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Dan Wallis
Director of KP OnCall, Kaiser Permanente
SuperNova Award Category:
The Company:
KP OnCall is a clinical contact center that provides integrated programs in remote care management, or ‘telehealth’. A wholly owned subsidiary of Kaiser Permanente, KP OnCall provides nurse triage, advice, wellness and chronic care for over 4 million members in Southern California, Hawaii and Georgia. KP OnCall strives to maintain an innovative and agile culture by developing and deploying new solutions to provide exceptional value in quality care, customer service and positive health outcome.
The Problem:
KP OnCall has managed a Nurse Telephone Triage and Advise Line since 1994. This service provides diagnostic support for members (patients). While offering a much needed resource for members, the service required nurses to ask a series of questions, which led to a lengthy phone conversation for information gathering. KP OnCall recognized an opportunity to streamline this process and improve the member experience by automating interviews to mimic existing diagnostic protocols. KP OnCall decided to test the premise using one specific problem/diagnosis state: Urinary Tract Infections (UTIs).
KP OnCall wanted to improve and expedite the diagnostic process for its members. The organization also wanted to increase the effectiveness and productivity of both its contact center agents and nurses. Automating appropriate diagnostics services would create an immediate ROI by deflecting members to the automated system for diagnosis and only escalating to a live phone or e-chat conversation when needed. This was important because the full yearly cost for one live nurse phone agent is more than $150,000. For this reason, the team wanted to ensure that the most urgent calls were escalated and addressed in a timely manner.
The Solution:
Always investing in healthcare innovation activities to better service its members, the Kaiser Innovation Fund id'd Oracle Service Cloud as a proven technology commodity available for use by Kaiser Permanente teams. While KP OnCall knew that there was an opportunity to increase the effectiveness of its Nurse Telephone Triage and Advise Line, they hadn’t yet considered the possibility of automating its services. The reason: Diagnostic protocols often include multiple indicators requiring significant back and forth conversation between members and nurses.This changed with Oracle Service Cloud’s Policy Automation (OPA)capabilities. KP OnCall discovered that the tool could significantly minimize work load and could readily automate the normally manual triage process. OPA took all aspects of the interview process and created logic that mimicked what the nurses were able to accomplish with a phone based protocol in a “like-to-like process”.
The Results:
Before leveraging Oracle, the UTI diagnosis process was manual and phone-based. At times the nurse line was inundated and it could take up to 2-hours to speak with a nurse. Today, KP OnCall’s streamlined UTI diagnosis process allows members to use a web questionnaire, alleviating the necessity to speak live with a nurse for routine questions. Members can complete the questionnaires at their convenience for a quicker, as effective, and clinically safe diagnosis of UTIs. If at any time during the diagnosis process the member has questions; he or she can simply click to chat or call a nurse for immediate assistance. Using Oracle, KP OnCall's member driven interface is available 24/7. Members can choose between phone, chat or questionnaire to assist in diagnosis, receive treatment options and minimize doctor office, Urgert Care and Emergency Department visits, while Kaiser Permanent decreases customer support costs. This helps provide a seamless experience across customer’s preferred channels. By surveying members who used the service, KP OnCall found that the majority of customers (approx. 90%) prefer the online option. With this success, Kaiser Permanente is working to roll out the solution on a much larger scale. The organization has identified additional disease states and approx 105 different symptoms, such as a diagnostic process for conjunctivitis, that are appropriate and match a defined pathway for automation.
Metrics:
Prior to implementation of Oracle Service Cloud, KP OnCall nurses spoke to 38K women per year with UTIs. In 2014, the cost for nurses just to speak to patients with simple UTI symptoms topped $640K. It was recognized that the standard interview questions posed by a nurse had little variation and were well-suited to a self-service interview. With roll out of the online questionnaire, by EOY 2015, KP OnCall is on track to free up 50% of the time nurses spend talking to patients suffering from UTIs. This will yield savings equal to $320K. Now, nurses who used to speak to UTI suffers can talk to patients with more serious symptoms. KP OnCall was also able to reduce the number of new hire nurses due to large membership growth. While cost savings to the clinical contact center are significant, the current and potential savings to the entire org (SCAL KP) are huge. Currently, the org saves money and improves access with each UTI encounter addressed via the web rather than at an urgent care or emergency rooms. Using web self-service allows the org to reach more women with UTI symptoms. There were at least 130K additional cases seen and treated in these other settings. Therefore savings to the org will be significant, with a nearly 12: 1 ROI.
The Technology:
Oracle Service Cloud:
Web Customer Service
Cross-Channel Contact Center
Policy Automation
Disruptive Factor:
KP OnCall wasn’t sure what the member uptake would be for an automated diagnostic option. To alleviate some of the inherent risk, the organization conducted an outcome study, complete with nurse interviews and proactive surveying of members prior to implementation. While the program was considered somewhat risky, the innovative component outweighed the risk factor.
In addition, the program has broader ramifications and a real opportunity to disrupt standard operating procedure for the healthcare industry at large. While there are services available that are working to redefine the patient doctor interaction scenario, none goes to the level of providing end-to-end diagnosis treatment and resolution like Kaiser Permanente. In the past, if a UTI questionnaire was received, you might be advised to make a doctor appointment or to go to the ER, only then to be told what you already knew. “You have a UTI”. Now, Kaiser Permanente members can sit in the privacy of their own home or office, fill out a web form and upon diagnosis, have a prescription sent to their pharmacy.
For the future, Kaiser is exploring adding diagnostic kiosks in Urgent Care facilities, expanding this new way of thinking about and assessing the delivery model for providing care to patients. The organization has challenged itself to think differently about solving the problems of its members on their terms, in their location and on their time.
Shining Moment:
Positive member feedback: “I first used the nurse call line, which had a call-back time of about one hour. So while waiting, I decided to try the online option. I had a response in 10 minutes and was on my way to pick up a prescription and stop by the lab. Amazingly easy and efficient.”; “This service is Great!!! For minor issues that do not require going to see a doctor, and to let other patients with serious issues see a doctor faster. THANK YOU KAISER!!!”
