It would be something if every enterprise had a staff of well-seasoned agents to give customers advice and keep them healthy. Even better, what if your enterprise was made up of a staff of trained agents–nurses–whose job is to keep patients healthy? Intellicare dispenses medical call-center services, including physician referral, class registration and disease management programs. Some 75 percent of the company’s workforce operates from home, and e-learning and virtual collaboration technology have enabled Intellicare to train and monitor a staff of 300 qualified nurses who manage patient relationships.
Intellicare has enjoyed rapid growth and moved away from traditional office buildings to house their business. The company’s three business units–providers, payers and disease management–have embraced online learning to certify nurses in critical job skills and knowledge. Intellicare deploys a remote network for its geographically dispersed staff from Maine to California, which means nurses can work from home on PCs the company has set up.
“We started this about a year and a half ago,” said Angela Keith, technology communications manager and nurse for Intellicare. “So, in about 18 months we’ve deployed 58 courses. It’s been very rapid development, everything from a one-page read to full, rich media with audio, video, animation. It’s very robust. We’re doing blended learning, so no one’s just learning from the CBT (computer-based training) the Learning Space. We also have follow-up sessions, and there’s constant updating and on-the-spot training that our staff do with their lead nurses through the IM (instant messaging) mechanism. It’s constant learning and updating of what we already know.”
Intellicare considers its call-center activities a strategic business asset, and those activities’ impacts on the business’ bottom line equals rapid growth, as well as lower costs. “We’re not building brick-and-mortar offices all over, and we don’t need to fly trainers out,” Keith said. That means no budget is needed for transportation or renting classroom space. Some of the nurses on staff don’t even have a physical office to go to; operations are completely online. “We really couldn’t operate any other way,” Keith explained.
“We also do a certain amount of acquisitions of small call centers. Our training is codified, so when we go into a call center to take it over, the intent is to deploy our remote model,” said Jeff Forbes, CIO for Intellicare. “We have a whole program of learning, packaged for the process. Everything from introducing the nurse population to the company, introducing the nurse population to the way we run quality in the company and all our quality metrics down to here’s how you use the application, then into the proficiency testing on what they’ve learned.”
Having training systematized has helped facilitate operations when Intellicare is in acquisition mode, and virtual collaboration helps to support core learning, which includes everything from mid-call help scenarios to developing a mini-course on how to improve the paging procedure for doctors. Virtual collaboration also supports continuous learning programs. “Because learning space is on the Web, it’s ubiquitous,” Forbes said. “You can give it to everyone at the same time and also measure their success in using it.”
Intellicare has a whole system of measurement and quality based on the phone work nurses perform when talking to patients. There are also quality measurements for use of the proprietary software. “We use the assessment part of Learning Space to create the tests for each course,” Keith said. “They have to pass the test in order to proceed to the next course or to be able to do their job. It gives us an opportunity to be aware of the weak spots in training. It’s also our methodology for evaluating training, which is constantly refreshed.”
“We have 16 quality metrics for our nursing staff and there’s a process by which we go evaluate and come up with those metrics,” Forbes said. “It’s not something we hit them over the head with. We trend those metrics, and if we see we need work in an area, we go back and put together a mini-course or we strengthen the existing materials in that subject, or both. Our evaluation process of our people as they’re doing their jobs has a closed loop back to this learning environment, and that’s sort of critical. You want to be teaching where you’re weak points are rather than, ‘Here, take the course and go forward.’ That may not be relevant to where your problems are. We can evaluate the folks going through the course and see where they’re having trouble. We can evaluate after they’ve finished the course to continually improve the offering.”
One of those 16 quality metrics is silent monitoring, where a nurse, supervisor or peer will actually listen to a call. The call is evaluated by another set of 26 or so metrics that cover everything from quality of clinical judgment, following clinical guidelines and call management. A numerical score is derived from those metrics. There’s also a counseling session with the nurse to discuss strengths and weaknesses, and that data makes up another of the 16 metrics. Silent monitoring is done at least once a month for each nurse.
“The other metrics that we have in there are fairly classic,” Forbes said, “things like referral patterns, what percent of your patients are you sending to the emergency room, what percentage of your patients are being sent home for home care. The way we use those numbers is not so much to grade the nurses, but to look for trends that may be deviating from our guidelines.”
These trends could indicate learning gaps. “We’re interested in providing a quality product,” Forbes said. “And if you’re spending three minutes on a call, it’s just as much of a problem as if you’re spending 45 minutes. Given the guidelines, given the disposition and what we’re trying to access, there’s a range that we should be operating in to give the person good, timely service and accurate medical direction.”