IBM and Cincom: Guiding Smarter Interactions in Healthcare Reform

Cincom® Synchrony™

Guiding Smarter Interactions
in Healthcare Reform
IBM and Cincom Systems Address the Challenges of Customer
Experience in the New Healthcare Reform
Commentary by Harry Reynolds, IBM

United States healthcare reform
legislation is a subject of considerable
debate and confusion.
Pundits on the right and left continue to argue about the potential
implications and whether or not parts and pieces of the legislation
should be repealed altogether. Uncertainty abounds, but most
agree that whatever the outcome, new reform legislation will
inevitably change the business of healthcare as we know it.

What will be the impact to health insurance providers when
the dust settles? No one knows for sure, but it is clear that
insurers must be prepared for significant changes in the way they
do business. This paper explores three of the most important
aspects to consider—Medical Home, Accountable Care and
Global Payments—and suggests steps to bolster information
systems using Cincom Synchrony in order to adequately respond
to evolving legislative and market demands.

Guiding Smarter Interactions in Healthcare Reform 1/18

Change Is Coming “We’ve got standards,
policies, technologies and
The concepts of patient-centered Medical Home, Accountable processes that never before
Care and Global Payments are three key areas that will have a have converged into this
powerful impact on the healthcare industry, says Harry Reynolds, industry at a time when all
the Director of Health Industry Transformation for IBM. Reynolds, these regulations and the
a respected industry veteran who knows the health insurance rising cost of healthcare
business inside and out and spent over 30 years with Blue Cross have forced people to listen
Blue Shield of North Carolina before joining IBM as Chairman of and react.”
the Council for Affordable Quality Healthcare initiative. He currently - Harry Reynolds, the
serves on the National Committee on Vital and Health Statistics. Director of Health Industry
Transformation for IBM
“I spend a lot of time with payers and providers, and whether
or not you are on this side or that side of the debate, change is
going to happen,” says Reynolds. “Medical Home is one example
of that change. The focus is on providing care holistically and all
the incentives are built to encourage that the information flows
seamlessly amongst the professionals involved. Providers and
organizations will be expected to work proactively together to
ensure that the patient has a more unified experience.”


According to Reynolds, the concept of Accountable Care is
another important aspect of new legislation to consider. “If you go
one step past Medical Home, you start having an entire organization
being held accountable for all the patients that they see. Proposed
legislation stipulates seamless delivery of high-quality care for
Medicare beneficiaries and the scope includes group practices,
hospitals and hospitals in partnership with those practices. The
activities of hospitals, doctors and insurers will be viewed together;
whereas today they are most often regarded separately.”
Hear Harry Reynolds live on
Expert Access Radio
Reform legislation is also poised to change the current payment
structure for hospitals and providers and, according to Reynolds,
this will be a significant change from the status quo.

“Going forward, there will be one payment, usually to the hospital,
that will be split amongst the practitioners and organizations
involved,” says Reynolds. “The new legislation also stipulates
that if a patient leaves a hospital and is readmitted for that same
reason within 30 days it will be the responsibility of the hospital
to cover that additional expense; the government won’t pay for
it again.”


Improving Care, Reducing Costs
Healthcare reform legislation is focused on improving care and
reducing costs. Insurance and healthcare companies can respond
to the implications in two ways: with great efficiency or with great
inefficiency. Understanding the following will have a direct
bearing on your ability to navigate the transition.

Medical Home
The concept of the patient-centered Medical Home model is an
approach to providing comprehensive primary care that facilitates
partnerships between patients and medical providers.

The aim of the Medical Home model is to improve access
to care, increase patient satisfaction with the care received
and ultimately, improve the health of patients. The idea
behind legislation is that every American should have a
“personal Medical Home” through which to receive services
and that those services should be “accessible, accountable,
comprehensive, integrated, patient-centered and satisfying to
both patients and their physicians.”


With the current economic challenges facing the United
States, it is easy to see why the move to a patient-centered
Medical Home approach has become a cornerstone to new
legislation. One study estimated that if recommendations were
followed, healthcare costs would likely decrease by 5.6%, resulting
in a national savings of $67 billion dollars per year. Indeed, in
2006—before healthcare reform stepped into the national
spotlight—industry leaders including IBM and others started the
Patient-Centered Primary Care Collaborative to promote the
Medical Home model. Membership includes some 500 large
employers, insurers, consumer groups and doctors.

