1. Using the Provider Management Database and Proactive Customer Service to Facilitate Provider Retention
Introduction
Letty Cherry Kreger, MHA
VaxTrack Immunization Registry
Riverside County Department of Public Health
Riverside, CA

2. Overview Provider Retention & Proactive Customer Service
Care Calls and Site Reviews
Use of Technology – The Provider Management Database
Statistics – Care Calls Make a Difference
Conclusion
Today I will talk about our proactive customer service philosophy
Care calls and site reviews
The use of technology in making care calls
Share statistics to show how care calls can and do make a difference
Conclude

3. Provider Retention: If You Build It, Will They Stay?
A strong help desk is essential for provider retention
Promoted at trainings
Phone number placed on training materials, incentives
Is it sufficient to maintain provider retention?
As providers are enrolled and trained, it is essential to have a strong help desk.
You want to reinforce the role of the help desk as often as possible so new users remember that it exists – that it is there to help when they have a question or when they have staff turnover
Promote it continuously at trainings and place the help desk number EVERYWHERE
But is that sufficient to keep them using the registry?

4. Provider Retention: If You Build It, Will They Stay?
Yes, if all users immediately call whenever they have a question or need.
However, they don’t
Busy / Forget
Don’t know who to call
Complete staff turnover – we have an IIS?
Excuse not to use
Proactive Customer Service is a necessary component of provider retention
It can be, if the users call… however, they don’t for a number of reasons

5. Proactive Customer Service: An Historical Perspective
Registry staff received 312 phone calls from providers during 2004
Only 8 were about issues critical to the maintaining compliance with registry use
Add users
Inactivate users
Train users
Care calls started in 2004
210 unreported compliance-related issues
When we started making care calls in 2004, we looked at how many times providers called us for reasons critical to their on-going use of the registry
Out of 312 phone calls received, only 8 were to add or inactivate users. No one called because they needed more training.
When we looked at the care calls made that year, we found another 210 compliance related issues – and about a third of those calls were for additional training.

6. Provider Retention Begins with Care Calls
How do we learn of compliance issues when providers don’t call?
We call them!
Care calls are a form of customer service
Make sure “customer” (provider) is happy with the service
Determine if there are any problems or needs
Build a relationship
Retain the provider
Since providers are not routinely going to call us when there are staffing changes or training needs, we need to call them. Care calls are a form of customer service. Not only do we use them to make sure that our customers (providers) are happy with the registry, and that they have no problems or needs that need to be addressed, but we also use these calls to build a relationship with the users. Aren’t you more likely to pick-up the phone and call someone you know?

7. Care Calls
Begin with the end in mind – start care calls during the implementation phase
Reinforce role of IIS Help Desk and see how users are doing.
Care calls are the responsibility of everyone!
Help Desk - Intro Call made 2 to 3 days after training
Trainer calls 1-2 weeks after training
Trainer or Support Staff - One month follow-up call
When it comes to Provider Retention, we begin with the end in mind and start care calls during training. All staff have the responsibility for making care calls:
Help Desk Intro Call
Post-Training Call
One-Month follow-up call

8. Care Calls, continued
Once office has fully implemented IIS, schedule routine follow-up calls every 3-6 months
3 months if new or struggling
6 months if staff and usage level is stable
Made to primary user contact
Once the site has fully implemented the IIS, routine care calls are scheduled every 3 to 6 months, depending on how long the site has been using the registry OR how well they are doing. To ensure that the calls are most effective, staff speak with the primary user contact. This person is usually best able to answer all of our questions.

9. Care Call Outline Introduction Employee turnover Disclosure compliance
Record lookup activity
Data entry activity
Materials/supplies needed
Help Desk reinforcement/sign off
Because there are many critical components to the care calls, we have the support staff making them with an outline. Once staff have completed introductions, they review
Employee turnover – to see whether any users need to be added + trained or inactivated
Disclosure compliance – how is the site disclosing to new patients
Record Look-up/Data Entry – how/when are staff looking up and entering shots into the registry
Materials/supplies – do they need anything
At the end of the call, we reinforce the purpose of the Help Desk

10. Beyond Care Calls – Site Reviews
You must do more than call – schedule site review visits every 6 months (goal)
Face-to-face follow-up reveals more than what takes place on the phone
Another way to build relationships and look for teachable moments
Calls alone are not enough – it is important to show up
The trainers or assistants schedule a site review at least once a year, although the goal is every 6 months. Face-to-face follow-up always reveals more than what takes place on the phone – actions speak much louder than words. Not only do site reviews allow us to build relationships further, but it gives the trainer or assistants the opportunity to look for teachable moments to reinforce registry use.

11. Site Review Visit Guidelines
Review IIS implementation plan (disclosure, record look-up, data entry) & watch main users enter a record
Deliver Provider Appreciation gift, bring small incentives (pens) replenish forms, etc.
Site visit can replace the Routine F/U Call
Start a conversation similar to the Routine follow-up call (covering all the outlined topics). However, sometimes just show your face, do something nice, and leave (especially if you are in the area on other appointments). A site review visit can replace the routine follow-up call. However, a drop-in visit to bring goodies does not (unless you manage to cover staff turnover and you know from registry reports that the site is a consistent user).

