These Oncologists Made a Promise to Their Patients. We helped them keep it.
In 30 days, we built a solution that kept chemo patients out of the ER
At one of the largest, most innovative, and most progressive oncology groups in the nation, patients were suffering. After receiving chemotherapy, they were returning home and experiencing nausea, soreness, and fatigue.
In anticipation of these side effects, their oncologists had told them to “call early and call often.” But when the patients called, instead of receiving guidance and support from their doctors, they were often asked to leave a message.
For most of these patients, their calls weren’t returned for hours or sometimes even days. Because of this, many of them ended up in the emergency room, where they received substandard care that was very expensive but not very effective.
For the group’s chief medical officer, this was unacceptable. The group prided itself on providing convenient, high quality care. Its 36 practices were located in a range of metropolitan areas, from city centers to suburbs and towns, so patients wouldn’t have to travel long distances to receive treatment. Its oncologists were some of the best in the field, and it was partnered with a variety of highly regarded hospitals and research institutions.
But if its doctors weren’t responding to patients in time to help them manage their symptoms, the chief medical officer reasoned, they were failing them.
Searching for a Solution
A practicing oncologist herself, the chief medical officer knew how important it was to help patients cope with the side effects of chemotherapy. As the group’s liaison with the American Society of Clinical Oncology (ASCO), she also knew about an opportunity to solve this problem.
ASCO was accepting proposals for projects that would help its members improve how they cared for patients. Proposals approved by ASCO would be presented at the society’s annual meeting. The project would also help the group adopt the Oncology Care Model, a new reimbursement program designed to encourage practices to transition to value-based care.
The chief medical officer assigned the development of an ASCO proposal to the manager of the clinic where she worked. He was known throughout the group as an early adopter of new technology, always eager to innovate if it meant care might be improved. When he learned what the chief medical officer wanted to do, he jumped at the chance to spearhead the project.
The practice manager knew technology would play a role in the proposal, but he didn’t quite know how. Unfortunately, when he approached the group’s IT department with his new endeavor, he didn’t receive much guidance. IT was busy with large infrastructure projects like building a unified communications system and implementing a new electronic medical record. In comparison to these tasks, what the practice manager wanted to achieve was a low priority.
When he turned to Microsoft for help, the practice manager encountered an obstacle of a different kind. At first, everything seemed to be going well. Microsoft set him up with one of its elite implementation partners, a technology provider who could build him a solution using Microsoft Dynamics, the enterprise software platform already in place at the group’s practices.
But as the practice manager waited for the implementation partner to draw up a proposal, the days turned into weeks, and the weeks turned into months. With the deadline to submit his own proposal to ASCO nearing, the practice manager realized something.
The implementation partner was taking months to draw up a proposal because its team didn’t understand the business of oncology.
30 Days to Deadline
While the practice manager had been waiting for the implementation partner to learn how his business worked, time had been running out for his project. He decided to act fast. He ended the relationship with the implementation partner. Then he turned to Salesforce and requested a new technology provider, one who understood healthcare. Salesforce put him in touch with us.
My first impression of the practice manager was positive. Passionate about his project and committed to improving care, he was the kind of client we liked to work with. When he told me about the ASCO proposal and the problem he wanted to solve, I saw an immediate opportunity to build a solution that would make a big difference in the lives of his patients.
“There’s just one catch,” he said. “We have to have it up and running in 30 days to meet ASCO’s deadline.”
“Sure,” I told him. “No problem.”
My team set to work, talking with the practice manager, the chief medical officer, and the group’s director of value-based transformation. We quickly figured out what we were going to build, how we were going to build it, and when it would be ready to start collecting data for ASCO.
While designing the solution, our philosophy was, “If you can’t measure it, you can’t manage it.” With this in mind, we developed a call-tracking system that let the group know what kinds of calls were coming into its practices, and how quickly those calls were being returned.
With our solution, when an administrator answered a call, they would pull up the patient’s file, log a new call, and select the type of call it was from a menu. The system then automatically prioritized the call, tagging anything symptom-related as high priority and the rest as low priority.
High priority calls went to the top of a nurse’s queue so the nurse would have a chance to respond to them first. After 30 minutes, low priority calls jumped to medium priority. If another 30 minutes passed without a call back, medium priority calls then leaped to high priority.
When the solution was ready to roll out, we joined the practice manager at his clinic. We spent an entire week working with the clinic’s doctors, nurses, and administrators, teaching them how to use the new call tracking system and making any changes and adjustments in real time.
Within 30 days of our first conversation with the practice manager, the solution was live. Thanks to the data it gathered, ASCO accepted the group’s proposal.
Keeping Their Promise
A funny thing happens when you start collecting data. The finger pointing stops. Doctors can no longer say that calls aren’t being returned because the nurses aren’t working hard enough. Nurses can no longer blame the administrators for sending them calls that aren’t clinical.
For the group, the data our solution collected revealed the depth of their problem. The chief medical officer had determined that symptom-management calls needed to be responded to within two hours to keep patients out of the emergency room. But the baseline our system established showed that only 1-in-5 calls were being returned within that two-hour window.
The shock of this discovery galvanized the group. They immediately began using our call-tracking system to turn the situation around. Their results impressed even us. Within 30 days of establishing a baseline, they had decreased that ratio from 1-in-5 to nearly 1-in-2.
Since then, our call tracking-system has been implemented at more and more practices, allowing the group to become better and better at returning calls. We’ve worked with staff to refine the solution, adding more functionality and integrating it further into their existing systems.
Patients may not have even noticed the difference. With everything they’re going through, I wouldn’t be surprised. But if waiting for their doctor to call them back is one less thing they have to worry about, then the project was a success. I think the chief medical officer would agree.
Because when oncologists tell their patients they’ll be there when they call, that’s a promise they should keep.
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How we built a solution that saved money and lives
Responsive oncology care
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