Client services overview

Client Services Presentation

Sample Accession: Pre- to Post- Sale

What is Client Services?• A correspondent who provides information

and resources on genetic testing – Performed or Scheduled to be Performed

• A correspondent between the client and the remainder of the company– Operations– Financial– Executive– Medical Director

Client Services Goals

1. Information Resource for Client2. Approachable and Friendly Attitude3. Exude Professionalism4. Information Resource for Company on Client

Opinions and Comments

Client Services Needs• Client Services needs to have:– CRM system

• Allow for tracking of all communication systems

– Communication Tools• Landline Phone• E-mail• Fax

– Access to LIMS system• Determine where samples are

– Access to Financial Services• Determine costs and insurance claim resolutions

• It would be nearly impossible to perform Client Services virtually without all of these capabilities

Who is a Client for Genetic Testing?

• Genetic Counselor• Physician• Nurse Coordinator• Laboratory / Sendout Coordinator• Patient

The verbage for each client can be dramatically different depending on the situation.

Client Services is your front line

World-Class Service• “World-Class Service” is a potential model for Client Services

to utilize in their operations.• "World Class Service" is a term which means that you

anticipate the needs of your customers before they actually have the need. In order to do this, you must intensely study your customers and employees to see where

a) your employees fail your customers, b) your services or products fail your customers, and c) how your customers change over time.

• Only by having this knowledge can you create a business plan that completes the prerequisites of world class service.

World-Class Service Example #1 – Action – Reaction

• Nurse Coordinators and phlembotomists often call Client Services to ask about blood draw tube type – Reason: paperwork containing information is in doctor’s office, not with nurse – Created small adhesive on inside of specimen kit which indicates draw tube type

World-Class Service Example #2 – Action – Reaction

• Preliminary report explanation – preliminary reports still lack several amplicons– Issue: Nurse / Doctor

understanding may be difficult because genetic testing is different from other clinical testing

– Use Scratch Ticket analogy – unable to change information on ticket – and information given will not change – more time needed to fill in gaps.

World-Class Service Example #3 – Action – Reaction

• Physician requests a genetic test which is not currently offered by the facility

• Issue: Testing selection is not offered by facility

• Provide information of potentially where test can be performed even if direct competitor– Client will view you as a resource plus provide

information of what customer desires are

Client Service Correspondence• Phone• Mail Correspondence• Fax• E-mail

The level and type of communication varies dramatically and differently depending on the medium used especially when considering sensitive client information

Client Services and HIPAA• A goal of Client Services is to be resourceful• A goal of Client Services is to protect patient’s PHI• The nature of genetic testing involves the

understanding of parental information at times

Client Services Do’s & Don’ts

• Do:– Provide a resource for understanding genetic

testing – even in cases where it may not directly help the company

– Answer questions before even asked by clients• Don’t:– Provide results to the client directly• Possible interpretation issues may occur

– Sell

How does Client Services help the company?

• Interact with the customer in a resourceful manner• Provide information of correspondence to track

trending of samples and comments – typically through a CRM

• Provide input into operations how to efficiently handle samples– Flag important samples: STAT samples, Business

Objective Samples, etc.– Flag lagging samples to possible finish or provide

feedback

High Call Volume versus Growing Sales

• Depending on ongoing interactions during the year, call volume can vary.

• Particular actions performed one month can reverberate several months later

• Oscillations in call volume should be tracked, but not misconstrued.

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High Call Volume versus Growing Sales

• Depending on ongoing interactions during the year, call volume can vary.

• Particular actions performed one month can reverberate several months later

• Oscillations in call volume should be tracked, but not misconstrued.

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Is this growing sales or just a Client Services backlog?

Importance of CRM

• CRM provides cataloging of all Client Services action on day-to-day basis

• Importance to log all information, however banal, with understanding that message would be read 3-18 months later by another party.

