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CRM Layout 7/23/02 2:14 PM Page 1

Building the Customer Cen

Customer Relationship
Management in Health
CRM Layout 7/23/02 2:14 PM Page 2

Customer Relationship Management

in Healthcare

Building the Customer Centric HDO

July 2002

©2002 Cap Gemini Ernst & Young U.S. LLC or its licensors. All rights reserved. Cap Gemini Ernst & You
registered trademark.

Reproductions may be made with the written permission of Cap Gemini Ernst & Young by writing, faxing,
your request to:

Hindy Shaman
Cap Gemini Ernst & Young
8484 Westpark Drive
McLean, VA 22102
Fax: (703) 747-0113
e-mail: hindy.shaman@cgey.com
CRM Layout 7/23/02 2:14 PM Page 3

Table of Contents

A 21st Century View of the Healthcare “Customer” 2

The State of Customer Relationship Management in Healthcare 3

Business-Based Reasons for CRM in HDOs 5

The Strategic Cornerstones of Healthcare CRM 7

The Value of Staged Migration 9

The Technology Side of CRM 11

Principal CRM Challenges and Barriers 14

Getting Started: Building the CRM Strategy and Business Case 15

CRM Focus: Patient Access 15

CRM Focus: Web Portals 16
CRM Focus: Call Centers 17

About Cap Gemini Ernst & Young Health 18

CRM Layout 7/23/02 2:14 PM Page 4

Building the Customer Centric HDO

Never before have healthcare delivery

organizations (HDOs) been so driven
to out-perform, out-market and
out-serve their competitors. Much
of the reason is a dramatic change
in financial and operating environ-
ments: Reduced Medicare and
Medicaid reimbursements have
slashed operating margins while
concurrently increasing pressure to
improve efficiency, effectiveness and
productivity. At the same time, reg-
ulatory and political entities have
been force-feeding HDOs with new
privacy-assurance, error-reduction
and electronic communication initiatives.
relationship between a health delivery looking to collect, stor
Events such as these have created a organization and physician, a trian- and disburse informati
new kind of healthcare marketplace, gular relationship that fully involves and for the benefit of —
where the need to compete — and the patient now predominates.
the costs associated with competi- Physicians and patients now are All in all, HDOs have n
tive failures — have never been the HDO’s key customers! more compelled to und
higher. Small wonder that, in such embrace, reach out to,
an environment, innovative HDOs Compared to previous generations, their current and futur
are rethinking and realigning their today’s patients also are more physicians and patient
organizations and systems to better sophisticated about assessing the purely competitive stan
satisfy the needs and desires of their quality, cost and value of healthcare need to understand th
key customers. goods and services. Moreover, their more completely and w
ability to retrieve information and sively to develop and m
But who are HDOs’ “key customers?” make basic transactions via Web or lifetime relationship. A
In the past, a typical HDO’s princi- phone with financial institutions, patients are assuming
pal customer was the physician, brokerage houses, travel/entertain- more accountability fo
while the actual patient was prima- ment services, etc., has raised the care, HDOs also need
CRM Layout 7/23/02 2:14 PM Page 5
A 21st Century View of the Healthcare “Custom
As the experiences of any number
of industries have shown, stiffer
competition and evolving markets
are inspiring more-customer-centric
business models — operating
approaches that spur companies to
proactively identify, attract, engage,
serve and covet customers. At the
highest level, the elements of such
a paradigm are almost universal:
• Work harder to profile, identify
and connect with today’s and
tomorrow’s customers.
• Give those customers a choice
about how and when they
interact with you (e.g., e-mail,
Web, fax, phone, mail or in
person).
• Ensure that every interaction
offers a comprehensive and
accessible profile of the cus-
tomer and the information he
or she desires.
• Ensure that new information
gleaned from each customer
interaction is captured, dissem-
inated and “put to work.”
• Develop mechanisms that mini-
• Develop the capability to satisfy An integrated, e
customers’ requests for insights
and information at first contact focused definiti
