A Business Case for ervice Desk Partnership€¦ · A Business Case for ervice Desk Partnership ......

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A Business Case for Service Desk Partnership

Determining the real costs of support services.

Health Care providers looking to upgrade their IT support desk services face the choice of adding resources in-house or outsourcing helpdesk services to a third party. This decision requires assessing current resources and needs, as well as estimating the capability, time-line, risks, and costs associated with each option. When considering these variables, many healthcare organizations find that the best solution is to outsource both system and portal support functions to a customized, HIPPA compliant, on-shore helpdesk providing 24/7/365 support via highly skilled staff. Such a solution will typically cut costs and eliminate management concerns when compared to deploying in-house resources. It will free existing IT resources to focus on core IT challenges while ensuring that internal and external users get the domain-specific support they need. Such a solution typically improves IT operations overall and contributes to higher levels of customer satisfaction as well as better patient outcomes.

A B U S I N E S S C A S E F O R H E L P D E S K P A R T N E R S H I P


Introduction

The move from traditional to digital models of administration has been one of the most significant in the history of healthcare. Driven in equal part by evolving technologies, government regulations, and changes in what the market expects, healthcare service providers have rapidly expanded their digital capabilities. From a business perspective, going digital is an obvious strategic choice—offering greater efficiencies in operations and a net cost savings over traditional processes. Organizationally, providers benefit from the consistency, easy access, and portability that electronic records ensure. The move to digital has also been a major factor in redefining the relationship between the patient, the patient’s information, and the provider.

As healthcare providers have worked to bring all the parts together into a consistent electronic environment, they have faced the challenges of integrating clinical systems with specialty systems. They have taken steps to integrate their own digital environment with a broader industry ecosystem that includes standardized technologies. And they have introduced self-service portals, allowing patients to access their own information via back-end systems and enabling them to ask questions, schedule appointments, and interact with the provider in a wide variety of ways.

As healthcare organizations continue to develop, implement, and evolve their digital strategies, they face significant and growing challenges when it comes to providing IT support. Smooth operation of the digital environment requires continuous support both for internal and external users—for caregivers, patients, and administrators alike. Providers rely on an in-house user help desk for calls to support internal and external users of these systems, including patients who need support using the customer portal. Providing 24 /7 support for this large and diverse set of user needs is taxing from a management, resource, and skill-set perspective. Managing such a help desk consumes a tremendous amount of staff hours and requires skill sets that go far beyond what would be required in other IT settings.

Filling the Support Gaps

Staffing an IT service desk within a healthcare provider setting requires more than system knowledge and expertise. In order to provide users the guidance they need, support staff must have a basic understanding of core clinical processes and organizational structures as well as HIPAA and other regulations. Deploying such expertise in-house around the clock can be a challenge even for the largest organizations.

Outsourcing IT functions is nothing new within the healthcare space. As the most recent HIMSS (Healthcare Information and Management Systems Society) industry survey indicates, 60% of healthcare providers overall outsource some IT functions. The diagram below shows that the percentage of institutions that outsource IT rather than directly hiring staff is higher for hospitals (65%) and higher still for ambulatory care centers (71%). The same survey data indicates that IT support positions represent the most commonly outsourced role, and that the practice of outsourcing support positions is consistent across the various provider types.



Outsourcing support staff is the norm

This document provides the business case for outsourcing health services IT support with PDS. Determining whether outsourcing is right for your organization requires a careful assessment of the current situation, including available resources and gaps in the support process. This is followed by a breakdown of the risks and benefits, along with a review of alignment with company goals. Finally, you need to take costs and time-line into consideration. The following sections provide an in-depth look at this process.

1 2017 HIMSS Leadership and Workforce Survey, Healthcare Information and Management Systems Society, https://goo.gl/XPcPX2



1. Making the AssessmentSnapshot: Current Environment

Determining the total value of an outsourced solution begins with a snapshot and assessment of the current environment, resources, and requirements. Typically, the organization will identify one or more critical pain points that begins the assessment, for example:

• Resources stretched beyond capacity. Support team is working 80-hour weeks for three weeks at a time and burning out. This brute force approach can last for only so long. Something that can’t go on forever, won’t.

• Bottlenecks and misaligned resources. Support resources are spending virtually all their time on level 1 and 2 requests, with not enough attention going to more advanced problems (or the reverse.) There may be a lack of prioritization among internal calls, calls from other care providers, and customer calls causing one of these groups to have to wait. Or the support team may lack the skill set to appropriately handle one or more of those groups.