Accountable Care
On March 31, 2011, the Department of Health and Human
Services released proposed rules to help doctors, hospitals and
other providers better coordinate care for Medicare patients
through Accountable Care Organizations (ACOs). The goal of
an ACO is to deliver seamless, high-quality care for Medicare
beneficiaries, and incentives are designed to encourage healthcare
providers to work together to treat an individual patient across
care settings—including doctors’ offices, hospitals and long-term
care facilities.


The Medicare Shared Savings Program will reward ACOs that Improving coordination
lower growth in healthcare costs while meeting performance and communication
standards on quality of care and putting patients first. through Accountable Care
Organizations will help
Experts estimate that more than 50% of Medicare beneficiaries have improve the care Medicare
multiple chronic conditions such as diabetes, arthritis, hypertension beneficiaries receive, while
and kidney disease. As a result, these patients often receive care also helping to lower costs;
from multiple physicians. A failure to coordinate care can often Medicare could potentially
lead to patients not getting the care they need, duplicative care save as much as $960 million
and increased risk of medical errors. Improving coordination and over three years.
communication through ACOs will help improve the care
Medicare beneficiaries receive while also helping to lower costs;
Medicare could potentially save as much as $960 million over
three years.

Global Payments
Healthcare-reform legislation calls for a Global Payment system
with significant incentives to encourage more holistic patient
care. The idea is to encourage more careful coordination and
collaboration between a patient’s physicians, nurses, hospitals


and other care providers. Section 2705 of the Patient Protection Experts say that an emphasis
and Affordable Care Act is intended to further states’ efforts to on patient-centered medicine,
shift from the current Medicaid fee-for-service payment structure with doctors and other
to a global, capitated payment model. providers providing better
coordination of information
Experts say that an emphasis on patient-centered medicine, and services, will help to
with doctors and other providers providing better coordination reduce healthcare costs
of information and services, will help to reduce healthcare costs while providing more
while providing more effective care for patients. Providers would effective care for patients.
receive payment that is adjusted for patients’ health statuses
and it would be based on meeting common core performance
measures to ensure high-quality care. Legislation calls for a careful
transition to global payment within five years, during which
“shared savings” would serve as an interim payment model to
help providers become more familiar with global payment with
reduced exposure to risk.


Cincom Synchrony—Optimize
Interactions with Unified Information
Healthcare reform is quickly changing the industry. The concepts
of Medical Home, Accountable Care and Global Payments
will require that companies foster more seamless and personalized
interactions across patients, providers and payers while adhering
to an incentive-based mandate to reduce costs and improve care.

Cincom Synchrony offers an innovative, cost-efficient way to
overcome the challenges of healthcare reform. It guides smarter
interactions with patients, providers and payers, and leverages
the insight a company has about each patient or member in the
context of each interaction. Supported by a robust and highly
flexible platform of IBM technologies, Synchrony is a powerful
software application specifically designed to help customer care
centers in healthcare provide smarter, streamlined experiences
across complex, cross-channel interactions that utilize multiple
back-end applications. The centerpiece of the solution is real-time
Intelligent Guidance that automatically displays the information
you need no matter the activity or the application.


By combining real-time Intelligent Guidance, Synchrony allows Cincom Synchrony offers an
you to focus on the patient or member experience instead of innovative, cost-efficient way
spending time on labor-intensive internal processes such as to overcome the challenges
customer look-ups, interaction history or content research. It of healthcare reform.
has also been developed to work with the healthcare-specific
components of the IBM Health Integration Framework, so
you can expect high reliability.

Depending on the type of interaction, Synchrony retrieves and
presents critical information, pulling it from any back-end source.
You can see the patient or member’s entire interaction history.
After every customer response, Synchrony identifies the next
step in the process, providing context-specific language and
interaction guidance. This is critical in standardizing interactions
across departments.


Respond to Legislative Demands
IBM ISV & Developer Relations Healthcare
Solution Brief

Cincom and IBM: guiding
smarter interactions
Enabling provider and payer customer care centers
to optimize interactions with real-time intelligent
guidance and a dynamic, unified information view

Synchrony helps you respond and adapt to the new legislative Highlights:
In an increasingly competitive and quickly changing industry,
providers and payers face a stark new reality – today’s customers
expect an efficient, personalized, high-quality experience every
time they connect with a healthcare organization. At the same

models brought about by the transition to Medical Home,
time, providers and payers have an ongoing mandate to manage
costs, improve productivity and increase revenue.