(“one and done”). how an instituti
• Treat customers as valued indi- to relate to its v
viduals by learning about their constituencies
preferences, interests, concerns
and desires.
how it intends t
support change
These capabilities represent the
conceptual framework of Customer
people, process
Relationship Management (CRM), a and technology
management discipline geared to
needed to realiz
helping companies of all kinds
become more effective marketers the bulk of CRM
and service providers. Like other potential value.
industries, CRM cannot be HDOs’
sole response to burgeoning compe-
tition. But because it concurrently
works to optimize revenue, support
profitable customer relationships
and improve the efficiency of cus-
tomer-facing processes, CRM may
be one of the most straightforward
and important actions that many
healthcare organizations can take.
The remainder of this paper scruti-
nizes the current state of “provider
CRM;” discusses the value proposi-
tions associated with an integrated,
enterprise-wide customer relation-
ship management initiative; identifies
CRM Layout 7/23/02 2:14 PM Page 6
The State of Customer Relationship
Management in Healthcare
HDOs’ service-delivery and technology
challenges are well documented:
Most organizations are highly frag-
mented, with diverse business
enterprises, organizations and deliv-
ery models. Many, too, are the by-
product of a merger or acquisition —
and most of these have yet to fully
streamline and standardize opera-
tions and technology platforms.
HDOs also tend to be a patchwork
of business enterprises spanning
inpatient care, ambulatory services,
sub-acute facilities, clinics, home
health services and long-term care
entities. As a result, their technology
environments usually contain dis-
parate legacy systems that support
only parts of the enterprise and/or
specific business functions, such as
scheduling, registration and patient
accounting. The net effect is that
HDOs’ most ubiquitous technology
challenge is creating a single, enter-
prise-wide view of each patient — a
360 degree view of the customer.
Healthcare’s technology challenges
are unusually acute but, in fact, no
industry or company has actually
embedded into their operating
models all of the CRM-related
capabilities noted in the previous
CRM issues and objectives to
healthcare, given the latter’s many
unique characteristics and constraints?
Technology issues aside, healthcare
is still a unique business. For exam-
ple, the typical HDO sales model
targets the physician — the referrer
of its services — rather than the
patient, who is the consumer of its
services. This fact accounts for
many of the relationship discon-
nects that healthcare providers now
are seeking to remedy. Secondly,
there is no other industry in which
financial responsibility extends so
far beyond the consumer, e.g., to
employers, health plans and federal
and state governments. (However,
as more of the cost of care is shifted
by employers to their employees,
the actual consumers of healthcare
are becoming more involved in
deciding how their healthcare
dollars are allocated.) Thirdly, the
industry’s customer relationships
are fundamentally influenced by the
implied right that patients have to
state-of-the-art healthcare regardless
of the cost. Whereas no sane consumer
would believe that he is entitled to
the latest model in BMW’s “7”
series, it is not unreasonable for
Despite the above diffe
HDOs are affected by t
financial and operation
that other industries ex
For example, they ope
petitive environments,
financial constraints an
imperatives to improve
reduce cost. It also is t
patients and physicians
more emphatic about w
care providers they wis
result, most HDOs are
become more custome
Unfortunately, even th
with long-standing cul
emphasize customer se
satisfaction are behind
when it comes to deve
prise-wide, technology
customer-management
models. That is what C
Ernst & Young confirm
recent research initiativ
in partnership with the
Group. The survey soug
the healthcare industry’s
proficiencies and short
those of other industri
capabilities were closel
• Value segmentatio
CRM Layout 7/23/02 2:14 PM Page 7
• Institutional memory: the ability
to capture and make available
to customer-facing personnel a
regularly evolving, composite
profile of each customer,
