Cincom® Synchrony™

Guiding Smarter Interactionsin Healthcare ReformIBM and Cincom Systems Address the Challenges of CustomerExperience in the New Healthcare ReformCommentary by Harry Reynolds, IBM

United States healthcare reform legislation is a subject of considerabledebate and confusion. Pundits on the right and left continue to argue about the potentialimplications and whether or not parts and pieces of the legislationshould be repealed altogether. Uncertainty abounds, but mostagree that whatever the outcome, new reform legislation willinevitably change the business of healthcare as we know it.

What will be the impact to health insurance providers whenthe dust settles? No one knows for sure, but it is clear that insurers must be prepared for significant changes in the way theydo business. This paper explores three of the most importantaspects to consider—Medical Home, Accountable Care andGlobal Payments—and suggests steps to bolster informationsystems using Cincom Synchrony in order to adequately respondto evolving legislative and market demands.

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Change Is ComingThe concepts of patient-centered Medical Home, AccountableCare and Global Payments are three key areas that will have apowerful impact on the healthcare industry, says Harry Reynolds,the Director of Health Industry Transformation for IBM. Reynolds,a respected industry veteran who knows the health insurancebusiness inside and out and spent over 30 years with Blue CrossBlue Shield of North Carolina before joining IBM as Chairman ofthe Council for Affordable Quality Healthcare initiative. He currentlyserves on the National Committee on Vital and Health Statistics.

“I spend a lot of time with payers and providers, and whetheror not you are on this side or that side of the debate, change isgoing to happen,” says Reynolds. “Medical Home is one exampleof that change. The focus is on providing care holistically and allthe incentives are built to encourage that the information flowsseamlessly amongst the professionals involved. Providers andorganizations will be expected to work proactively together toensure that the patient has a more unified experience.”

“We’ve got standards, policies, technologies andprocesses that never beforehave converged into thisindustry at a time when allthese regulations and the rising cost of healthcarehave forced people to listenand react.”- Harry Reynolds, the Director of Health Industry Transformation for IBM

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According to Reynolds, the concept of Accountable Care is another important aspect of new legislation to consider. “If you goone step past Medical Home, you start having an entire organizationbeing held accountable for all the patients that they see. Proposedlegislation stipulates seamless delivery of high-quality care forMedicare beneficiaries and the scope includes group practices,hospitals and hospitals in partnership with those practices. Theactivities of hospitals, doctors and insurers will be viewed together;whereas today they are most often regarded separately.”

Reform legislation is also poised to change the current paymentstructure for hospitals and providers and, according to Reynolds,this will be a significant change from the status quo.

“Going forward, there will be one payment, usually to the hospital,that will be split amongst the practitioners and organizationsinvolved,” says Reynolds. “The new legislation also stipulatesthat if a patient leaves a hospital and is readmitted for that samereason within 30 days it will be the responsibility of the hospitalto cover that additional expense; the government won’t pay forit again.”

Hear Harry Reynolds live onExpert Access Radio

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Improving Care, Reducing CostsHealthcare reform legislation is focused on improving care and reducing costs. Insurance and healthcare companies can respondto the implications in two ways: with great efficiency or with greatinefficiency. Understanding the following will have a directbearing on your ability to navigate the transition.

Medical HomeThe concept of the patient-centered Medical Home model is anapproach to providing comprehensive primary care that facilitatespartnerships between patients and medical providers.

The aim of the Medical Home model is to improve access to care, increase patient satisfaction with the care received and ultimately, improve the health of patients. The idea behind legislation is that every American should have a “personal Medical Home” through which to receive servicesand that those services should be “accessible, accountable,comprehensive, integrated, patient-centered and satisfying toboth patients and their physicians.”

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With the current economic challenges facing the UnitedStates, it is easy to see why the move to a patient-centeredMedical Home approach has become a cornerstone to newlegislation. One study estimated that if recommendations werefollowed, healthcare costs would likely decrease by 5.6%, resultingin a national savings of $67 billion dollars per year. Indeed, in2006—before healthcare reform stepped into the nationalspotlight—industry leaders including IBM and others started thePatient-Centered Primary Care Collaborative to promote theMedical Home model. Membership includes some 500 largeemployers, insurers, consumer groups and doctors.

