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How Do Healthcare Call Centers Differ From Traditional Call Centers?


Customer service can make or break a business—and healthcare businesses are no different. From commercial health plans to nonprofit health systems to wellness programs, patients and members expect and deserve on-demand engagement. They want an experience similar to what they are offered from other service-based industries.

But healthcare call centers—or healthcare engagement or healthcare contact centers, as they are often called—are different from call centers that serve other industries.

They have to be.

How are healthcare call centers different?

Healthcare call centers aren’t just answering phones; they’re holding patients’ hands on journeys to recovery or chronic care management. These crucial pathways impact lives and well-being, making their objectives and operations stand apart from typical call centers.

A Healthcare call center must adhere to an even more precise set of engagement standards. And ensure compliance with federal and state regulations. And handle high call volumes, 24 hours a day. All while delivering a compassionate customer experience, among other factors. Plus, in no other industry is member and patient experience a key marker of published quality and satisfaction ratings. (Think CMS Star ratings for both health plans and providers, for starters.)

Consider this, too: A person calling their favorite retail business will not typically be in a life-or-death situation. But every call that comes into a healthcare call center can potentially be just that. Whether the call to a health plan’s member services line is from a parent in need of benefits coverage information quickly or an older patient calling a provider’s patient services line with worrisome chest pain, these callers have immediate needs.

Given all of this, healthcare engagement centers have to measure and analyze performance metrics differently than a traditional, all-industry customer service center.

Healthcare contact center metrics

Most contact centers measure things like first-call resolution, call time and availability, handling and abandon rates, and call/service quality.

While healthcare call center metrics are similar, there are some nuances. Healthcare-focused outreach goals are more about emotional connections, trust- and relationship-building, empathy, and influencing individuals to take the next best step for their health. And most importantly: The patient or member always determines the success of the interaction. Success is not just about hitting designated numbers or thresholds. This distinction makes medical-related engagement centers much different than “typical” call centers.

At Carenet Health, we use an integrated performance management platform for every client engagement program. Real-time, individual Carenet team member dashboards and sophisticated technology help us monitor 100% of all interactions. Those tools and our robust management team help us continually check for factors such as levels of personal engagement and service focus.

The bottom line on metrics: Our clients’ return on investment is always a priority. However, to get there, determining success often looks far different than a conventional service center’s measurement.

Healthcare engagement center training and coaching

While all call centers train their customer service representatives, the training regimen for healthcare call center teams goes beyond use of telephonic and other platform technology and knowledge of program specifics.

In a health-related service center, there will likely be rigorous education and role-playing. The training may focus on a population’s cultural and demographic sensitivities, motivational conversation and listening techniques, proactive relationship-building, and engagement triggers—in addition to HIPAA and other compliance needs like URAC.

There may also be mandatory, one-on-one coaching to improve interaction quality and ensure the team is truly a seamless extension of the provider or health plan. In addition, at Carenet, our team managers are required to complete coaching training, and our patient engagement specialists have at least one personal coaching session per week.

What does a high-performing healthcare call center look like in action?

Healthcare call centers in general focus on specific business value for the provider or health plan, but a high-performing one will offer (or engage with a partner who offers):

  • Secure, accredited IT platforms and communication channels
  • Compassionate, confident engagement that provides both comfort and expert guidance
  • Multichannel, multilingual engagement platforms
  • Specialized monitoring for key performance indicators (KPIs) and continuous quality improvement

A modern, best-in-class health-related patient engagement center will be a textbook combination of human interaction, data-driven personalization and proven technology.

Want to learn more? Discover the difference our engagement teams can make in your organizational strategy. Simply contact us for details.

Ready to write an RFP for healthcare call center services? Check out our guide or this quick checklist.