American healthcare organizations, for- and non-profit alike, are engaging in a tricky balancing act between cost management and patient satisfaction.
Management must ensure efficient administration and strong revenue streams to finance patient treatment. And, at the same time, they must manage patients’ abilities to pay for that care. The goal is to improve the outcomes for the patients and the organizations caring for them.
(Full disclosure: my stepson is a director with a large healthcare organization.)
At the tipping point in this balance is the contact center. In healthcare organizations they represent a vital means of driving in revenues through handling billing and ensuring patient satisfaction. But they are a cost source, whose performance and productivity must also be carefully managed.
Unfortunately, maintaining that balance and meeting that objective has become arguably more difficult in the post-COVID-19 pandemic era.
Healthcare organizations must cope with factors including an uncertain economy, whipsawing public policy changes, rising costs, and an aging population creating a higher demand for healthcare services. While, at the same time, they must also be mindful and ready for the next major public health crisis.
So, how can these organizations – and their contact centers – best plan and respond to ensure favorable outcomes all round?
Introducing CaduceusHealth
CaduceusHealth, based in Jersey City, N.J., is a leading outsourced management company. It focuses on large physician groups, typically those employing 100 to 1,000 physicians.
Employing the Athena Health software, CaduceusHealth helps physicians and healthcare providers analyze their business processes and discover new ways to create efficient and compliant workflows within their practices. It provides revenue cycle management, analytics, and management services.
To assist the clientele and their patients, CaduceusHealth has a fully remote contact center with over 200 on-staff agents located across the U.S. It moved the center to the remote model during the COVID-19 pandemic and has continued with it.
But like other healthcare organizations, CaduceusHealth has been facing challenges in maintaining that balance in the contact center. It not only has overcome them, but it is also now exceptionally ready to face what is next.
To find out how, we had a virtual conversation with Grant Knaggs, who is CaduceusHealth’s COO. Here are the highlights and insights from it.
Q. Tell us about the functions of your contact center.
Our contact center primarily handles patient billing, inquiries, and scheduling for major healthcare providers. The staff researches and resolves billing discrepancies and ensures patient satisfaction and efficient payment collection.
Q. What were the challenges that your contact center faced?
We had several quality assurance (QA) issues. After shifting to the remote model, we faced significant inefficiencies due to a lack of visibility into agent processes and work hours. This resulted in an unacceptably high call abandonment rate of 14%, coupled with an equally unsatisfactory staff turnover rate reaching 27%.
There was also inconsistent tracking of work hours: i.e., agents getting paid for scheduled hours rather than actual hours worked. This not only led to poor call center performance but also unnecessary labor costs.
“Our primary goal was to improve productivity...we aimed to bring the call abandonment rate to below the industry best practices of 5%.” — Grant Knaggs
Despite a skilled workforce, we also faced challenges in meeting growing service demands and maximizing client satisfaction. But traditional tracking methods, manual reporting, and spreadsheets failed to provide real-time visibility. This left managers in the dark about productivity bottlenecks that impeded our meeting those demands and ensuring satisfaction.
We realized there was a pervasive lack of accountability. This was due to the combination of a lack of visibility into remote work, as noted, and an absence of accurate data for measuring and supporting agent processes. Something had to change.
Q. To help with QA were you recording all your calls or only some of them? And if only some, why was that?
We were recording some of the calls, but we couldn’t analyze them to help us with quality management at scale. We didn’t have a technical solution that enables this process.
Q. What solutions did you select and why them, and their vendor?
We wanted a solution that could provide the level of visibility we needed to effectively manage and assess contact center performance.
So, in October 2023, we selected Insightful for its real-time workforce analytics, which has been purpose-built for contact centers. After testing it alongside two other solutions we made our choice due to its ease of use, straightforward deployment, and detailed productivity analytics.
Unlike traditional tracking tools, Insightful pinpointed workflow inefficiencies, optimized staffing based on demand, and increased employee engagement with clear performance insights. Instead of reacting to problems, leadership could now proactively improve efficiency.
Q. What were your goals and expectations?
Our primary goal was to improve productivity by reducing call abandonment rates, enhancing employee accountability, and building a culture focused on transparency and excellence.
Specifically, we aimed to bring the call abandonment rate to below the industry best practices of 5%. A significant part of our inefficiency was also due to a discrepancy between paid hours versus worked hours. Our goal was to close the gap in the difference between these two numbers, as this would deliver real efficiency and productivity.
We sought data that would allow them to perform qualitative and quantitative assessment of calls. We have a team of 11 full-time analysts. The adoption of Insightful was designed to provide data that the analysts could use to analyze the quality of their work by following call best practices, and the quantity of their work by tracking claims processed per hour.