• New initiatives. What happens when a whole new product or line of service is added to a support team that is already stretched to the max? Such gaps often emerge when the healthcare organization begins providing self-service through a customer portal, or expands the self-service options already available.

The initial pain point may be brought up by hospital leadership, ambulatory leadership, clinical leadership, customers expressing concerns, employees, or by IT itself. Wherever within the organization the pain point emerges, IT feels the pain. Use the checklist shown here as a guide to assessing the current scenario.

Who owns the support Desk Function?

• IT• Customer Support• Business Units• Other __________________

Which of the following are occurring regularly?

• Missed performance goals / SLAs• Customer satisfaction levels• Misalignment of requirements and resources• Constraints on growth• Regulatory non-compliance • Other __________________



Which of the following are needed but not currently available (or not currently sufficient?)

• Patient portal support• 24 / 7 support• Patient telehealth support• Patient mobile application support• Clinical expertise• Rapid turnaround • Other __________________

From the initial pain point, it is clear that the existing support infrastructure and resources are either insufficient or misaligned. Completing the above assessment gives a better idea of the size of the gap between the current situation and what is needed. If you determine that the size of the gap indicates that a simple realignment of current resources will not solve the problem, the choice is either to add resources in-house or to outsource support. Determining which of those two approaches is preferable requires looking at risks, benefits, alignment with company goals, and costs.

Assessing Risks

There are certain risks associated with either hiring new staff or outsourcing support. Deciding which path to follow requires, in part, determining which option represents the greater risk. One of the biggest potential risks is cost, which is outlined in its own section, below.

The risks associated with hiring new staff are apparent from the pain points identified in the assessment above. Hiring new staff is a time-consuming and inherently risky process. A long ramp-up process for new staff simply extends the duration of missed performance goals / SLAs and low customer satisfaction. In addition to these delays, hiring of new staff consumes the time and attention of existing support staff as they work to bring the new hires up to speed, often at even greater cost to their own performance. And even after the new staff is integrated into the existing support structure, you may find that there is still misalignment with your rapidly changing requirements.

Some healthcare providers go through multiple attempts to hire the new staff to close the gaps only to find themselves in a state of chronic misalignment. IT support requirements become a moving target that is very difficult to hit. These organizations tend to experience a long-term loss of productivity brought about by ongoing process inefficiency. In addition to putting compliance at risk, these organizations face ever-dwindling levels of customer satisfaction and the potential for significant loss of reputation.



Hiring Staff: Potential Risks

Hiring staff is not a guaranteed fix

Outsourcing IT support enables providers to avoid all of these risks provided they find a partner that can meet their very specific, and often rapidly changing, requirements. A knowledgeable and capable partner will provide the right set of resources, with the right skill sets, in significantly less time than it takes to hire new staff, and without the additional drain on existing resources while the new staff are ramped up. A qualified outsourcing partner can also respond quickly and flexibly to new initiatives, seasonal changes, and other factors that might otherwise throw an in-house support team into misalignment.

When asked to name the risks associated with outsourcing, health care providers often cite spending too much and exposing patient data as the primary concerns. We will look at the concern over costs in a separate section, below. Exposing patient data is a very real risk for healthcare providers, regardless of whether they outsource IT support. Keeping patient data secure is a primary goal for every healthcare services provider. Management of internal systems, management of partner access to those systems, and management of self-service tools for customers all share the common goal of protecting the privacy of the patient and keeping patient data in compliance with established regulations.

In establishing a support outsourcing partnership, it is critical to identify a partner with experience managing patient data for healthcare providers. The potential partner must demonstrate knowledge of applicable regulations and should be able to provide multiple reference customers who have can confirm their commitment to keeping patient data secure.

Outsourcing Potential Risks

The decision to outsource involves fewer overall risks as identified by healthcare providers



Assessing the Benefits of Outsourcing

Outsourcing management of customer support provides numerous potential benefits to health care service providers, including:

• Increased Staff and Management Productivity• Increased Process Efficiency• Improved Compliance• Improved Alignment with Company Goals• Reduced Total Cost for Support Services

Let’s take a closer look at each of these.

Increased Staff and Management Productivity

As noted in the previous sections, one of the biggest drivers of change to a healthcare IT support environment, and one of the biggest risks associated with hiring staff internally to address support issues, is misalignment of IT staff. Typically, your IT staff is capable of more strategic tasks than low- or even mid-level support, and should be focused on areas of higher value to the business. Too often, strategic concerns are left unaddressed while skilled IT professionals spend their time helping out with password resets and other easily offloaded tasks. The question every IT organization must answer is: what business are we in? Outsourcing support enables the IT organization to define a more strategic mission. It enables the IT team to complete strategic development, implementation, and optimization projects rather than leaving them to languish while the team members are called away to provide support. Plus, it enables the organization to provide a consistent level of support in the face of seasonal and other workload changes. The result is consistently faster and better resolution of issues along with better alignment with more strategic, long-term goals.

