Part 1: Accreditations and Certifications

If you’re looking to improve the patient/member service experience at your health plan or health system, an improved centralized support center is a foundational starting point. But as the industry deals with labor challenges, changing expectations and rising costs (including  technology and equipment), many organizations are rethinking whether they should build or rebuild their own contact center, or find a partner with innovative solutions and the core competencies they need.

To provide you with a few insights for that decision, this new blog series from Carenet Health looks at relevant factors to consider. In this first post in the series, we examine accreditations and certifications.

In deciding how to source and staff your healthcare contact center operations, one important element to consider is that some vendors will be able to offer accredited, certified solutions; some will be able to offer limited certifications or none; and even your own patient contact center (or health plan member contact center) will likely lack objective accreditations and certifications on its own.

For example, at Carenet Health, we are both URAC-accredited and have a Health Information Product Certification from the National Committee for Quality Assurance (NCQA).

The URAC accreditation includes standards for clinical staff qualifications, training and roles of non-clinical staff, telephone performance thresholds, response times, handling of triage calls, information sharing, feedback to physicians and more. Meeting these standards is a sure pathway to building consumer trust.

Could you meet these same standards by training your own staff and developing more detailed policies and compliance standards? Yes, but doing so would typically require a significant investment of time and resources.

If you decide to go with a healthcare contact center vendor, you’ll want to verify that the service and support solution has the URAC accreditation and the NCQA certification. Not all of them do. In fact, Carenet Health is one of only 20 organizations with the NCQA Health Information Product Certification, and even fewer vendors have both accreditations.

Do certification and accreditation really matter?

Yes. You can be more confident in a service when an independent and objective third party has rigorously and comprehensively examined its systems, protocols and performance.

For example, URAC’s health call center accreditation requires that the call center vendor meet 40 specific core standards across the following areas:

  • Organizational structure
  • Policies and procedures
  • Regulatory compliance
  • Delegated functions
  • Marketing and sales
  • Information management
  • Quality management
  • Staffing and oversight
  • Consumer rights, safety and satisfaction

These comprehensive standards mean that URAC-accredited health call centers are best-in-class operations that few insourced call centers can match.

In addition, vendors that seek and maintain certifications and accreditations continuously enhance their quality of service—in part because they have to. For example, organizations with the NCQA Health Information Product Certification undergo an assessment against NCQA standards at least every two years. Thus, these organizations must constantly improve their offerings to comply with the continually evolving NCQA standards.

What are the benefits of embracing the new consumer-centric focus in healthcare?

Most hospital and payer executives are now taking steps to provide more consumer-centric healthcare. Why is that? Because a consumer focus makes financial sense. In particular, improving your consumer engagement leads to better patient outcomes and reduced costs.

(Learn more about how Carenet Health is providing insights into the healthcare-specific consumer service journey and experience.)

Other considerations for build vs. buy relating to health plan member or patient support

Be sure to check back on our blog for new articles in this series. In the meantime, you can read more about sourcing patient support and health plan member service in our helpful guide. Or simply contact us to further explore the topic with our experts. Carenet Health is the nation’s premier, healthcare-only, 24/7 consumer engagement and support partner.