Cincom Synchrony offers an innovative, cost-efficient way to overcome
this challenge. Supported by a robust and highly flexible platform
of IBM technologies, Synchrony is a powerful software application
specifically designed to help customer care centers in healthcare

Accountable Care and Global Payments systems. Some of the
provide smarter, streamlined experiences that deliver intended results,
even for complex, cross-channel interactions that utilize multiple
back-end applications.

The centerpiece of the solution is real-time intelligent guidance that
automatically displays the information employees need and directs
them to give every customer individual attention.

capabilities of Cincom Synchrony include: Solution overview
Healthcare providers and payers are working hard to improve
the industry’s customer experience rankings, but the obstacles are
considerable. Hiring, training and supervising customer-facing
employees are costly. At the desktop level, agents and other customer
care representatives are dealing with unprecedented complexity, from
the technology they use, to the processes they follow, to the issues they
are expected to resolve.

Synchrony is a smarter solution. Combining real-time intelligent
guidance, a customer-centric desktop and interaction automation,
Synchrony allows employees to focus on the patient or member

Real-time Intelligent Guidance – This is a key feature of Synchrony
experience instead of spending time on labor-intensive internal
processes such as customer look-ups, interaction history or content
research. It has also been developed to work with the healthcare-
specific components of the IBM Health Integration Framework,
so users can expect high reliability.

that will help you respond to the demands of seamless data
access and communication across channels and data repositories. Cincom and IBM
Solutions Brief (PDF)
Intelligent Guidance easily surpasses conventional scripting
and walks you through every step of even the most complicated
interactions based on the context of the interaction. All of this
happens automatically in real time, insulating personnel from the
mundane tasks that can compromise the flow of information and
the quality of the experience. This enables multi-tiered interactions
where non-medical personnel are now able to provide triage-level
interactions, such as reminding a patient to take medicine.

Single, holistic customer view – Medical Home, Accountable
Care and Global Payments all require a holistic and unified view of
patient and member information. The Synchrony unified desktop is


a web-based interface that instantly presents the right information
and resources for a specific patient or member. It provides a
single view of data from multiple information systems, including
CRM, HIM, patient management, billing, EMR/EHR and other
supporting applications. Information is presented in a clean,
tab-driven format that adjusts dynamically so you never have to
toggle back and forth among multiple windows.

Seamless, cross-channel continuity – Today’s hyperlinked business
environment combined with the demands of healthcare reform
will require companies to have more continuity across multiple
channels of communication. The Synchrony desktop offers a
single interface for all customer interaction channels, including
phone, e-mail, IM/chat, fax and the web. During every interaction,
you can see the patient or member’s complete contact history.
Synchrony uses this history to guide the current interaction and
ensures a seamless, continuous experience no matter what touch
points are used.


Personalized, success-based routing – Synchrony tracks the
results of every interaction, prompts and escalates follow-up
actions and automatically generates personalized correspondence
and documents. It can be configured to route incoming calls
based on the success rates of individual employees in handling
the type of call, the patient or member’s demographic information
and the employee’s previous outcomes with similar customers.

“Decisions are not going to get easier,” says Reynolds. “More
complex decisions are going to need to be guided through to
a resolution. This guidance will need to be personalized and
across all channels.”

Meet Healthcare Reform Goals
U.S. healthcare reform is all about improving care while reducing
costs. Synchrony allows you to do both while strengthening patient,
provider and payer relationships.


Higher-quality care – With Synchrony, healthcare providers can A Complex Care Case
“As customer service increasingly
becomes a differentiating factor
between healthcare facilities,
Industry Profile: Healthcare

ensure that patients receive the right care, whether they are calling
consumers expect a more
customer-centric experience or
likely will take their business
elsewhere.” – The Beryl Institute
The healthcare industry is
Guiding Smarter Interactions
undergoing massive transformation in Healthcare

to schedule an appointment or to inquire about test results.
around the globe. From a
customer-care perspective,
consumers are demanding more
control over their own health, and
there is a growing awareness of
risks and adverse events with higher
expectations of care and service
quality. But while expectations are