Benefits: Staff Productivity

Outsourcing enables greater productivity both for better support and improved IT performance overall



Complete Projects

Increased Process Efficiency

Improved staff productivity is key to improving the overall efficiency and effectiveness of internal processes. User support processes can easily become overburdened with excessive hand-offs, or prolonged periods of waiting, when resources are misaligned. An outsourced support environment provides a new level of flexibility when it comes to adapting and optimizing processes.

As a result, healthcare providers can streamline support and resolution processes. Fewer steps from initiation to resolution almost always translates to less total time required for completion. Outsourced support processes are not only streamlined relative to the healthcare organization—i.e., translating a 9-10 step internal resolution process into a two-step hand-off and resolution—with a sole focus on providing support, outsourced support processes also tend to be faster in an absolute sense. Along the same lines, healthcare organizations often struggle with internal prioritization issues that can stall support for one set of users over another. For example, patients may end up queued behind internal users and other healthcare providers. With its sole focus on managing the support queue, the outsourced helpdesk can ensure that requests are prioritized without subjecting lower priority users to a wait that might be detrimental to overall productivity within the organization.

Benefits: Process Efficiency

Outsourcing eliminates repetitive steps and bottlenecks for faster problem resolution

Improved Compliance

Improving productivity and process efficiency provides benefits that cascade throughout the organization. A primary benefit of outsourcing support services is improved compliance in a number of different areas. Outsourcing support enables organizations to be more service-focused, driving both better patient outcomes and better interactions with other institutions. This contributes to better performance on both internal and external service-level agreements (SLAs), ensuring greater levels of customer satisfaction and a more smoothly running ecosystem.



With the right partner, outsourcing can also provide a tremendous boost towards regulatory compliance, including compliance with HIPAA, Meaningful Use, and other standards. Healthcare organizations employ painstaking efforts to ensure that patient data is managed privately and securely. As noted previously in the Risks section, protecting patient data is one of the primary concerns these organizations raise when considering outsourcing. Choosing the right outsourcing partner is critical to ensure that the organization does not face new compliance burdens. Instead, the outsourcing partner should have the appropriate expertise built into its practices such that compliance is ensured from day one.

Benefits: Compliance

The right outsourced support partner simplifies compliance.

Improved Alignment with Company Goals

Outsourcing support can be a very effective step in helping the healthcare provider to match the services it provides to its mission as stated. The value proposition for improving support is ultimately to give the patient a better experience.

Although care providers tend to think of customer interactions as occurring in silos, the situation looks very different from the customer perspective. They tend not to differentiate between phone support for making an appointment and coming in and visiting a doctor. They see these all as interactions with the organization as a whole.

Health care providers that pride themselves on offering the most compassionate and personal of care, that make such care a cornerstone of their overall mission, often miss this important customer perception. A patient can have a great experience being checked in, seeing the doctor, getting a prescription, etc. But it they later go the portal to schedule a follow-up appointment and are confused or frustrated by the experience, much of the positive experience is lost. Patients tend to remember and see as relevant the most negative aspect of the overall interaction.

With the right partner, outsourcing of support can play a pivotal role in keeping the organization in line with its goal to provide excellent end-to-end care.



Reduced Total Cost for Support Services

As noted in the Risks section, above, spending too much is one of the key concerns that IT leadership within a healthcare organization tend to raise when contemplating outsourcing support services. However, contrary to conventional wisdom that says that outsourcing is expensive relative to providing an in-house solution, outsourcing typically involves a lower total cost of ownership for support. We will look at this in greater detail in the section that follows.



2. Calculating TCO

Estimating costs for healthcare IT support is a complex issue. How you go about calculating in-house costs will have a lot to do with where you are in the cycle.

• Are you starting from scratch with a new problem? • Do you already have a service desk that you intend to repurpose?• If you are starting from scratch, what is the cost of standing up a new call center?• What are the hard and soft costs you will encounter using your internal team?• What are the cost savings of using an external team?

The answers to these questions will vary tremendously from organization to organization. And the best approach to providing support will vary accordingly. Implementing a new service desk creates a major operational burden for an organization, as does managing the desk over the long term. The organization has to hire, train, and manage staff as well as provide and maintain the basic infrastructure (computers, phone system, etc.) that enables the service desk to function.