Accountable CareOn March 31, 2011, the Department of Health and HumanServices released proposed rules to help doctors, hospitals andother providers better coordinate care for Medicare patientsthrough Accountable Care Organizations (ACOs). The goal ofan ACO is to deliver seamless, high-quality care for Medicarebeneficiaries, and incentives are designed to encourage healthcareproviders to work together to treat an individual patient acrosscare settings—including doctors’ offices, hospitals and long-termcare facilities.

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The Medicare Shared Savings Program will reward ACOs thatlower growth in health care costs while meeting performancestandards on quality of care and putting patients first.

Experts estimate that more than 50% of Medicare beneficiaries havemultiple chronic conditions such as diabetes, arthritis, hypertensionand kidney disease. As a result, these patients often receive carefrom multiple physicians. A failure to coordinate care can oftenlead to patients not getting the care they need, duplicative careand increased risk of medical errors. Improving coordination andcommunication through ACOs will help improve the careMedicare beneficiaries receive while also helping to lower costs;Medicare could potentially save as much as $960 million overthree years.

Global PaymentsHealthcare-reform legislation calls for a Global Payment systemwith significant incentives to encourage more holistic patientcare. The idea is to encourage more careful coordination andcollaboration between a patient’s physicians, nurses, hospitals

Improving coordination and communication through Accountable CareOrganizations will help improve the care Medicarebeneficiaries receive, whilealso helping to lower costs;Medicare could potentiallysave as much as $960 millionover three years.

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and other care providers. Section 2705 of the Patient Protectionand Affordable Care Act is intended to further states’ efforts toshift from the current Medicaid fee-for-service payment structureto a global, capitated payment model.

Experts say that an emphasis on patient-centered medicine,with doctors and other providers providing better coordinationof information and services, will help to reduce healthcare costswhile providing more effective care for patients. Providers wouldreceive payment that is adjusted for patients’ health statusesand it would be based on meeting common core performancemeasures to ensure high-quality care. Legislation calls for a carefultransition to global payment within five years, during which“shared savings” would serve as an interim payment model tohelp providers become more familiar with global payment withreduced exposure to risk.

Experts say that an emphasison patient-centered medicine,with doctors and otherproviders providing bettercoordination of informationand services, will help to reduce healthcare costswhile providing more effective care for patients.

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Cincom Synchrony—Optimize Interactions with Unified Information Healthcare reform is quickly changing the industry. The conceptsof Medical Home, Accountable Care and Global Paymentswill require that companies foster more seamless and personalizedinteractions across patients, providers and payers while adheringto an incentive-based mandate to reduce costs and improve care.

Cincom Synchrony offers an innovative, cost-efficient way toovercome the challenges of healthcare reform. It guides smarterinteractions with patients, providers and payers, and leveragesthe insight a company has about each patient or member in thecontext of each interaction. Supported by a robust and highlyflexible platform of IBM technologies, Synchrony is a powerfulsoftware application specifically designed to help customer carecenters in healthcare provide smarter, streamlined experiencesacross complex, cross-channel interactions that utilize multipleback-end applications. The centerpiece of the solution is real-timeIntelligent Guidance that automatically displays the informationyou need no matter the activity or the application.

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By combining real-time Intelligent Guidance, Synchrony allowsyou to focus on the patient or member experience instead ofspending time on labor-intensive internal processes such ascustomer look-ups, interaction history or content research. Ithas also been developed to work with the healthcare-specificcomponents of the IBM Health Integration Framework, soyou can expect high reliability.

Depending on the type of interaction, Synchrony retrieves andpresents critical information, pulling it from any back-end source.You can see the patient or member’s entire interaction history.After every customer response, Synchrony identifies the nextstep in the process, providing context-specific language andinteraction guidance. This is critical in standardizing interactionsacross departments.

Cincom Synchrony offers aninnovative, cost-efficient wayto overcome the challengesof healthcare reform.

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Respond to Legislative DemandsSynchrony helps you respond and adapt to the new legislativemodels brought about by the transition to Medical Home,Accountable Care and Global Payments systems. Some of thecapabilities of Cincom Synchrony include:

Real-time Intelligent Guidance – This is a key feature of Synchronythat will help you respond to the demands of seamless dataaccess and communication across channels and data repositories.Intelligent Guidance easily surpasses conventional scriptingand walks you through every step of even the most complicatedinteractions based on the context of the interaction. All of thishappens automatically in real time, insulating personnel from themundane tasks that can compromise the flow of information andthe quality of the experience. This enables multi-tiered interactionswhere non-medical personnel are now able to provide triage-levelinteractions, such as reminding a patient to take medicine.

