Horizon Health recently improved its business processes and profitability by increasing efficiencies thanks to the successful introduction in April 2006 of Oracle's Siebel Healthcare 7.7 integrated healthcare management suite. The new application replaced a largely homegrown system. Cindy Sheriff, vice president of employee assistance program services at Horizon Health, indicates that the implementation process went very smoothly. The firm reports that already the average time to process a claim has been reduced to 2 minutes from 10 minutes. In addition, the training necessary for new call center member advocates has been reduced from 10 days to 2 days. Horizon Health began addressing challenges with call center inefficiencies by consolidating its 18 call centers to three centers. It chose Oracle's Siebel Call Center because the application is functionally rich. In particular, Horizon selected Siebel because it is commonly used in many corporate call centers and many workers are already familiar with it. In addition, the Siebel has a strong community of support integrators. Siebel Call Center enables Horizon Health member advocates to do a better job answering questions from customers. It also has streamlined the management of appointments, and facilitated claims processing. Horizon Health appreciates that the Siebel software is very customizable and flexible, leading to valuable time savings and cost reductions.

As Published In November 2006

Healthy Overhaul
By George V. Hulme

For Horizon Health, IT Consolidation is good medicine.

At 6 a.m. on April 3, 2006, Cindy Sheriff, vice president of employee assistance program services for Horizon Health, was braced for the worst. It was the day the Lewisville, Texas-based healthcare provider switched from a largely homegrown call center and custom services support software to Oracle's Siebel Healthcare. Sherriff's team had spent months preparing for this day.

Snapshot Horizon Health www.horizonhealth.com Headquarters: Lewisville, Texas Number of employees: 3,000 Annual revenue: US$207 million (2005) Oracle products and services: Oracle's Siebel Healthcare 7.7, Siebel Call Center, Siebel Service

Sheriff had endured several software migrations in her career. "My previous experiences were miserable. We had dropped and abandoned calls, irate customers, and HR directors calling in wanting to know what was going on. It was chaotic," she recalls.

To prepare for the implementation—which included call centers in Lewisville; Denver, Colorado; and San Diego, California—Horizon added additional member advocates or call center agents, the office was decorated with balloons, and plenty of food and candy were on hand. "We wanted to make sure we were ready and could keep morale high," Sheriff says. Zeke Zoccoli, Horizon's vice president of IT, had scheduled what he called "fire call" meetings throughout the day at 10 a.m., 12 noon, 2 p.m., and 4 p.m.

None of those calls were necessary. "We waited for disastrous things to happen—and they didn't," says Sheriff. "It was a boring day."

Maybe so, but the day proved to be a powerful turning point that dramatically improved Horizon's business processes and profitability by slashing inefficiencies that had hampered its operations. From that day forward, the average time to process a claim fell from 10 minutes to 2 minutes, and the training required for new call center member advocates fell from 10 days to 2 days.

Statistics like that are welcome news for a company such as Horizon. Founded in 1981, Horizon currently owns and operates behavioral health facilities throughout the United States and is a provider of contract management services for psychiatric and physical rehabilitation programs within general care hospitals. And its growth is strong. The company, consistently adding to its current head count of more than 3,000 employees, is on track to see revenue increase from US$207 million last year to an estimated $300 million this year.

In 2004, Horizon embarked on a growth strategy that included acquiring independent behavioral health facilities around the country—and each facility possessed its own call center software. As a result, the overall system quickly grew unwieldy. Just last year, Horizon had six primary call centers and a dozen more smaller satellite call centers. The hodgepodge was both cumbersome to use and difficult to maintain. Member advocates taking calls had too many screens to flip through just to input or find the most basic client information. "The application had tabs and fields all over the place. Sometimes fields would execute SQL queries; then you'd hear the member advocates sigh as the program went off for 20 seconds," says Zoccoli.

Even worse, the software was limiting the types of products and services Horizon could offer. Software change requests for the disparate system continued to grow and would take weeks or longer to complete. "We were spending $1 million a year just to keep up with the change requests," says Zoccoli. To streamline its operations, Horizon consolidated its 18 call centers into three.

The Search for Call Center Software

While such inefficiencies are unacceptable for any company, they're especially troublesome for call centers that often serve as the first point of contact for those reaching for help. "People calling us often are upset and under a lot of stress," says Sheriff. While the old system often required member advocates to walk callers through specific questions, Horizon wanted the new system to allow distressed callers to freely explain their situations. "The system needed to be flexible enough for the people managing the intake to get the information they need without having to walk through a forced chain of questioning," says Sheriff.

The employee assistance programs that Horizon offers are a substantial part of the company's business. According to the Society for Human Resource Management's 2005 Benefit Survey, 73 percent of companies currently offer their employees access to an assistance program. These programs—that historically have their roots in helping employees fight substance abuse—have grown to provide a wide variety of services, including stress management, relationship counseling, managing the loss of loved ones, and even access to legal resources.

After a careful market evaluation that included offerings from Sage Software, Salesforce.com, and RightNow Technologies, Horizon selected Oracle's Siebel Call Center to turn its operations around. "It was the most functionally rich," says Zoccoli. The Siebel solution also came with two critical added benefits: a robust community of support integrators and, because of its prevalence in corporate call centers, a healthy pool of workers who would already be familiar with the application. "We knew we'd have no trouble finding skilled support and member advocate employees familiar with the software," he adds.