12. Care Calls and Site Reviews… They’re a Nice Idea, but…
Don’t have the staff, don’t have time
Sound familiar?
Good news!
Don’t need a large staff, just an efficient, well-organized one
You may be sitting there thinking … “you know, this is a nice idea. But we have hundreds of providers and we don’t have the staff, let alone the time to provider proactive customer service.”
Does that sound familiar? Isn’t that what the providers tell us about using the registry?
Riverside County VT has well over 400 of provider sites enrolled and only 2 to 3 staff members who routinely call them (along with 900+ additional providers who are not yet enrolled).
If we just looked at the sheer volume of calls on top of their other responsibilities, There is no way we have time to provide proactive customer service!
You don’t need a large staff – you just need a staff that is organized and efficient

13. Technology to the Rescue: The Provider Management Database
The VaxTrack Provider Management Database (PMDB) was developed in 2002
Used as a tool for
Recruitment
Retention
Program Evaluation
Effective way for staff to communicate about providers
Our solution to becoming organized and efficient was to use technology. The VT PMDB was developed in 2002 as a tool for recruitment, retention and program evaluation. Riverside County covers more than 7200 square miles, and staff are based in different locations. The PMDB has been an effective way for staff to communicate about providers.

14. The Provider Management Database (PMDB)
Several components of the PMDB are used during Care Calls
Site ID
Training Tab
Expectations Tab
Activity Tab
Notes Tab
There are several screens in the PMDB which are before and during care calls. We’ll take a look at each one in depth:

15. Provider Management Database: Site ID Tab
Verify address, phone,
Current contact info important
The site ID tab is where staff verify contact information, including address. This information should be verified at least annually

16. Provider Management Database: Training Tab
Contains list of all users at facility, training dates
Used to verify current users
The training tab allows staff to determine whether there are any users who have left (and need to have their user accounts inactivated). Staff also check to see whether there are any new employees who need to be trained

17. Provider Management Database: Expectations Tab
Contains data about practice size, # IZ/day, etc.
Used to confirm site’s plan for disclosure, look-up & data entry
The expectations tab is used to confirm the site’s plan for patient disclosure, record look-up and data entry.

18. Provider Management Database: Activity Tab
Tracks activity at each site by user
From IIS report showing # IZs entered (new + hx) and # look-ups
By reviewing the activity tab, staff know if a site has been using the registry. If a site says they are entering records, but no activity shows – then an appointment is scheduled (training)

19. Provider Management Database: Notes Tab
All contact entered on Notes Tab
Allows IIS staff to communicate about providers at all times
Used to track non-enrolled sites
The notes tab is critical for care calls. All contact made or received (phone/mail) to the provider, or any changes staff has made to the provider file are entered into the Notes. This is the main way that IIS staff communicate about providers.

20. Using the PMDB to Track Call Due Dates
PMDB makes it easy to keep track of
Which providers need to be called
When they need to be called
Notes Tab is key to Call Tracking
Customer Service reports provide the detailed information
How does this work?
The PMDB makes it easy to track who needs to be called and when they need to be called through the Notes tab. Information entered on the Notes tab is pulled into the customer service reports that are used to provide the detailed information needed for the calls. How does this work?

21. Tracking Call Due Dates
● Action Due Date assigned
● F/U assigned to appropriate staff
● Call left open
When staff make an assigned follow-up call, they enter a new note containing call date, pertinent notes about the call, including next action due (eg, routine follow-up in 3 months) and then enter the future follow-up date and assign the call. The future call is left open and previous call is closed. There must always be one open call to ensure that provider follow-up continues on a routine basis. The PMDB has a report that will ID any site without an open call.

22. Tracking Call Due Dates: Weekly Call Sheets
●Each staff member prints their call sheets (3x/week)
●Make calls and update PMDB for next F/U
The Weekly Call Sheet report is printed out by each staff member 3x/week (occasionally, the manager or trainer will add a call for urgent follow-up). As calls are made, staff update the PMDB and the calls fall off the report until the next date. If they cannot connect with the provider office, the calls appear on the next printing of the report

23. Provider Calls to VaxTrack: Retention-Related Issues
Between 2004 and 2007, VaxTrack received 46 calls from provider offices to add a new user, inactivate a user or to schedule training. However…

24. VaxTrack Calls to Provider: Retention-Related Issues
When VT staff called providers, there was a tremendous increase in the numbers of users to be added/inactivated or trained.

25. Call Comparison: Calls from vs. Calls to Providers
Provider Calls
VaxTrack Calls
Year
Retention
Related
Total Calls
2004 8
312
210
1591
2005 11
446
357
1296
2006 18
921
637
2706
2007 9
915
450
2014
Total 46
2594
1654
7607

26. Summary Between 2004 and 2007, providers made 2594 calls to VaxTrack
only 46 (2.7%) of the calls related to issues critical to their continued compliance.
VaxTrack staff made >7600 calls to providers and identified an additional 1654 compliance-related issues.
How many staff to make these calls?
On average, 2 to 3
Although providers made almost 2600 calls to VT between 2004 and 2007, 97% of those calls were for issues that were not related to continued use of the IIS.
Proactive customer care calls, however, identified 1654 compliance-related issues. On average, these calls were made by 2 to 3 staff members.

27. Summary
If providers only contact IIS Staff 3% of the time when they need to add, inactivate and/or train users, then IIS Staff must provide proactive customer service
You don’t need a large staff
Use technology to make the impossible possible
It’s our responsibility to bridge the gap and good provide customer service IN SPITE OF our customers!
You don’t need to have a large staff
Use technology to your advantage– it really does make things easier!

28. Letty Cherry Kreger, MHA
Questions?
Contact Information:
Letty Cherry Kreger, MHA