If you already have a service desk and are looking to re-purpose staff, it is important to assess impact of the new initiative across the various levels of support. Will you be tying your best and most experienced staff to basic administrative support functions or will you be freeing them to handle more in-depth problems?

With these considerations in mind, there are three ways to approach the question of costs when it comes to outsourcing healthcare IT support:

• Administrative costs• Costs per call• Cost of quality

We will look at each of these in turn.

Administrative CostsUsing a staffing costs calculator, you can make a straightforward comparison of the cost of in-house versus outsourced support resources. For example, if you are paying new hires at the helpdesk $12 per hour, but the outsource provider is charging $18 per hour for resources, you might think that working in-house will save you $6 per hour. The calculator enables you to get closer to the true difference between the two. As shown in the diagram below, employee costs can be divided into the categories of Government Mandated Costs, Hiring Costs, and Benefits.



Cost of Internal StaffingGovernment Mandated Costs (In USD)14.50 Hourly Wage1.38 FICA, Fed & State Unemployment, Workers’ Comp0.73 Estimated Hiring, Training Costs1.43 Vacation, Holidays, Sick Pay, etc.4.35 Health Insurance

22.38 Estimated Cost Per Working Hour

Internal staffing costs significantly more than the hourly wage

When these costs are taken into consideration, the difference in price between the two approaches decreases significantly:

Summary Total employee cost while working $22.38 per hourBill-rate with staffing services $18.00 per hourCost difference $4.38 per hour

Note that this is one of many possible examples. Depending on what the organization pays Full Time Employees, what benefits are offered, and what the outsourcing partner is charging, the difference could be significantly more or less than what is shown here. For this example, it appears that in-house and outsourced support are very different in price, with outsourced being slightly lower. But that assessment fails to take a number of other factors into consideration. In-house staff require office space, power, lighting, phone lines, mobile devices, software licensing, computers, etc. All those costs are included in the fixed rate for outsourced service. The training cost of staff shown above is not one-time, but a recurring cost as new tools and skill sets are required. Staff turnover is a significant expense for in-house resources, but completely transparent when outsourcing. Sick time, worker’s compensation, family leave, and other resources also drive up the relative cost of in-house staff. And then there are unpredictable, uncontrollable events that add significant risk and expense to managing a service desk in-house. What happens if a key member of the support team leaves unexpectedly – how do you cover the gap? What happens if there is a major natural disaster at your hospital? How do you deploy resources and provide the needed support?



Long Term Expenses

Outsourcing provides tremendous long-term savings

When longer-term factors such as these are taken into consideration, the cost advantage of outsourcing becomes apparent. And there are more than costs at stake. Healthcare organizations that outsource IT provide better, more consistent service to patients and other users and enjoy better internal IT productivity than organizations that try to do everything in-house. (All while saving money.)

Costs Per CallAnother way of calculating the difference between the two approaches is to look at costs on a per-call basis. Benchmarks show that in a generic call center setting, handling each call can range from $6-$29 per call. Some estimates run higher, particularly if you look at the overall cost per incident rather than just the cost per call. Benchmarking by MetricNet reveals shows that these costs can run much higher than organizations tend to anticipate.

2 “Building a World-Class Call Center,” Best Practices LLC, https://goo.gl/vXDjEn3 Rumburg, Jeff “The True Cost of Desktop Support” MetricNet https://goo.gl/5QafkZ



Most analysts agree that calls run somewhat higher for a helpdesk in the healthcare space, with the cost increasing significantly based on the level of support provided. The table below provides a breakdown for a typical healthcare organization IT helpdesk.

To calculate your total support costs, estimate the cost per each level of call for your organization. Smaller organizations are typically closer to the low end of the range, with larger organizations at the high end. Bear in mind that the cost per call ultimately includes all of the staff and infrastructure expenses outlined in the previous section. Then multiply the per-call estimates by your projected call volume for each level of support. This makes it easy to get a handle on how much these calls cost the organization and to compare those costs with what an outsourcing partner charges.

Caution: cost per call is easy to underestimate, as there are numerous hidden and non-obvious contributers to the total cost. For example, when calculating cost per call, always remember to factor in all of the costs shown in the previous section. If your total is substantially less than the benchmarks, you are probably leaving something out. Returning the MetricNet study cited above:

The true cost of desktop support is much greater than most companies realize. It goes well beyond the obvious costs of personnel, technology, and facilities. A full reckoning of desktop support costs must include the cost of defects – tickets resolved at desktop support that could have been resolved at level 1 – as well as costs that result from the IT environment itself. These environmental factors include the mix of incidents and service requests, the user population density, the number of mobile devices, and the standardization of the desktop.