Finally, we aimed to lower employee turnover, thus reducing agent recruiting and training expenses and to eliminate productivity lag as new agents come up to speed. While, at the same time, ensuring quality care for our clients’ patients.
Q. How did you implement the solution, including agent training and overcoming any challenges?
The initial implementation involved trialing Insightful internally with senior leadership, then gradually rolling it out department-by-department.
Agent training focused extensively on clear communication of expectations, standardized operating procedures, and rigorous QA practices.
Overcoming initial resistance from IT was a notable hurdle, but this was managed by demonstrating tangible benefits through pilot deployments. The adoption accelerated after seeing improvements in visibility and operational consistency.
As part of the restructuring and the launch of Insightful, we decided to record all call center interactions as we now have the means to effectively analyze their data.
We introduced a QA process that involved reviewing a random selection of recorded calls against established standards. In the event of a complaint, the relevant call recordings were reviewed in detail using the same criteria. QA results were regularly shared with employees to support feedback and ongoing training efforts.
Q. You mentioned restructuring. Could you outline that?
When COVID hit, and everyone went home, we realized we could run our operations as a remote model and downsize our office space.
Once COVID ended, we couldn’t bring people back in even if we wanted to, because we’d hired people all over the country. That really drove us to start making more investments in our work from home model. Now our entire call center is remote. And we use Insightful as the backbone for this remote model.
Q. What were the results and how did they compare with expectations?
The results exceeded expectations significantly all round. Here are the data points from 2023 to 2024:
- Call abandonment rates dropped 78% to just 2.7%, well below the industry benchmark, and almost three times better than the healthcare industry benchmark of 7%.
- Staff turnover decreased by 27% thanks to a 30% increase in employee engagement by creating a culture of transparency.
- Productivity increased by at least 20% year-over-year through smarter workflows and real-time insights.
- Faster response times and reduced service delays drove increased customer satisfaction and loyalty.
- Meanwhile, our operational budgets consistently met aggressive monthly targets.
An unexpected positive outcome from the investment and the data collected was the lack of employee misuse of network resources. Thus, showcasing high compliance and ethical standards.
Every department now shares daily updates. Even in a virtual environment, I can see performance in real time. That level of visibility just didn’t exist before.
We look at major variances in the data. Then managers can have a much more detailed conversation with the employee to get back on what’s the reason for this large variation.
As an organization, we need to make sure that we’re articulating what we want in detail across the board on every single item. So, there is a vast amount of standard operating procedures that you have to write and then reinforce through training. We also need to show that not only is this what’s expected, but we will train you to show you exactly what we need to do.
“Agent training focused extensively on clear communication of expectations...”
We’ve also implemented a career development plan that promotes high-performing individuals into more advanced, higher-paying roles that require greater skill. To support this growth, we are making significant investments in employee training. While this results in some backfilling of positions, it’s a reflection of internal advancement rather than external attrition.
I’m very proud of our call center. We’ve managed to build a process where we handle the callers here in the U.S. So, our clients’ work isn’t sent to India, and this is due to our efficiency and ability to get things done.
We’ve had offers to buy our call center. That tells you something: we’re doing it better than companies whose entire business is running call centers.
Q. Where does CaduceusHealth go from here?
We are expanding our use of workforce analytics company-wide, driving operational excellence across all 50-plus departments.
We are also planning to refine our remote productivity model continuously, focusing heavily on enhancing employee training and skill development, and leveraging analytics to optimize workforce management further.
Finally, we are also working on a progression plan to internally promote and retain skilled employees, leveraging their refined productivity practices and cultural alignment.
Q. What are your best practice recommendations to other similar healthcare contact centers?
When implementing QA technology or processes, we recommend clearly articulating employee expectations, maintaining high transparency, and sharing the results of the data collected.
To drive culture change, it’s got to be a numbers-driven culture. This data provides a clear north star for what an organization is trying to achieve and then allows tracking against this stated goal. To build a culture of excellence, this approach has to start with company-wide leadership buy-in.
We also note that when using workforce analytics data, it’s not about micromanaging or calling out a few hours here or there. That’s not a focus. It’s about spotting patterns of inefficient processes at a more macro level and then providing the necessary support or training to instill best practices.
Finally, the expectation of exactly how we service our clients’ calls needs to be there, the training needs to be there, and then in terms of how you are going to be graded.
It ties exactly back to how you’ve trained agents. You have to make sure, as an organization, that you’re driving that expectation clearly in terms of want and making sure that everything’s in that secret source to blend it all together.