including demographic and
preference data, prior interac-
tion history and outstanding
service requests.
• Touch point alignment: making
it possible for the customer to
interact with the HDO through
their channel of choice (telephone,
Internet, person-to-person, etc.)
with consistent service levels
and information access.
• One and done: putting in place
the processes and technologies
that provide complete resolu-
tion to customers’ needs during
the first contact (thereby elimi-
nating hand-offs and multiple
interactions for single inquiries)
• Customer experience manage-
ment: proactively managing a
complete set of interactions
with each customer, at a cost
that is aligned to the perceived
value of the relationship.
• CRM vision: aligning the entity’s
corporate mission, organiza-
tional structure, processes,
people and technology in
accordance with its customer-
service strategy.
Based on these measures, CGE&Y
determined that many health care
vision or strategy. And without an
integrated, enterprise-focused defi-
nition of how an institution plans to
support its various constituencies —
and how it intends to manage
changes in people, processes and
technology — those stand-alone
solutions cannot hope to realize the
bulk of CRM’s potential value. This
is not to say that elaborate and
expensive “big bang” implementa-
tions are needed for CRM to be
effective. In fact, the opposite often
is true: Early-stage initiatives such
as aligning and streamlining cus-
tomer access can be designed to
offer fast, significant payback.
But to be really effective, even
these undertakings must be part Figure 1: “The CR
of a strategic, enterprise-wide has demonstrated
CRM strategy that helps the organi- healthcare — like m
zation articulate where it’s going industries — often
and what stages it must pass fully support its cu
through to get there. relationships.
Relation- Relationship Relationship Rela
ship Builders Managers Op
Focused 0% 4%
Customer Relationship Customer Cu
Focused Transactors Satisfiers Con
4% 66%
CRM Layout 7/23/02 2:14 PM Page 8
Business-Based Reasons for CRM in HDOs
Regardless of the industry’s many
unique characteristics, missions and
relationships, there are numerous
financial and practical justifications
for CRM in healthcare. For example,
CGE&Y research has shown that
the average hospital sacrifices
between two and four percent of
its revenues to poor revenue-cycle
management. CRM can help recap-
ture this revenue by creating an
enterprise-wide foundation of
information sharing, customer-data
capture, contact management, payer
identification and coordination with
external resources, such as health
insurance companies.
CRM implementations also can help
HDOs conform to the privacy and
security mandates set forth by
HIPAA. That is because the basic
functionality of most CRM applica-
tions aligns closely with the capabil-
ities HIPAA requires to manage pri-
vacy notices and consents, and to
create audit trails. Thus CRM repre-
sents a unique opportunity for
HDOs to leverage their customer-
management investments by also
complying with HIPAA mandates.
Lastly — and perhaps most impor-
For example, operational CRM Elaborate and e
solutions are being developed to
manage Patient/Physician Access by “big bang” imp
enabling scheduling and pre-regis- tions are not a
tration, and integrating these activi-
ties with back-office functions to
prerequisite. In
improve billing and collections. early-stage initi
Referral management and discharge such as aligning
planning also are supported with
redesigned business processes, streamlining cu
workflow, automation and messaging. access usually
The resulting solution can lower
operating costs, improve customer significant payb
satisfaction with front-office processes, can be used to
and set the stage for self-service
options enabled by the Internet and additional unde
Interactive Voice Response (IVR).
Outbound communication can be
designed into service delivery
processes to confirm appointments,
validate insurance information, pro-
vide maps, and disseminate health
information and pre-care instructions.
A Patient/Physician Access solution can create
significant business value by:
1. Cutting transaction costs for customer-facing processe
2. Improving patient/physician satisfaction and loyalty.
CRM Layout 7/23/02 2:14 PM Page 9