4 Rumburg, Jeff “The True Cost of Desktop Support” MetricNet https://goo.gl/5QafkZ



Calculate lossThe other way to look at costs is to review the risks associated with not outsourcing as outlined in the previous section, and estimate the toll these potential downsides will take on your bottom line. For example, misaligned resources will prove expensive if new IT projects are consistently delayed in favor of providing immediate support. The organization may fall behind on SLAs or fall out of regulatory compliance as key staff are consistently reallocated to support issues. Customer service levels, industry reputation, and even patient outcomes all stand to suffer as a result of chronically misaligned support. And then there are the new initiatives that can never make it out of the whiteboard stage because the organization is tethered to a support service desk that won’t allow for growth. What looks like a few dollars savings per hour on in-house versus outsourced staffing costs can end up costing the organization millions of dollars in lost business.



3. The Outsourced SolutionThere is more at stake in every helpdesk interaction than conventional wisdom would lead you to believe. Each interaction represents a moment of truth with an employee, a partner, or a customer. You get only one chance to make a first impression, and with a growing number of patients, the portal and helpdesk are it. If the initial interaction is less than what it should be, it can be very difficult to overcome the negative perception.

If your organization is not prepared to handle this yourself, what are you risking with every customer interaction? More critically, what are you risking with each initial customer interaction?

Enter PDS

With strong relationships within the healthcare ecosystem, PDS provides patient portal and healthcare user support services to IT leaders in the healthcare space. These services leverage a team of on-shore analysts offering 24/7/365 customized support for your patients on the software or hardware you specify.

With more than ten years of providing service to leading healthcare organizations around the country, PDS has built a robust knowledge base for healthcare support. Our analysts are expert in a wide range of devices and systems, and can quickly align with your internal processes. The team is well experienced with HIPAA, ensuring that your patient data is secure and compliance regulations are met. Each analyst is Help Desk Institute certified in customer service and possess advanced technical knowledge allowing them to troubleshoot a wide range of problems. Additionally, they have worked with clients ranging in size from small clinics to some of the largest healthcare companies in the United States.

Eliminating all training and hiring costs, PDS can be ready to take your support calls in as little as four weeks. The service desk is located on-shore in the Midwest and operates 24/7.

The PDS Difference

A typical technical helpdesk can offer technical skills, while a typical sales helpdesk offers product and service support from the customer’s point of view. An IT helpdesk for healthcare must combine those two skill sets, understanding what the patient needs and how to provide the best possible solution for that patient. The in-house help desk is typically skilled at solving a technical problem for a customer or providing what a doctor needs in their application. But there is often a gap when it comes to external facing, customer facing support.

This is a very different skill set. When looking for a provider of outsourced IT support services, it is important to find one that can provide these skills. Many healthcare organizations turn to an



outsourced solution when they realize that they have been so focused on dealing with internal and inter-institutional support that they have not adequately built the concerns of the patient into the process. They realize that what they need is not just outsourced support, but a real channel for connecting with their patients.

You need a scalable partner who can help triage, answer, and resolve those calls with a keen understanding of what the patient needs.

PDS describes this combination as ‘bedside manner over the phone.” Our analysts are trained to combine clinical experience and technical experience, providing the human touch as well as the technical expertise. They know and understand patient concerns, and are also current on the latest technologies. As your outsourcing partner, we are here to save you money and optimize your customer support process.

PDS provides a highly efficient, highly reliable outsourced service that removes the burden of leading people – managing time off requests, discipline, oversight, vacations, training, hiring, firing, etc. But these are all table stakes. Our core value proposition is in meeting the patients’ needs.

ConclusionAs noted at the beginning of this document, outsourcing has become a fact of life, if not a best practice, for many healthcare IT departments. A recent study showed that 73% of all surveyed hospitals over 300 beds are now relying on outsourced IT services in some capacity, while at institutions with fewer than 300 beds the percentage rises to 81%.

The decision to outsource IT support for your healthcare organization is a critical one. Making that decision requires looking at all of the factors outlined above: risks, benefits, costs, alternatives. It’s important to define and track the full value of the potential system, including value going forward. It seems likely, in light of current trends, that the predominance of outsourced IT support systems will continue to grow. The time to move may well be now.

5 “Providers to Adopt IT Outsourcing Solutions,” Black Book Survey, https://goo.gl/VhM1aB

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