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TownHall: The Ongoing Journey in Modernizing a Patient Access Center

February 16: Today on TownHall Reid Stephan, VP and CIO at St. Lukes talks with Jeffrey Sturman, Senior Vice President & Chief Digital Officer at Memorial Healthcare System about the ongoing modernization effort for their patient access center. What has he learned in going from a decentralized to centralized model in the patient access center space? Has he found any effective ways to measure success of new implementations and initiatives? What have been the challenges and unexpected delights of the journey so far?

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Today on This Week Health.

think healthcare has always been hard to adopt change. Yeah. So when a physician practice that has, been private or independent from a healthcare system is incorporated into our environ.

That's a very hard thing to manage.

Welcome to TownHall. A show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels dedicated to keeping health IT staff and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward. We want to thank our show partners, MEDITECH and Transcarent, for investing in our mission to develop the next generation of health leaders now onto our show.

Welcome to this week, health Community Talent Hall Conversation. I'm Reid Stephan, VP and CIO at St. Luke's Health System in Boise, Idaho, and I'm joined today once again by Jeff Sterman, senior Vice President and Chief Digital Officer at Memorial Healthcare System in Florida. Jeff, welcome and thank you for being a return.

Thank you Reid. Looking forward to it.

Okay. Last time we had just started to dive into , your patient access center journey and we ran out of time and so I'd asked even on our interview, if you come back and you graciously accepted, so I wanna pick that back up. Let me kind of start with a high level summary of some of the key points we covered and that'll create the backdrop for our conversation and.

Clarify or correct if I get any of this wrong. So from my recollection, your C E O approached you and said, Hey Jeff, I want you to lead our patient access center, which is really your centralized scheduling and intake capability. You then took that on and one of the first things you did was to deploy. A cloud-based call center solution, the rmg with the information and the capabilities that you needed to improve operations capabilities like metrics, texting, chatbot, ivr.

Is that a fair, high level overview?

Yeah, absolutely. And I think that's all correct. I mean, this is a journey though, so to say that we have. Implemented all of those kind of omnichannel solutions, not quite yet. .

Yep. And that's what I love about this conversation, right? This is not a mission accomplished kind of conversation.

It's, Hey, here's what we've done, here's what we're learning, here's where we're going, and there's great value in that as we all kind of are in different stages of maturity in our own journeys. So you had talked last time about you've moved from, or maybe are moving from more of a decentralized model to a centralized model in this space.

And in my experience, that kind of move can be a really difficult change management exercise. What have you learned through this? How have you successfully been able to navigate this and accomplish.


I mean, , you hit the nail on the head just by your question. It, is more about culture and operations and change management than it always is about technology.

The technology here was foundational to where we wanted to go and how we wanted to get there. We knew we needed to get data to make good insights into where we needed to look at improvements and look at opportunities for efficiencies But the journey has been very much that it is getting a bunch of physician practices that have historically worked very independently of each other, not in a centralized manner, candidly, had different voices even on the other side of the phone in terms of automation.

So creating that level of consistency has been part of our mission so that we can standardize and get to, again, a much more consumer centric model while also trying to figure out what do we need to do operationally? So do we centralize? All call centers right out of the gate. We decided that was a, non-starter.

We knew we needed to start in a phased approach. So that's where we are. We're still phasing in physician practices. We have centralized many of those specialty practices. We have also centralized all of our hospital based imaging, radiology visits. which By volume is by far the largest volume of centralized scheduling for the healthcare system.

And like I said, there's a lot more to come over the next couple years by bringing in more and more physician practices. But the learnings have been that one doesn't equal one and one physician practice the way they operate is not necessarily the way another physician practice operates. So It is very much a change management exercise, a cultural and operational change exercise for each one of these practices as we incorporate them in there.