Another solution — a Business

Growth Initiative — focuses on the
implementation of strategies for
increasing market share, referral
capture and new revenue opportu-
nities. Aimed at physicians and/or
patients, a business growth solution
features market segmentation and
business analytics geared to identi-
fying promising market opportunities
and supporting campaigns to
capture business.

A Business Growth
solution creates
value by:
1. Improving physician and
patient loyalty.
2. Capturing more referrals
per physician.
3. Targeting and creating
profitable new physician
relationships.
4. Improving brand image
and recognition.
CRM Layout 7/23/02 2:14 PM Page 10
The Strategic Cornerstones of Healthcare CRM
All CRM initiatives — regardless of
industry or business mission —
begin with the acknowledgment
that customer relationship manage-
ment is a business strategy that
seeks to align people, processes and
technology within a goal-focused
framework. In effect, it’s a different
way of doing business — of culti-
vating, interacting with and relating
to people. The natural tendency, of
course, is for companies to not do
this — to instead think of CRM as
a bolt-on technology that might
require a process tweak here or
there, but functions largely like a
new tool. But this latter perspective
is a recipe for failure. Entities that
do not accept the need to rethink
and redesign their basic business
processes and organizational struc-
tures have little chance of succeeding.
There also is an important paradigm
shift that HDOs must make:
Historically and culturally, provider
organizations have viewed their
interactions with patients and refer-
ring physicians as episodic. That is,
costs and benefits are assessed per
episode of care. In healthcare, we
need to think of success in terms of
ongoing (mutual) value of the patient
and observe, and that drive the – Developing scri
right behaviors around the desired answer Frequen
customer experience. This is not to Questions.
say that CRM initiatives must focus – Developing/enh
solely on cost-reduction. In fact, tomer self-servi
that approach can actually lead to ties, such as sch
reductions in customer satisfaction, follow-up appo
increased costs of service and high- prescription ref
er levels of customer dissatisfaction. registration, clas
Ideally, quantitative measures will and concierge se
be blended with qualitative ones —
factoring in customer-oriented • Service effectivene
process measures, such as “customer result of an organi
satisfaction” or percentage of “one transformation fro
and done” calls (where the customer management” to “r
issue was resolved in one call). building.” Such in
on customer satisf
Incorporating the philosophical getting the right in
cornerstones noted above, health- and service to the r
care providers then should seek at the right time. P
to develop or adopt a health care efits often include
delivery organizational model with fied customers (w
a primary focus on increased efficiency, more loyal to the H
service effectiveness or growth. a broader deeper k
of each customer.
• An efficiency focus seeks to
address customer/patient
inquiries and concerns more
quickly, more completely and
more cost-effectively. Toward
this end, CRM efforts usually
involve:
CRM Layout 7/23/02 2:14 PM Page 11

• Market/revenue growth is
achieved with well-defined
campaigns targeted to specific
market segments and supported
by personalized messaging
and interaction management.
Growth-focused CRM initiatives
often seek to segment markets,
leverage business intelligence,
develop contact-sensitive mar-
keting capabilities and design
trigger-based marketing programs
to achieve desired behaviors.

– For physician-focused
campaigns, the desired result
often is measured by the
number and value of patients
referred to the HDO, as well
as the extent to which they
encourage referrals from
other physicians.
– For patient-focused cam-
paigns, the success of growth
initiatives is measured by the
number, type and duration of
interactions they have with
the HDO, and their influence
on the healthcare choices of
physicians, friends and family.

In both cases, successful growth-

focused initiatives create differ-
entiation in the marketplace
that results in more contracting
leverage with payers and
employers, and new opportunities
to cross-sell other services,
such as concierge, wellness
classes, home health, assisted
living and long-term care services.
CRM Layout 7/23/02 2:14 PM Page 12

The Value of Staged Migration

Gartner Group has observed that (e.g., telephone-based call centers).

healthcare CRM is in the introductory
stage of a four-phase evolution,
with each phase marked by increas-
ingly sophisticated and interconnected
capabilities (Figure 2). While not
disagreeing with this assessment,
Cap Gemini Ernst & Young’s posi-
tion is that Healthcare CRM is an
ongoing migration that is initiated
within a strategic framework and
implemented in calculated steps to
achieve specifically defined value.
More specifically, our view is that,
after an overriding CRM strategy
and mission have been defined,
most providers need to begin with
efficiency-focused initiatives that
improve customer-facing functions
Today, most healthcare call centers
are small, fragmented operations
organized around functional needs,
such as general patient information,
billing/patient account inquiries
or scheduling. Consolidating call
center functions can improve service,
increase standardization and
reduce costs.
Other efficiency improvements can
be made by enhancing HDOs’ Web
sites to minimize static content,
increase personalization and pro-
vide greater support for self-service
transactions, such as scheduling,
pre-registration and billing status.
This is a marked departure from the
mission of many current provider

Fragmentation Integration Collaboration Transform

• Disparate systems • Integrated systems • TES • Integratio
• Limited technologies • Data sharing and • TEM consume
• Unintegrated channels integration technologies • Speech recognition transact
• Basic Web presence • Zero latency • E-mail response the oper
• Rules-based workflow management systems environm
• Interactive Web • Enterprise data • Common
management

