Every January, US healthcare operations workers go through hell. With Omicron, this year has been worse than most years. Here’s a behind the scenes look at what happens..on healthcare phone-lines across the US in January. Why?

Note: We helps specialist offices, specialty pharmacies and health systems so my vantage points and data may have a related bias.

Every Jan, healthcare offices around the country go nuts because insurance plans renew on Jan 1 and providers want to make sure their patients are covered before seeing them / getting them on therapies or treatments.

Let’s step back and see how different parts of the ecosystem have traditionally prepared for this.

1. Providers outsource some of this work to third party RCM companies who shore up tons of temporary staff members in Oct, Nov & Dec to train for only 3 weeks of hard work in Jan. This group has to do things in inefficient ways because the system can’t trust their judgement. One example of inefficiency is they are trained to ask 100 questions per call instead of the 66 needed questions for a given case. That’s 50 percent more questions than needed! Another example of inefficiency is that this group doesn’t have access to the same digital systems those at the providers offices do because they aren’t ‘in house’. So they waste time on phone calls asking for data available online.

2. Payers spend Oct, Nov, Dec hiring and training tens of thousands of seasonal agents to answer these calls for the 3-4 weeks in January.

3. Both sides spend Oct and Nov in classrooms teaching these temp workers about US health insurance as well as Standard Operating Procedures of being on phone calls. Dec is spent shadowing and reverse shadowing more experienced agents.

The unfortunate part here is the provider side and payer side don’t coordinate their preparations e.g. they don’t help each other with volume projections so both sides must guess the specific year’s volume to build staffing plans. This year, many agents on both sides started feeling the effects of Omicron started taking time off causing hold times that were already bad to get terrible.

So now we have hundreds of thousands of newly trained folks working from home (i.e. with no over the shoulder guidance) starting to feel unwell, pushing through the day because the temp work pays 1.5x for the 12-15 hour days that everyone is being asked to do.

The healthcare operations world we live in is a clusterf&*k. Shyam and I started Infinitus to fix this. Subscribe to hear more about our journey in the coming weeks.

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