Again, the technology all in place Today, everyone's using our cloud-based call center solution, so we have metrics that can guide us, but the hard part is really bringing all the people and making sure that we have the volume of resources that exist in the call. center To do the things that they need to do, whether that be answer the phone or whether that be texting and chatting and ultimately where we're gonna go with more IVR chat bot type solutions.

Yeah, and I think you articulated that so well. Like this is not a a one size fits all approach. For sure. Have you found any effective ways to be able to measure success so you can go back and show both your operational partners But also the patients that we're trying to improve the experience for how are you kind of measuring to ensure that you're accomplishing what you set out to accomplish, and then be able to tell that story in a way that reassures people who are having their cheese moved that is worth it.

Well, a a couple things here. I mean, I, I think measuring , is always a hard thing to do. But the proof is, there, when you look at the statistics, when you look at the data, when you look at our call abandonment rates, when you look at call, answer times. So all of those data points point in a direction that we're getting better at the way in which we communicate from a volume and data standpoint but I think the real value and the real proof is just by level of customer satisfaction. I know we get a lot of stories and we're hearing a lot of information. Frankly secondhand sometimes, but if we're getting less and less calls, we're doing star ratings now. So we're doing more with regard to marketing and consumer experience than we ever have.

And we're sending text messages as a result of interactions for survey information. So we know based on that. , information the good and the bad and you have to do something when there is something bad. So just getting information that, the level of satisfaction wasn't what a patient or a consumer wanted.

As long as there's follow up and we're seeing this, there's a higher level of satisfaction historically. We didn't know how bad we were and therefore there was very little follow up. part of this is setting expectations and communication patterns but I think it's rooted in all of those kind of aspects, both quantitative and qualitative.

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You know, I think evidence shows that, and just from personal experience, the likelihood of a consumer getting a call, receiving a voicemail, listening to that voicemail, then returning the call, it's like a single digit kind of engagement measurement versus if they get a text and respond that way, there's a much higher kind of engagement measure.

So, I'm gonna assume here that you've seen that benefit with your operations. , how was that translated in terms of, increased productivity and has that meant like you've re reduced the number of agents you need, or you redeploy them to work in higher value kind of areas? What does that look like for you on your


I wish I could say that it had been a reduction in total number of agents, but Reid, I can't because candidly, we were so understaffed Yeah. In our call centers that we needed more resources, not. No matter what channel we go after, and so as we get more mature in the way in which we're communicating with our patients and our consumers, again, not everyone is gonna want to make a phone call.

Not everyone's gonna wanna receive a text. Not everyone's gonna want to communicate through an IV r or automation. So we have to have the right seasoned and knowledgeable resources for each one of those channels. And so that's the journey we're really on right now. In fact I'll digress for a moment, but we're mm-hmm.

we're building epic decision trees. We're very specialty heavy here at Memorial Healthcare System, meaning that we don't have a lot of primary care providers. We have a good number and a very sophisticated primary care department. However, in the grand scheme of things, we've invested over many years now in our specialists and specialists to.

Appointments is a lot more complicated. And so whether it's authorizations or referrals and working with the different insurance companies, we're creating decision trees that can really guide patients to be much more self-sufficient. Yeah, so that idea of self-service and using MyChart to drive that level of interaction is huge for us.

I think this is gonna. probably unfortunately multi-years in the making. It's already been at least a year in the making. But that's gonna drive the way I think most of our consumers are gonna wanna interact with us in the future, and that's through a level of automation. And if they don't want to communicate with us that way, they can always call the call center.

We haven't seen a reduction in FTEs. We've outsourced some components of the call center that we feel are really easy and high volume and can be done by external agents while our internal agents are focused on the more complicated stuff.

You know, I think you made a couple of points that are so important and I hope listeners who maybe are just starting a journey around trying to modernize their call center.

Take this, point to heart. I don't think you should ever lead with, you know, as we do this, , we're going to reduce headcount because I think the situation you're in is pretty typical where call centers are already understaffed and so , the automation, the operational capabilities that you bring, the productivity gains.