Horizon selected eVerge Group, based in Plano, Texas, to help with the call center implementation because of its years of expertise and experience with Siebel applications. They set a ten-week goal for completion.

Step Back, Leap Ahead

Soon after eVerge began modeling Horizon's business processes that would be driven by the software, it became apparent that call center software alone would not bring all of the efficiencies Horizon desired in a new application. "It became clear that just replacing the call center software wasn't going to be the total solution. That would come only by putting in the full vertical that integrates the call center with the other parts of the business," says John Peketz, vice president of eVerge Group.

"We were getting ready to implement the call center solution when it became apparent that it would be much more valuable if we could complete a project that encompassed the whole process," says Zoccoli.

The fastest route to their goal was determined to be the implementation of Siebel Healthcare 7.7, including Siebel Call Center and Siebel Service. The integrated healthcare management suite could improve member advocates' ability to answer questions about plan coverage, streamline the identification and management of the provider appointments, and smooth the claims process.

"This was a huge change of direction for us," says Zoccoli. "We saw the potential to radically improve our claims processing and benefits management beyond what just the call center software would do," adds Zoccoli.

Everyone's Onboard

For the expanded rollout to be successful, the Horizon team knew that it had to have all stakeholders involved—from call center, claims, and benefits managers to member advocates. From the very beginning, employees were kept informed about the new application and contributed to the development process. "eVerge played a substantial role driving this approach," says Zoccoli. "There would be 20 to 30 people in a room, and there were workflow diagrams on every whiteboard in the building."

This process included meticulous iterative prototyping. eVerge would complete part of the application and show the results to Horizon employees—who would have a chance to suggest changes and improvements. "They had seen the software, and worked with it so many times, that by the time of the launch they already owned it," says Zoccoli.

The Results Are In

Sheriff and Zoccoli largely credit this approach with the immediate success of the Siebel Healthcare software—not only with the flawless implementation but with many of the metrics Horizon uses to measure results. While the previous system could validate only 5 percent of claims on the first pass, the Siebel system sustains a 90 percent validation rate. The streamlined database means that the number of provider records has dropped from 240,000 to 14,000—a huge reduction that Zoccoli attributes to the elimination of a great deal of redundancy within the system.

For More Information Oracle Solutions for Healthcare

"Much of the speed and the benefits come from how customizable the software has truly proven to be," says Zoccoli. That flexibility and customization has slashed the average time advocates need to research accounts from one hour to just minutes. It has also reduced the staff needed to manage appointment-setting—such as when a benefactor needs to see a doctor or a lawyer—from eight employees down to two.

Going Forward

Horizon is already well on its way to expanding its implementation. In August of this year, the company began making available to its customers and account managers comprehensive reports about the benefit services that its customers' employees are using, something the old system couldn't easily do. "Our customers eventually will be able to access all of the key usage metrics that matter to them," says Zoccoli.

"The opportunity is here to take advantage of the technology to reduce all of the overhead associated with delivering care that just drains the system," states Zoccoli. "My ultimate vision is that our customers don't merely interface with the system—they become a part of it. Who can better upload eligibility information about employees than the company itself? Who can best provide accurate information about doctors and medical codes than the providers themselves? That is our ultimate vision for this system."

Despite Obstacles, States Are Embracing Electronic Health Initiatives The benefits of electronic health records have long been documented. Electronic records are subject to fewer errors, and there is even faster and more-precise care when physicians and providers have access to medical information whenever and wherever they need it. A study released by Rand Health late last year found that electronic medical records could save the U.S. healthcare system more than US$81 billion annually. "There are many inefficiencies," says Emily Welebob, senior vice president of program delivery for the eHealth Initiative and its associated foundation, a nonprofit organization dedicated to improving the quality, safety, and efficiency of healthcare through information and information technology. "One of the biggest problems is simple access to data. Patients are getting duplicate lab tests, duplicate radiology tests, and all the inefficiencies that come from paper-based systems." That should change in the coming years. A recent survey from the eHealth Initiative found that 54 percent of states either have passed legislation or have clear plans underway to create statewide electronic health information exchange (HIE) initiatives. The federal government has called for the national use of electronic health records by 2014. "It's not just about building the electronic infrastructure, it's about improving the quality of healthcare delivery, improving patient safety, and gaining control over rising healthcare costs," says Welebob. Welebob says that states are increasingly working together to learn how HIE can drive down costs. States with implementations in place, such as Arizona and Texas, are sharing their success stories. But setting standards that provide for IT interoperability and HIE is one of the biggest challenges ahead. "Solving this is critical, with a capital C," Welebob says. Fortunately, such standards will soon be on the way. The Healthcare Information Technology Standards Panel (HITSP), funded through the U.S. Department of Health and Human Services and sponsored by the American National Standards Institute, will deliver specifications this fall that will make it possible for government, IT vendors, hospitals, and others to more easily exchange electronic clinical information. Next year, HITSP hopes to develop standards and implementation guides that will aid the development and exchange of electronic health records. "For local, state, and national efforts, the standards are critical. Many states are saying, 'If someone just told us what standards to use, we'd use them,'" says Welebob.