Synchrony also enables patients to take a more proactive role
rising, the industry lags in
“customer service.”
Addressing the Balancing Act
While understanding the need to
deliver better patient experiences,
healthcare organizations from both
the provider and payer sides are

in their own care, which can help identify serious conditions
also challenged to manage
operational costs and increase
productivity and/or revenue. In
reality, you don’t have to sacrifice
one of these objectives for another.
Cincom® Synchrony™ is a flexible
technology platform for contact

earlier. Synchrony enables providers to acquire and retain the
centers that enables healthcare
organizations to deliver better
experiences; drive up productivity,
efficiency and revenue while also
lowering costs and training.
Cincom Synchrony and IBM for the
Healthcare Industry Some of Life’s Most Memorable Moments Happen

best patients and reduce errors that can delay reimbursement.
IBM’s Healthcare Industry Framework in a Healthcare Setting
provides healthcare-specific software,
solution accelerators and best Some of these moments are joyful, while some may be extraordinarily
practices to help you reduce costs painful. How can you make each experience the best it can be? For
and manage risk while delivering an healthcare contact centers, the people you place on the end of every
outstanding customer experience. telephone call, e-mail or web chat—and the quality of the technology
Cincom Synchrony is validated in this they rely on—are instrumental in delivering patient/member
framework to guide customer-facing experiences that are compassionate, personal, private and accurate.
employees to deliver smarter
interactions and experiences.
“A phone call is often the first point of contact and thus,
can be the most important.”

Reduce the cost of care – By increasing member accountability
– Paul Spiegelman, executive director of The Beryl Institute

and facilitating proactive care, Synchrony helps reduce claims View Guiding Smarter Interactions
in Healthcare (PDF)
and patient re-admittance. Synchrony also reduces the cost of
employee training and streamlines the entire process to reduce
the total cost of claim processing and payment. Insurers and
other payers can use Synchrony to turn high-quality member
service into a differentiating competitive advantage.


Moving Forward with Cincom Synchrony The cost of doing nothing
could be great, and now
Clearly, healthcare reform will have a number of major impacts in is the time to react in order
the health insurance industry, not least of which will be the impacts to be prepared for the
of Medical Home, Accountable Care and Global Payments. many changes on the
According to IBM’s Harry Reynolds, now is the time to move legislative horizon.
forward regardless of the debates and pending repeals on
Capital Hill.

“Eighty percent of what should happen is going to happen
whether or not the whole thing gets turned upside down or inside
out,” says Reynolds. “We’ve got standards, policies, technologies
and processes that never before have converged into this industry
at a time when all these regulations and the rising cost of healthcare
have forced people to listen and react.”


Indeed, the cost of doing nothing could be great, and now is
the time to react in order to be prepared for the many changes
on the legislative horizon. Contact us today to learn more about
how Cincom Synchrony can help you implement a well-planned
and holistic approach to managing member and patient
information across multitude channels and repositories in
order to be prepared for the changing regulatory and market
demands resulting from healthcare reform.

Brian Flagg, Account Executive
55 Merchant Street
Cincinnati, OH 45246
bflagg@cincom.com
www.synchrony.cincom.com


About Cincom Share This:
Cincom recognizes that it is your people—your customer-facing Email
employees—who represent your brand. And in each interaction, it LinkedIn
is the experience that they deliver to your customers that either Twitter
builds value for your brand or destroys it. It is a powerful role to play. Facebook
Cincom's Customer Experience Management initiative is focused
on helping companies and their employees consistently deliver
experiences that not only build your brand, but are valuable to
both your customers and your organization. Cincom does this
through its Synchrony offering that guides employees to deliver
smarter interactions.

Since 1968, Cincom has helped thousands of clients worldwide
by solving complex business problems with its software and
services. Cincom is an IBM Premier Business Partner and has
been integrating IBM technologies and leveraging IBM services
for over 40 years.


Will she build your brand
or destroy it?
Every customer touch with the
contact center is a test of your
brand and your promise to the
customer—and the stakes are
high. A recent study shows
that 87% of customers stopped
doing business with a company
after a bad customer experience.
When a customer picks up the
phone, your agent is the brand
and possibly the only human
voice that customer will experience
with your business. It pays to make
that experience great.
Learn the seven categories to
consider when evaluating an
effective agent desktop—and who
ranked as a “hot vendor”—in the
Ventana Research Value Index for
Customer Experience Manage-
ment: Agent Desktop 2011.

Download your FREE summary of this independent report at www.cincom.com/agentdesktop

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IBM and Cincom: Guiding Smarter Interactions in Healthcare Reform

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IBM and Cincom: Guiding Smarter Interactions in Healthcare Reform