Phase 1 Phase 2 Phase 3 Pha

CRM Layout 7/23/02 2:14 PM Page 13

sites, most of which were set up to

provide static content as a branding The Old Model Future State Vis
strategy (i.e., to ensure that an
HDO was no less “visible” than • Communication is • One-and-Done
its competitors). Slightly more fragmented
advanced Web presences can pro- • Integrated inform
vide self-service capabilities for • Departments and services
high-frequency and low-complexity are siloed • Front-end and b
functions such as scheduling integration
requests, coordinating pre-registra- • Information systems not
integrated • Alignment of cus
tion, and making physician referrals
access points
to the HDO.
• Customer access is
fragmented • Interactive, pers
Another important step HDOs
web pages
can take is to enhance the level of
• Web function is limited
business intelligence they collect • Customer segm
on their customers. This capability • Marketing not well targeted
sets the stage for analyzing cus- • Customer-centri
tomer information, personalizing • Employee incentives are organization
interactions, extending offers and misaligned
managing marketing campaigns.

Further down the migration path,

many providers will develop inte- Figure 3: CRM’s ultimate vision is a customer service
grated, multi-channel capabilities “transformation” of the healthcare organizati
that include:

• Computer-telephone integration.

• Data warehousing and continued

use of analytical tools.

• Web-contact-center integration —
allowing movement between
Web and phone.

• Application of Web chat and

guided discussions.

Each one of these initiatives has

potential standalone value. But the
ultimate vision is a customer-centric
CRM Layout 7/23/02 2:14 PM Page 14
The Technology Side of CRM
As noted earlier, CRM is not just a
technology. It is a business strategy
that aligns people, processes and
technology within a goal-focused
framework. Nevertheless, CRM has
a strong technology component.
In effect, its potential is released
through the well-considered use
of technology.
To help readers understand how
technology supports CRM, Cap
Gemini Ernst & Young developed
the Enterprise Solution Architecture
Model. The model depicts the
channels through which customers
access the organization, and it
defines how information is
organized to support customer
requests. It also shows how events
are linked, how information is inte-
grated with existing legacy systems,
and how consistent, recognizable
interfaces are leveraged to track
customer interactions and create
“institutional memory.”
As shown in Figure 4, the model
works its way from customer-facing
functions at the top (“customer
touchpoints or channels”) to inte-
gration with healthcare providers’
back-office systems at the bottom
(“touches”) can be conducted via CRM implemen
several contact channels: e-mail,
Web, telephone, fax, walk-in and
can help HDOs
so forth. But regardless of the to the privacy a
channel, every interaction requires
security manda
1) immediate access to the same set
of customer information, 2) a decision- set forth by HIP
support process for relating to the
customer’s needs and 3) connectivity
to business processes that are
driven by uniform, yet flexible,
business rules.
Customer Interaction Enabling Technologie
Management. Dealing effectively the Architecture’s unde
and consistently with customers ponents: the technologie
across disparate touchpoints and marshal, move and ma
multiple channels is significantly information. Key playe
less complicated — and less the following:
expensive — than it used to be.
The reason is an innovation called • Interactive voice re
a multi-channel contact server, transforms the tele
which allows HDOs to work quickly computer-emulati
and economically to gather, manage Responding to voi
and use huge volumes of physician, pad commands, th
patient, employee and customer look up and prese
information. Functioning as an inte- tion, or it can con
grated, desktop platform (a sort of transactions, such
intra-enterprise portal), the server directions and det
associates customer interactions billing status.
with appropriate enterprise business
functions, such as scheduling, regis-
tration, billing, clinical applications
CRM Layout 7/23/02 2:14 PM Page 15

