About this Hospice

This large multi-state hospice organization covers a service area of 18 counties and supports an average census of nearly 640. In addition to end-of-life and palliative care, services provided include nondenominational counseling, grief support, a volunteer-based assistance program, and special pediatric and perinatal programs for life-limiting illness in the very young.

Growing Pains

This sprawling hospice had a vision for change. Serving over 18 counties across two Southern states, the organization’s centralized approach to providing after-hours triage, customer service to their patients and caregivers, and scheduling of on-call nurse visits was beginning to show its weaker points. Census numbers were increasing while staffing issues strained team morale and negatively impacted the organization’s high standard of care. The hospice leadership was in serious need of a solution that would support their continued growth while improving their quality of care for patients and caregivers.

The hunt for this solution would lead them down a path of trial and error that would eventually arrive at CareXM and a unique mHealth tool called the CareXM mobile app.

Finding the Best Fit:

Prior to finding a fit with CareXM, the organization trialed four different approaches to reduce response times with varying levels of success.

Trial 1 – Local Answering Service

• Pros: Live answer of calls with a warm transfer to the on-call nurses.
• Cons: Still had service failures and long wait times. Non-clinical, creating a delay in service and added stress for the patient.

Trial 2 – 24×7 In-House Staff

• Pros: Faster response times. Able to offer clinical support during call.
• Cons: Staffing costs at an all-time high, especially during low call volume.

Trial 3 – Hybrid Approach

(In-house staff until midnight/answering service from midnight to 8AM)

• Pros: Somewhat improved speed-to-answer rate.
• Cons: Response times are not consistently better. It still had service failures.

Trial 4: Adding Telephony Solution

(Calls routed thru system directly to nurse and roll-over to an administrator)

• Pros: Most successful solution of the four trials. Callers linked directly to the centralized triage nurses and could wait in a queue until the nurses were available.
• Cons: Major pitfall if the nurse was unavailable or on another call. Callers sent to queue but still some callers experienced up to a 15-minute wait time. After 15 minutes, caller connected to non-clinical administrator, creating further delays in care.

“CareXM worked with us to ensure seamless continuity of care.”

CareXM Responds to An S.O.S.

The hospice’s vision for change saw the organization embracing a solution to assist them through the transformative journey they had already begun. This solution would not only allow them to decentralize their strategy of care. Still, it would scale with their continued rate of growth while enabling them to provide prompt and compassionate care to their patients and caregivers. The need for this solution peaked when their central team of 5 after-hours triage nurses dropped to 3, and it became a struggle to provide quality customer service for approximately 400 patients and counting. The hospice approached CareXM in a state of crisis:

• Hold times were at 10 to 15 minutes
• Wait times for a visit were 1 to 1.5 hours
• Interim solutions were costly and/or ineffective
• Census numbers were increasing while staff morale suffered

Within just months of implementation, the services provided by CareXM, along with the staff-wide deployment of the CareXM mobile app, helped the hospice to:

• Reduce call wait times to <30 seconds
• Cut visit wait times by two-thirds (20 minutes)
• Provide invaluable continuity of care
• Re-energize staff and boost morale
• Provide around-the-clock clinical phone support
• Reduce afterhours call volume by 50%
• Realize an annual expenditure
  of at least $150k in the first year

A CareXM Solution

The mission to reduce response times led the hospice organization to investigate solutions with third party service providers that offered a bit more than backup phone support. What they were looking for was longevity, a solution that would sustain the broader changes the organization was making internally for its future growth.

“We had a vision,” stated the hospice’s CIO and Product Manager. “And the services offered by CareXM seemed specifically designed for making that vision a reality.” After demoing a number of other providers, the hospice organization found CareXM’s mobile app especially intriguing. In the efforts of decentralizing their strategy of care, the CareXM mobile app would help empower their 10 teams across a service area of 18 counties.

“Much of the infrastructure was already in place to make the use of the CareXM’s mobile app a natural fit in our care process,” stated the CIO. “For example, each of our offices had its own local number, though we had our patients calling into one central number at the time. Decentralizing was a matter of linking those local numbers to the CareXM mobile app and re-educating our patients on the number to call for their location.”

“We were able to cut our after-hours call volume in half.”

Obstacles of Change

But the process of implementation still had its kinks. According to the CIO, many of the on-call nurses were uncomfortable with taking calls cold, having grown used to warm transfers by the central triage team. “However,” she stated, “everyone who stayed on through the change quickly realized that the anticipation of change was far worse than the actual process of adapting to something new.”

Despite some turnover at the time of implementation, the success of the solution they had found with CareXM was immediately evident in the first stages of the switch to a decentralized strategy. The first priority for CareXM was assisting the hospice’s short-staffed afterhours triage team, which was in critical need of rollover phone support. At least 20% of calls were overflowing to their previous, unreliable backup solution, but within two months, that percentage dropped to 7% of calls being promptly answered by CareXM’s RNs. In addition, call wait times were consistently less than 30 seconds, but those were the expected benefits.

Unexpected Benefits of CareXM Services & App

One of the most significant unexpected benefits came with the CareXM mobile app’s call reporting capabilities and the process improvement plans that were made possible with the new data.

“We were able to cut our after-hours call volume in half,” shared the CIO. “All because we could now track the types of calls we were getting after hours and pinpoint how we needed to improve our care plans during the day. With this information, we’ve been able to launch effective education programs that empower our patients and keep our staff providing 5-star care.”

Then there’s the bottom line, which includes more than the annual savings made possible by reallocating staff and spending less on supplemental phone support: the quality of care patients and caregivers can expect to receive from their hospice provider.

“By decentralizing our care approach with the help of the CareXM mobile app, we were able to begin providing continuity of care that hadn’t been possible with a centralized care strategy,” stated the CIO. “The nurse who answers a call is now the same one who makes the visit typically within twenty minutes later. Our patients do not have to repeat their stories over and over, and whatever we can do to provide them with a 5-star experience is a win for us and much needed comfort for them.”

About CareXM

CareXM’s patient engagement platform, including clinical and non-clinical 24/7 medical answering services, is used by home health and hospice providers, physician practices, hospitals, and many other care providers across the United States. All services are HIPAA-compliant, available 24/7, and can be integrated with providers’ existing electronic medical record and scheduling platforms. CareXM’s mission is to transform healthcare through tech-enabled services that provide a proactive approach to addressing patient and client needs, leading to a faster, more personalized, and attentive care experience.