission Park saw patients leave when other local groups signed contracts in 1993. Market research showed that the slow referrals to specialists was the biggest patient gripe.
The medical group turned to its parent, Sharp HealthCare in San Diego, for help and eventually imported a customer service system called Making Your Mark. The program analyzes systems and drops unneeded steps. In Mission Park's case, the big bottleneck was the requirement that a panel of doctors approve all referrals. Plowing through stacks of patient charts not only frustrated busy physicians, but also caused delays of nearly two weeks for routine referrals for dermatology and other services.
Mission Park's solution: Set up protocols for referrals and put nurse reviewers in charge of handling requests. The group later hired more reviewers to help with the added workload, while a panel of doctors considers only nonstandard requests.
The results are encouraging- a 90 per-
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cent drop in reviews handled by doctors. More important, the medical group whittled down the average wait for routine referrals to less than 48 hours. "We're shooting for 24 hours," says Ybarra. That and other moves, including better training for staff who handle phone calls, have transformed Mission Park from pariah to paragon. "Good clinical quality is
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similar reports for other states next year.
Whether the information influences how members select doctors and medical groups isn't yet clear. But employers are cheering. PacifiCare even won the Pacific Business Group on Health's Blue Ribbon HMO Award, thanks largely to the Quality Index. "We believe the information is very important to the purchasing community and to individuals," says Ann Castles, a senior project manager at the employer coalition. "This gives them far more data than they've had before."
California's biggest public employee group is equally bullish. "This is exactly the kind of information our members have been looking for," says Fred Steinmetz, health benefit services chief at CalPERS, which represents a million state, county, and municipal employees. "The Quality Index will give our members an information tool enabling them to make informed decisions and ensure that they're receiving quality health care."
Aware of criticism that such data can be incomplete and misleading, PacifiCare checked with medical groups in developing the index and let them make changes before the first release. The plan saw a big improvement in data reporting-even overdue figures started showing up-once medical groups realized the information would have a wide audience. A major goal, says Norman, is convincing doctors to report data on every patient visit, so the HMO can keep closer tabs on quality. "We're working mostly in a capitated environment [in California], so we don't get the claims data that PacifiCare plans get in other parts of the country."
Not surprisingly, medical groups that did well applaud the report. "We're thrilled about the results," says Ron Bangasser, medical director of Beaver Medical Group. He and his colleagues won "best practice" stars in five categories, the most of any medical group. Even so, Bangasser worries that because HMOs lack standards for collecting performance data, they may distort the picture: "We have some trouble communicating, particularly with inpatient data. Others have more."
The Pacific Business Group also wants to be sure data collection is on the same page. "It's less confusing to consumers if it's uniform," says Castles. "If it's going to be used, it has to be understood."
Freelance writer Howard Larkin lives in Oak Park, Ill.
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"INSTEAD OF MAKING
THE PATIENT
TRAVERSE THE SYSTEM,
THE SYSTEM WILL COME
TO THE PATIENT."JAYNE OLIVA, Consultant
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assumed around here," says Ybarra. "This gives us a competitive edge." The bottom line: Medicare HMO enrollment has stabilized and even started to climb.
DOCTOR DATA SET HMO APART
Raising questions has a way of raising expectations. That's what PacifiCare of California, Cypress, learned when querying its members about how long they wait for appointments or how well their doctors explain treatment options.
In September, the HMO began posting clinical, administrative, and service outcomes from its biggest medical group on its Web site. These details, some coming from patient surveys, track quality benchmarks like cancer screenings and admission rates for congestive heart failure. The HMO also published typical markers of customer service, such as the number of complaints about access, disenrollment rates, and how often members are seen according to actuarial models.
The first public release involved 59 PacifiCare medical groups in California with at least 1,000 commercial and 500 or more Medicare members-1.3 million enrollees in all. Known as the Quality Index, the information also appears in PacifiCare's network directory.
"We hope to achieve a higher level of competition," says Gordon Norman, vice-president and medical director. "We're hoping the winners might win some market share through recognition of their efforts." PacifiCare should start releasing
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© The Croes•Oliva Group, 394 Lowell Street, Suite 6, Lexington, MA 02420
ph: 781-860-5131; email:
joliva@cogrp.com |
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