May not result then necessarily in an immediate headcount reduction, but they could result in we're not gonna have to grow our staff and we're gonna be able to use what we have to then scale and do more than we would've otherwise. And the other point you made that's important is like this isn't something you measure in weeks or months.

This is likely gonna be a multi-year journey, and you just have to make sure you understand that and articulate that clearly. Going in. So you don't create expectations that aren't based on reality and then create the sense that it wasn't delivered as effectively as it could have been. So I think that's a really important point that you raised.

Yeah. And just to the, previous point around scale, I mean, what I hope we translate this to over time is that okay, maybe we haven't reduced headcount, like you said, maybe we create more channels by which we're interacting with our. Patients and our consumers, and therefore we're increasing the opportunity for access.

Yes, everyone is trying to solve the access problem. Yes, and I keep saying I don't control access, but what I control and what I can help facilitate is an efficient process by which a patient or consumer interacts with us. And then if I can get the decision trees to be much more in tune with physician templates, which is where the magic really happens, then I can potentially impact access.

And I think that's the silver bullet that we're all trying to really solve.

Yeah, and that's exactly where my mind was going as you were, saying that, you know, you said last time that you're called a patient access center and it's misnomer in that it's not about patient access the way we think of it traditionally, but.

What you provide that capability absolutely. Moves the needle on access. Yeah. And if we can give patients that omnichannel kind of methodology to engage with us when they want. How they want, where they want, that's absolutely going to improve, the quote unquote access challenge that we all face.

So, well said. Hundred percent. Yep. So as you think about your journey, I've got a two part question. What has been a challenge that you've faced that kind of caught you off guard or were surprising? And then on the flip side, what has been something you hadn't anticipated that's been just a wonderful delight as a part of this journey?

Well, I'm not sure it's a surprise, but I will point to people. People are always, always the challenge in these equations. We're very set in our ways and I think healthcare has always been hard to adopt change. Yeah. And so when a physician practice that has, again, historically been private and or independent from a healthcare system and is incorporated into our environ.

That's a very hard thing to manage. So to affect that change, to impact the way in which we do things for standards, for consistency, for what we know ultimately will be a better patient experience. It's a very hard story and a very hard sell at times to get providers and their operations to think about things differently.

I'm not sure that's surprising to anybody. It's certainly not surprising to me, but I will just tell you, it's harder. it ever was, or it's harder than it should be, I suppose. Yeah. And then, the flip side of that is, what has been surprising that has been, a nice delight, so to speak has been the willingness by, I think the very large organization that we're all a part of to get behind this, to sponsor it, to understand the strategy that we're ultimately driving to.

So it's not just Jeff in a corner by himself on an island, waving a flag. We need to do this because it's the right thing to do. It really is the senior leadership. It's the organization that sees the value of why this strategically is so important to get. Sometimes, as I said, the hard part, that doesn't translate down all that well sometimes, but it is nice to have this be viewed as a huge strategic differentiator.

Yeah. A way in which we need to move our healthcare system to be what I will call much more of a healthcare system as opposed to a hospital based system. Thinking about healthcare delivery in this new world that we're all living. Knowing that technology and digital means is a way in which we can modernize again, care delivery but also knowing that you're not by yourself.

Yeah. And that we're all beating the same drum, so sometimes. These sort of things. We've all implemented EHRs and ERPs and other technologies, and we always say it is not the reason we're doing this. It needs to be operationally, it needs to be strategic importance. It needs to be led by people that are not the C I O.

But in a lot of cases we get put on stage to talk about these initiatives, which I think is wrong in this scenario. Yes. This isn't about it. This isn't about digital. This isn't about something that is technical by nature. This is really transforming the way in which we interact with our patients and consumer.

And that's a hard thing to get through to traditional hospital executives who are expecting patients always to come to us. We're looking at this as a mechanism to get to our patients and consumers, as you said, any way they want to exchange with us. πŸ“

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β€ŠYeah, and I think, the way you worded that, it just strikes me that both your, what's been a delight is also the antidote to what's been the challenge or what is the challenge.