Figure 4: The Enterprise Solution Architecture Model

• Computer-telephony integra- while incorporating graphics, • Media blending al

tion (CTI) “calls up” specific video, flash animation or other CRM applications
information from an HDO’s information that assists users. systems to send an
CRM Layout 7/23/02 2:14 PM Page 16
• Rules engines apply guidelines
and parameters to the access,
formatting and movement of
data. They also are designed to
adapt quickly and seamlessly to
changes in business goals and
conditions.
• Skills-based routing technology
steers each contact to the
first available agent with the
right capabilities to meet the
customer’s needs.
Health CRM Applications. At the
heart of the model are healthcare
CRM applications. Although not
shown on the diagram, these appli-
cations subdivide into “operational
CRM” and “analytical CRM”:
• Operational CRM refers to
enterprise applications engi-
neered to streamline, automate
and enable customer interactions
across all contact channels.
As such, they collect customer
data, process transactions and
control health-process workflows.
Specific components include:
– Portal technology: software
and/or hardware that allow a
customer to connect with a
company via a Web site.
– Workflow/workload manage-
ment rules engines: “operating
instructions” that are deter-
mined by managers and
converted into software
code, thereby allowing com-
– Case management/accounta- The most logica
bility functionality tracks
and manages service requests universal — sta
through their lifecycle — point is acknow
until the each request is
fully resolved.
that customer r
– Knowledge management
ship manageme
refers to computer software business strateg
in which application-specific
aligns people, p
information is programmed
into a knowledge base in the and technology
form of rules to solve a par- goal-focused fra
ticular business problem.
Some solutions include
analytical tools and data
repositories as well.
Leading vendors in the opera-
tional CRM space include Siebel,
the Connected Health
Oracle, PeopleSoft and SAP.
Model—an “enabling s
• Analytical CRM can be thought set that covers CRM st
of as a subset of operational ment, readiness assessm
CRM. However, it also can be tion design, and imple
positioned as standalone appli- and change manageme
cation — a tool for providers
Health Integration Ar
that may not want to do opera-
The mission of the Heal
tional CRM but still need the
Architecture is to strea
data-analysis, repository and
link technologies and p
management (business intelli-
(new and existing) to m
gence) capabilities. In either
effectiveness and efficie
context, these applications
accomplished with the
deploy OLAP (on-line analytical
dleware (a layer of soft
processing) technologies and
allows CRM and health
tools to help decision makers
to interact across softw
develop and revise plans.
ware and network env
Leading vendors in the analytical
and application progra
CRM space include Hyperion,
interfaces (a programm
NCR Teradata, PeopleSoft EPM
that allows users to pro
and Oracle.
pre-constructed interfa
of programming a dev
The Connected Health Business
CRM Layout 7/23/02 2:14 PM Page 17
Principal CRM Challenges
and Barriers
From a technology viewpoint, CRM’s
initial mission is to create a “360-
degree view of the customer” — to
integrate data from all customer
interactions, no matter which touch
point is used. These insights then
can be used to optimize support
structures for effectiveness, cost-
efficiency and growth purposes.
Without such a viewpoint, it is not
possible to track a customer’s inter-
actions across the enterprise, or to
fully understand customers’ needs
and value.
Achieving a 360-degree view of the
customer requires integration across
all applications that create or use
customer data. Today, HDOs have a
very fragmented view of customer
information because it generally is
scattered across multiple applica-
tions, databases, departments and
business entities, such as physicians,
payers, ambulatory care centers,
home health agencies and pharmacies.
Generally, technology integration
challenges fall into one or more of
the following three categories:
1. Data definition, administration
and management: specific data
example, what is the definition
of a customer? Is a prospect a
customer? When does a
prospect become a customer —
when contact is first made or
when payment is received?
Are only active customers
considered customers? What
constitutes an active customer?
2. Application Integration: There
has been a proliferation of
point CRM technologies across
multiple channels of interaction
with customers from call cen-
ters to Web sites. This forces
HDOs to choose between two
primary alternatives: CRM
application architectures based
on a single-vendor suite
approach, or a best-of-breed
applications approach.
Deciding between the two
involves questions such as:
• What specific applications
need to be integrated —
e.g., how will CRM systems
be integrated so that customers
have complete visibility?
• What application integration
methods will be used —
point-to-point using APIs or
• Will application
ent databases b
will all data be
application-spe
or files?
3. Customer Analyti
Intelligence: What
processes need to
and what data wil
collected? What cu