Single, holistic customer view – Medical Home, AccountableCare and Global Payments all require a holistic and unified view ofpatient and member information. The Synchrony unified desktop is

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Solution BriefIBM ISV & Developer Relations Healthcare

Cincom and IBM: guiding smarter interactionsEnabling provider and payer customer care centers to optimize interactions with real-time intelligent guidance and a dynamic, unified information view

In an increasingly competitive and quickly changing industry, providers and payers face a stark new reality – today’s customers expect an e�cient, personalized, high-quality experience every time they connect with a healthcare organization. At the same time, providers and payers have an ongoing mandate to manage costs, improve productivity and increase revenue.

Cincom Synchrony o�ers an innovative, cost-e�cient way to overcome this challenge. Supported by a robust and highly flexible platform of IBM technologies, Synchrony is a powerful software application specifically designed to help customer care centers in healthcare provide smarter, streamlined experiences that deliver intended results, even for complex, cross-channel interactions that utilize multiple back-end applications.

The centerpiece of the solution is real-time intelligent guidance that automatically displays the information employees need and directs them to give every customer individual attention.

Solution overviewHealthcare providers and payers are working hard to improve the industry’s customer experience rankings, but the obstacles are considerable. Hiring, training and supervising customer-facing employees are costly. At the desktop level, agents and other customer care representatives are dealing with unprecedented complexity, from the technology they use, to the processes they follow, to the issues they are expected to resolve.

Synchrony is a smarter solution. Combining real-time intelligent guidance, a customer-centric desktop and interaction automation, Synchrony allows employees to focus on the patient or member experience instead of spending time on labor-intensive internal processes such as customer look-ups, interaction history or content research. It has also been developed to work with the healthcare-specific components of the IBM Health Integration Framework, so users can expect high reliability.

Highlights:

Cincom and IBM Solutions Brief (PDF)

a web-based interface that instantly presents the right informationand resources for a specific patient or member. It provides asingle view of data from multiple information systems, includingCRM, HIM, patient management, billing, EMR/EHR and othersupporting applications. Information is presented in a clean,tab-driven format that adjusts dynamically so you never have totoggle back and forth among multiple windows.

Seamless, cross-channel continuity – Today’s hyperlinked businessenvironment combined with the demands of healthcare reformwill require companies to have more continuity across multiplechannels of communication. The Synchrony desktop offers asingle interface for all customer interaction channels, includingphone, e-mail, IM/chat, fax and the web. During every interaction,you can see the patient or member’s complete contact history.Synchrony uses this history to guide the current interaction andensures a seamless, continuous experience no matter what touchpoints are used.

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Personalized, success-based routing – Synchrony tracks theresults of every interaction, prompts and escalates follow-upactions and automatically generates personalized correspondenceand documents. It can be configured to route incoming callsbased on the success rates of individual employees in handlingthe type of call, the patient or member’s demographic informationand the employee’s previous outcomes with similar customers.

“Decisions are not going to get easier,” says Reynolds. “Morecomplex decisions are going to need to be guided through toa resolution. This guidance will need to be personalized andacross all channels.”

Meet Healthcare Reform Goals U.S. healthcare reform is all about improving care while reducingcosts. Synchrony allows you to do both while strengthening patient,provider and payer relationships.

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Higher-quality care – With Synchrony, healthcare providers canensure that patients receive the right care, whether they are callingto schedule an appointment or to inquire about test results.Synchrony also enables patients to take a more proactive rolein their own care, which can help identify serious conditionsearlier. Synchrony enables providers to acquire and retain thebest patients and reduce errors that can delay reimbursement.

Reduce the cost of care – By increasing member accountabilityand facilitating proactive care, Synchrony helps reduce claimsand patient re-admittance. Synchrony also reduces the cost ofemployee training and streamlines the entire process to reducethe total cost of claim processing and payment. Insurers andother payers can use Synchrony to turn high-quality memberservice into a differentiating competitive advantage.

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Some of Life’s Most Memorable Moments Happenin a Healthcare SettingSome of these moments are joyful, while some may be extraordinarilypainful. How can you make each experience the best it can be? Forhealthcare contact centers, the people you place on the end of everytelephone call, e-mail or web chat—and the quality of the technologythey rely on—are instrumental in delivering patient/memberexperiences that are compassionate, personal, private and accurate.

