Healthcare Call Center Fails and How to Fix Them

Open Enrollment just wrapped up, and call centers were center stage, handling a high volume of calls from patients looking to secure their health insurance for 2023. On the front lines, ready to prevent call center failures, was Cyara, a quality assurance technology company that helps organizations, including those in healthcare, spot problems and resolve them before the customers discover them and hang up.

Show hosts Kym McNicholas and Dr. John Phillips talk to Cyara Senior Vice President of Customer Experience Dennis Reno about the biggest call center failures and how to fix them.

Troubleshooting High Call Center Volume

Dennis, with 40 years in call centers before joining Cyara, talks about handling high call volume for healthcare companies during open enrollment. Their software tests the healthcare company call systems to see at what level they will have a meltdown, if at all.

Call Center Success and Failures

Dennis admits that the “automated” and “human elements” can have challenges. Extensive automated phone trees and long wait times can lead to patient frustration. Also, options may not cover all of what patients may have questions about. When patients talk to a call center representative, scripts may not address all of a patient’s concerns.

Dennis explains why he urges companies to focus their call center training on ‘talking points’ versus providing a full script. He believes it may lead to fewer ‘requests for a supervisor’ because it makes the call more conversational, ensuring a patient feels heard and that their issue is resolved. It allows a call center representative more freedom to adapt to a patient’s needs.

Dennis shared a few examples of call center issues his team discovered quickly and averted. One involved remote employees. When a call center representative stood by a microwave heating something up, it rejected calls to that representative afterward. Another involved a series of numbers associated with a company’s marketing campaigns that led nowhere because the campaigns ended. Another involved a mishap in routing that led callers looking for bloodwork results to the morgue.

The Near Future Healthcare Call Center

Artificial Intelligence is improving the effectiveness of automated call centers. Dennis explains how we already see it with United Airlines where, when you call, it recognizes your phone number, can instantly scan your records and determine that it’s likely you are calling about your upcoming flight, and the system asks first if that’s why you are reaching out.

He says he’s seeing this happening in some healthcare systems. Some can recognize your phone number or recognize you instantly once you input your medical record number. Then the system can scan your records to assess what you might call about and prompts you with whether you are calling about your upcoming appointment, checking on the status of recent bloodwork, or if you’re calling to check to see if a prescription you ordered is ready for pickup.

Dennis says more facilities will probably transition to this more intelligent frontline system. Most have already started rolling out AI with the billing department first, as it’s the simplest area to automate.

Retired Call Center Supervisor’s Limb-Saving Story

In this episode’s Save My Piggies series, Connie, a retired Communications Center Supervisor for the State Highway Patrol, shares how she fought for her legs while helping to save lives. Connie was diagnosed with Peripheral Artery Disease, restricted blood flow in the legs due to plaque build-up, in June of 2020.

For Connie, she had blood clots that were building up in one of her legs, causing severe pain and swelling. Her EMT friend told her it was likely a blood clot causing symptoms and to go to the emergency department. The ER doctor, without imaging, told her that her leg cramps were likely a lack of potassium and to ‘eat more bananas.’

The next day, her general practitioner ruled out symptoms of a DVT (Deep Vein Thrombosis) or blood clot in her vein and told her to seek immediate care if her discomfort doesn’t improve. Two days later, an urgent care doctor sent her back to the emergency room for a suspected blood clot. This time another emergency room doctor called in a vascular consult who had her in for imaging and on the table to remove blood clots from her arteries, not veins, within hours.

She was also diagnosed with Peripheral Artery Disease. Since the arterial blood clots weren’t discovered and treated soonest, tension had built up in the tissue and muscle below her knee because of the lack of circulation and needed to be released in a surgical procedure called a fasciotomy. Connie also lost her pinky toe due to the lack of circulation. But doctors told Connie she was lucky as it could have been more had she not received urgent treatment.

To try and prevent a repeat occurrence, Connie searched the web for more information on Peripheral Artery Disease and found patient groups supported by The Way To My Heart. The Way To My Heart is a 501(c)(3), providing comprehensive education, high-touch advocacy, and real-time support for peripheral artery disease patients globally.

Through patient advocates there, she learned more about the disease, how to spot a problem early, and critical questions to discuss with her vascular specialist before any procedure. So, when she started experiencing symptoms again months later, she was confident she was on track to getting the right treatment at the right time to keep her on her feet.

She expresses during this episode the importance of trusting your gut when you know something is wrong and to keep pressing healthcare workers to work with you on uncovering the source of trouble and helping to find resolve.