is required beyond
action data (demo
psychographic, ge
behavioral, etc.)? H
be collected? How
be analyzed and u
what business resp
it trigger? Often co
collect data first an
tions later. It is tru
data mining techn
get around this to
but more often tha
approach can resu
of useless data sto
in the (usually vai
deep insight can b
from them.
CRM Layout 7/23/02 2:14 PM Page 18
Getting Started: Building the
CRM Strategy and Business Case
The first step for HDOs seeking to
define and launch a CRM business
strategy is to create a cross-func-
tional sponsorship team that will set
the initiative’s direction, participate
in project implementations, assess
organizational impact, and ensure
consistent, enterprise-wide gover-
nance. The sponsorship team
should include representatives from
the HDO’s financial, clinical, opera-
tional, marketing and information
technology arms.
Item One on the sponsorship team’s
agenda should be the development
of a structured “Strategic Alignment”
process for attaining organizational
consensus.i Requiring about two
months, this phase begins with a
research effort to better understand
what customers want and what ini-
tiatives would improve their loyalty
to the HDO. Next, a current-state
assessment of organization, processes
and technology is made. This helps
to provide a clear understanding of
how customer-facing processes are
currently supported by the HDO’s
people, organization and technology.
It also sets a baseline from which
a gap analysis can be made.
CRM FOCUS: Patient Access
HDOs everywhere are struggling to manage the endless pho
paperwork, faxes and legwork associated with serving patie
physicians, payers and information seekers. Small wonder t
access is one of the single most important operational area
provider organizations are looking to transform.
Defined more or less by its functional components—schedu
registration, benefits eligibility, financial clearance, referral p
check-in and so forth—patient access generally has been s
by HIS legacy systems and managed in a very fragmented,
nated manner. Few of these front-end operations have been i
in any meaningful way with back-end operations such as bi
patient accounting and reporting.
Today, many providers are seeking to improve service and re
costs by centralizing their patient-access functions, e.g., via
centers and enterprise scheduling/registration supported by
patient index (MPI). This centralized view is increasingly crit
that, over time, the same patient may be seen in an ambula
center, a home health agency, a physician’s office and/or a h
Each entity is likely to have its own identifiers for that patien
obviously, multiple, un-integrated (and potentially inaccessib
records are counter productive, extremely off-putting to the
and potentially dangerous. Centralized capabilities, such as
are increasingly necessary to avoid such scenarios.
To make centralization happen, CRM technologies often pla
roles by providing workflow management, automated call di
and skills-based routing. And advancements in “interactive
response” and Web enablement also have given rise to self-
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With consensus developed around
the CRM strategic vision, the gap
analysis then is conducted to identi-
fy which initiatives address the
greatest areas of need. Those initia-
tives are prioritized and phased to
establish a CRM roadmap — a
migration plan. Each high-priority
initiative should include an imple-
mentation plan, human resource
commitment, detailed cost analysis,
and a sense of the qualitative and
quantitative value the organization
expects to achieve. With this infor-
mation in hand, a clear business
case can be developed.
CRM FOCUS: Web Portals
In recent years, many HDOs built Web portals as a defensive s
to maintain visibility and local market branding. Unfortunate
cess of these efforts has been spotty, usually due to an ove
of the organization’s original goals, combined with an under-co
of resources. Nevertheless, most providers now have Web s
provide general information about facilities, directions and p
access to basic medical content and health news; a calenda
events; employment opportunities; charity/donor information
links to other health-related Web sites.
Some leading organizations, however, have gone further—e
functionality and interactivity with capabilities targeted conc
at the general consumer, patient and referring-physician ma
segments. These capabilities include:
• Physician directories/search.
• Appointment scheduling requests.
• Referral requests.
• Health education/promotion class registration.
• Community chats regarding specific diseases, condition
concerns.
• Health plan linkages.
• On line library resources (Medline, Ovid, e-Journals).
• Customized patient home pages and personalization of
— Interactive conferences
— Online grand rounds
— Linkages to legacy applications (EDR, scheduling, reg
— Physician portals
— Employee portals
Going even further, innovative HDOs are launching initiatives
area of remote care (e.g., remote monitoring, e-consultation
disease management) that are enabled through the Internet
other emerging technologies. The challenge associated with
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CRM FOCUS: Call Centers