“A phone call is often the first point of contact and thus,can be the most important.”

– Paul Spiegelman, executive director of The Beryl Institute

A Complex Care Case

“As customer service increasinglybecomes a differentiating factorbetween healthcare facilities,consumers expect a morecustomer-centric experience orlikely will take their businesselsewhere.” – The Beryl Institute

The healthcare industry isundergoing massive transformationaround the globe. From acustomer-care perspective,consumers are demanding morecontrol over their own health, andthere is a growing awareness ofrisks and adverse events with higherexpectations of care and servicequality. But while expectations arerising, the industry lags in“customer service.”

Addressing the Balancing ActWhile understanding the need todeliver better patient experiences,healthcare organizations from boththe provider and payer sides arealso challenged to manageoperational costs and increaseproductivity and/or revenue. Inreality, you don’t have to sacrificeone of these objectives for another.

Cincom® Synchrony™ is a flexibletechnology platform for contactcenters that enables healthcareorganizations to deliver betterexperiences; drive up productivity,efficiency and revenue while alsolowering costs and training.

Cincom Synchrony and IBM for theHealthcare IndustryIBM’s Healthcare Industry Frameworkprovides healthcare-specific software,solution accelerators and bestpractices to help you reduce costsand manage risk while delivering anoutstanding customer experience.Cincom Synchrony is validated in thisframework to guide customer-facingemployees to deliver smarterinteractions and experiences.

Industry Profile: Healthcare

Guiding Smarter Interactionsin Healthcare

View Guiding Smarter Interactions in Healthcare (PDF)

Moving Forward with Cincom SynchronyClearly, healthcare reform will have a number of major impacts inthe health insurance industry, not least of which will be the impactsof Medical Home, Accountable Care and Global Payments.According to IBM’s Harry Reynolds, now is the time to moveforward regardless of the debates and pending repeals onCapital Hill.

“Eighty percent of what should happen is going to happenwhether or not the whole thing gets turned upside down or insideout,” says Reynolds. “We’ve got standards, policies, technologiesand processes that never before have converged into this industryat a time when all these regulations and the rising cost of healthcarehave forced people to listen and react.”

The cost of doing nothingcould be great, and now is the time to react in orderto be prepared for the many changes on the legislative horizon.

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Indeed, the cost of doing nothing could be great, and now isthe time to react in order to be prepared for the many changeson the legislative horizon. Contact us today to learn more abouthow Cincom Synchrony can help you implement a well-plannedand holistic approach to managing member and patient information across multitude channels and repositories inorder to be prepared for the changing regulatory and marketdemands resulting from healthcare reform.

Brian Flagg, Account Executive55 Merchant StreetCincinnati, OH 45246bflagg@cincom.comwww.synchrony.cincom.com

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About CincomCincom recognizes that it is your people—your customer-facingemployees—who represent your brand. And in each interaction, itis the experience that they deliver to your customers that eitherbuilds value for your brand or destroys it. It is a powerful role to play.

Cincom's Customer Experience Management initiative is focusedon helping companies and their employees consistently deliverexperiences that not only build your brand, but are valuable toboth your customers and your organization. Cincom does thisthrough its Synchrony offering that guides employees to deliversmarter interactions.

Since 1968, Cincom has helped thousands of clients worldwideby solving complex business problems with its software andservices. Cincom is an IBM Premier Business Partner and hasbeen integrating IBM technologies and leveraging IBM servicesfor over 40 years.

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Will she build your brandor destroy it?Every customer touch with thecontact center is a test of yourbrand and your promise to thecustomer—and the stakes arehigh. A recent study shows that 87% of customers stoppeddoing business with a companyafter a bad customer experience.When a customer picks up thephone, your agent is the brandand possibly the only humanvoice that customer will experiencewith your business. It pays to makethat experience great.

Learn the seven categories toconsider when evaluating an effective agent desktop—and whoranked as a “hot vendor”—in theVentana Research Value Index forCustomer Experience Manage-ment: Agent Desktop 2011.

http://smarterinteractions.cincom.com

Download your FREE summary of this independent report at www.cincom.com/agentdesktop

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Guiding Smarter Interactions in Healthcare Reform

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