So without that organizational support, it's gonna be hard to overcome some of that understandable resistance, although sometimes the intensity of that resistance , is surprising in my experience. So I think those are really complimentary observations there that, and to your point, you have to have that organizational support if you're gonna be able to have this viewed as a strategic imperative for your system and not just a technology project.

And that's for sure. That's fundamental. look, as you look to the future of , your patient access center, what are you most excited about?

Again, I'm, gonna just go to transformation and thinking about healthcare in a new, paradigm, in a new, evolution of where we are.

I think, we've always expected patients to come to us. We're, the acute care hospital-based organization that we're going to always see and generate revenue and. Good quality and satisfaction by patients coming to the hospital. Unfortunately, hospitals are probably the worst place you want to go, right?

Yeah. It's, you don't ever wanna be in that experience. So this to me, is an opportunity, it's one leg of a stool, but it's one area that I think we all need to invest in because it's changing the way healthcare delivery is really operating. We talked a lot about omnichannel. We talked about consumers and patients wanting to exchange information any way they want to and getting information any way they want to.

Whether that be, again, through self-service, through chatting, through texting, and of course always the phone. Because that's not going away. But I really think this sets a foundation for even much more to really think about getting out of the hospital environment, delivering care in much more progressive, innovative ways.

And this is just the start to a lot of that journey. You know, We're all, I know it doesn't seem like there's a touchpoint here to hospital at home and virtual care and remote patient monitoring, but I do think there's a touchpoint to all of these things. I think these, sort of innovations and ways in which we're exchanging and moving patient care from a call center environment, historically To a contact center world of much more innovative mechanisms is gonna be supporting some of these other innovations that we're focused on. So I'm excited about, just thinking about new and change , and figuring out. How we take healthcare, hospital care to the next level like so many other industries have done.

Whether that be a pure state technology, industry, manufacturing, automotive banking. Obviously we've been so far behind. I think we're finally catching up.

Yeah, agreed. And we've talked before , this topic of a call center can be viewed as kind of, blase or a little bit boring and basic.

But as you said, I love the word foundation. Like this is a, foundational cornerstone. And if you don't get this right, and to your point, if we don't kind of catch up with viable capabilities that have been around for a long time, some of the other stuff just isn't going to matter. And so I love this conversation because, A lot of these operational capabilities translate really cleanly, whether you're in Florida or Idaho.

And so the hope is as we talk about it with each other, one, we, create this space where no one feels embarrassed, that they're spending time talking about their call center strategy and investing in how they operationalize that more effectively. But then two, we can create this rising tide, learn from each other and get there more quickly.

because there is this, synergistic ecosystem that we all play in, in healthcare. And so what happens to you in Florida that benefits you? You know, In a weird kind of butterfly effect. Impacts me in Idaho in a positive way as well. So,

I think you're, I think that Reid, your point is so important.

Yeah. I mean, so Right on. Because we always say that we're special cuz every hospital system thinks they're special. Yeah. And I'm sure we all are. Yeah. But I think there's so much more similarity and so much that we do alike that we can learn from each other. That we have to borrow ideas and, innovation, I know that's a funny word because people define it all sorts of.

Yeah. But I think innovation is frankly stealing ideas from you in Idaho and vice versa. Yeah. And so that we can all lift each other up together because Right. We've been so far behind as an industry. Finally, I feel like this level of collaboration, what you're doing on this call with me and I know with others we'll help.


Like we can all be fast followers, we can all be open to shares with what we've done. And it's to your point, it benefits everybody. Well, Jeff, always a delight to visit with you. Thank you for making time for two parts of what I think is a very important conversation and wish you well there in Florida and just keep, running with your patient access journey or your patient access center journey.

I think you're doing great work,

Reid. Thank you. Good luck to you.

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