Call centers will play an increasingly important role in the healthcare provider setting, as patients, pat
families, physician offices and even vendors demand a single point of access into the organization. F
most part, call centers are organized around functional processing needs, and often are set up to sup
specific requirements of an operational or clinical department. These “calling pods” typically are sma
units (staffed by three to six full-time personnel) that support general patient/hospital information; sched
billing/patient account inquiries; pre-registration and insurance verification; referral processing; presc
refills; and nurse on call capabilities.

Generally speaking, provider call center capabilities are in their infancy. As such, they basically are set u
call processing, rather than relationship building. Few capabilities exist to escalate issues, route infor
appropriate individuals or confirm problem resolution. Nor are they generally successful at helping cu
resolve problems, since most of the processes are fragmented, accountability is dispersed and sever
nected pods often must be accessed to achieve resolution.

The technology supporting these early-stage call centers also is call-processing focused. Most are b
elementary call-routing or automated call-distributor (ACD) systems, with some voice-recognition cap
thrown in for good measure. Call center representatives seldom are provided with enough information
anything but rudimentary requests; since there is minimal integration to back-end transaction system
tomer-contact histories can neither be accessed nor updated. Thus organizations glean only the mos
ability to understand who is contacting them, what the issues are, how they ought to manage follow
problem resolution, and how can they proactively develop services targeted at their best customer se

Looking ahead, however, more and more HDOs will come to view call centers as vehicles for enhanc
tomer service, reducing overall transaction costs and even building and sustaining customer relations
addition to linkages with back-end systems, this transformation will be driven by:

• The convergence of voice and data networks.

• Workflow management technologies.
• Skills-based routing capabilities.
• Intelligent telephony.
• Integration tools.
• Data warehousing technologies.

Successful implementation of these technologies will require a significant investment in process trans
as well. In fact, for call centers to reach the next stage of sophistication, HDOs must begin to view th
core process area that is fundamental to the organization’s success.
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About Cap Gemini Ernst & Young
The Cap Gemini Ernst & Young
Group is one of the largest manage-
ment and IT consulting organizations
in the world. The company offers
management and IT consulting
services, systems integration, and
technology development, design
and outsourcing capabilities on a
global scale to help businesses con-
tinue to implement growth strategies
and leverage technology. In early
2002, the organization employed
more than 56,500 people worldwide
and reported 2001 global revenues
of more than 8.4 billion euros.
Cap Gemini Ernst & Young’s Health
Practice is the leading consulting
practice serving the health industry,
delivering broad-based and results-
driven solutions for today’s business
challenges. We work with health
organizations to drive them past the
visionary stage through solution
design, into solution implementation,
to bottom line results — facilitating
their business growth, gaining mar-
ket share, becoming more efficient
and reallocating capital to priority
areas. In many cases, we deliver
results through performance-based
contracts — the ultimate flexibility
in fee arrangements.
Our solutions are comprehensive,
innovative and sustainable, enabling
our clients to provide the highest
companies. In addition, we work
with 13 of the top 15 global
pharmaceutical companies,
9 of the top 20 medical device
companies, and 5 of the top
biotech companies.
• Unparalleled experience with
access to the multidisciplinary
skills and knowledge of more
than 2,000 CGE&Y Health
Practice professionals who are
dedicated to and trained specif-
ically for the health market.
Our teams draw from experi-
ence in and with managed care,
hospital, biotechnology, phar-
maceutical, and medical device
companies, as well as the feder-
al government. Our broad base
catapults the practice ahead
of industry competitors. Our
consultants include physicians,
nurses, pharmacists, coding
specialists and former executives
from life sciences companies and
managed care companies.
• Technology depth with full
resources in place to run an
IT organization, including the
depth and breadth to advise
or help clients outsource their
technology functions. Our
team has expertise in packaged
systems used by the health
industry, including SAP, Lawson,
• Scope of influenc
denced by our sur
thought leadership
help shape and ad
health care industr
the ground up. Fo
we have maintaine
ship role in HL7, a
related leadership
for more than a de
and participate in
other HIPAA-relat
tees and task force
before the Nationa
Vital and Health S
maintain active pa
a variety of industr
associations. In ma
we produced The M
Health Care Handb
reference publicati
its fourth edition.
• Range of health-s
solutions to help
We specialize in bu
and transformation
transformation, HI
services, FDA and
issues, information
integration and ma
outsourcing, custo
ship management,
cycle and support
enhancement, sup
management, phar
sales and marketin
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