Mexican insurance group Peña Verde needed to reduce the costs of healthcare whilst ensuring effective clinical assessments.
Peña Verde S.A.B, one of the largest Mexican insurance and reinsurance groups trading on the Mexican Stock Exchange with annual revenues of more than $5300 million pesos, decided to invest in cost reduction solutions due to rising service demand.
Background
Previous investment had led to the creation of Centro de Contacto De Servicos De Salud (CCSS), a health call centre service that offers clinical assessment, health advice and information (via medical phone guidance) to more than 50,000 patients.
The purpose behind the call centre is to direct patients to the most appropriate level of care in order to increase efficiency and reduce costs of healthcare for both users and providers.
Working collaboratively
We worked with CCSS Peña Verde (CCSS) to enable them to be a provider of telephone triage to their clients and patients.
Firstly, during a 6 month pilot, CCSS and the National Pediatrics Institute (INP) conducted a statistical study of hypothesis testing concerning the dispositions reached by our TeleGuides clinical content against conclusions reached via an in person paediatrician assessment. This was to verify the dispositions reached by the clinical content to be used in the solution provided to both CCSS and their clients and patients.
CCSS used its years of research and expertise to adapt the 200 symptom-related algorithms provided through Capita’s teletriage solution to Mexican clinical standards. During this process we worked closely with CCSS to ensure that health issues specific to Mexico were catered for.
We also trained CCSS staff to enable them to adapt their clinical algorithms as required over the coming years, so new guidelines can be adhered to easily.
The result
Over 1,000 completed calls were used in the study. The conclusions were that the teletriage dispositions reached matched with an ‘in person’ paediatrician assessment disposition in 98% of cases. In the remaining 2% of cases there was a significant difference in the algorithm result; however the CCSS physicians identified and modified the final recommendation based on their wide medical experience, reducing the non-matching final results. This proves the safety of working with teletriage algorithms and certified doctors simultaneously with the result that:
- CCSS´s clients benefit from increased productivity and efficiency using our technology and customised clinical protocols
- Patients receive fast, consistent and safe health advice directing them to the appropriate next level of care
- The solution enables CCSS to provide its clients with effective tools to improve patient satisfaction
- CCSS’s service will now enable them to offer health services cost-effectively
Conclusion
Following this work, CCSS can offer the most robust algorithm based telephone triage and medical orientation in Mexico. CCSS delivers its services through a professional team of certified doctors who follow the algorithms to achieve the effective assessment and referencing of patients to the appropriate care level and institution, and who are also prepared to identify unusual symptoms and react accordingly.
Mexican insurance group Peña Verde needed to reduce the costs of healthcare whilst ensuring effective clinical assessments – we worked collaboratively to enable them to provide accurate, safe teletriage.