• Importance for Management to establish uniform tracking method for all Client Services members to adhere – very high “learning curve”

• CRM provides “10,000 ft” view of operations through dashboards and other indicators– Importance of management to utilize and exploit CRM system to its

fullest

CRM Primer

• CRM is a tool which provides organization to the Client Services representative by logging every correspondence – e-mail, phone, fax into the system

• Typically CRM is a shell program towards the e-mail system, so manual integration is crucial

• Faxes should be scanned in, then attached and cataloged into the system

• Every phone conversation must be logged in and a fair representation of time spent should be performed

How did that phone call take 10 minutes?

• Scenario: Call received from nurse, unsure of ordering physician identity, needs report

• Receive call: Identify nurse from particular hospital, identifies patient, identifies needs report sent to particular fax number – this is physically done on scratch paper

• Post call: Using patient name, identify original ordering physician on order form, log information, print report, print appropriate cover sheet

How did that phone call take 10 minutes? continued

• Phone call: 3 minutes• Post-phone call CRM activities: 4 minutes– Look at patient documents– Identify doctor– Find doctor entry in CRM– Log phone call into CRM

• Post-phone call: 3 minutes– Print report– Print coversheet– Send fax– Confirm fax reception

Understanding Your Customer

• Keeping with “World-Class Service”, understanding your customer is tantamount to anticipating their desires.

• Although stereotyping may be considered crude, it helps follow a heuristic about what concerns a customer may have.

• Currently, Client Services faces two types of customers Cardiologist and Immunologists which have stark contrasts in their interactions.

• Understanding customer desires and worries and acting BEFORE it happens makes for good Client Services

Typical Pediatric Allergy/Immunology Department

Medical Director

Staff Physicians

Fellows

Nurse Coordinators

Any Combination of Relationships Possible

Medical Director

Staff Physicians

Fellows

Nurse Coordinators

Coordination between Departments may be necessary

Medical Director

Staff Physicians

Fellows

Nurse Coordinators

Immunology Department

BMT Group

Typical Hospital-Based Cardiology Department

Medical Director

Staff Physicians

Fellows

Nurse Coordinators

Hospital Administration(True Decision Maker)

Typical Suburban Cardiology Practice

Staff Physicians(Decision Makers)

Nurse Coordinators

Appointed Leader

Types of Questions answered in Client Services

• Technical Background Questions– How is my sample processed?

• Sample Completion Issues– Where is my sample?

• Financial Issues– How much will this cost me?

• Logistics Issues– How do I provide a sample for testing?

• Report Interpretation Issues– What does this on the report mean?

• Report Feedback Issues– How do I act accordingly with the results given?

Comparison of Customer type and typical questions

Does not understand

Complete Comprehension

Report Interpretation

C a r d i o l o g i s t s Immunologists

Little Concern

Very Concerned

Financial Concerns to Patients

CardiologistsI m m u n o l o g i s t s

No Belief Strongest Belief

Beliefs in Genetic Testing and Clinical Outcome

C a r d i o l o g i s t s Immunologists

Comparison of Customer type and typical questions

Does not understand

Complete Comprehension

Report Interpretation

C a r d i o l o g i s t s Immunologists

Little Concern

Very Concerned

Financial Concerns to Patients

CardiologistsI m m u n o l o g i s t s

No Belief Strongest Belief

Beliefs in Genetic Testing and Clinical Outcome

C a r d i o l o g i s t s Immunologists

Even if an immunologist does not completely understands the genetics behind an outcome, the physician knows to act in a very strong manner

Case Study AA09001828

• New Physician to ordering Genetic Testing• Consider ordering Wiskott-Aldrich Syndrome

testing (Immunology)• Briefly mentioned extensive history treating

patient – see as next step in determine best course of treatment

• Using this example because somewhat good flow with few “hiccups”

Case Study AA09001828 – Initiation – CRM Log

• 2/26/2009 11:13 AM 10 minutes• Call Received WAS Testing• Call received from Lab Tech Gerry Linden• understands needs 2-ml EDTA tube of blood• understands can pre-qualify patient from before• understands sending specimen kit to Alexandria office• confirmed location of alexandria office• works for Robert Dobrzynski• 17 yM WAS• needs kit on Monday• send specimen kit to 5226 Dawes Avenue, Alexandria, VA 22311

Case Study AA09001828 – Initiation – continued

• Goal is to understand situation– New Physician possibly ordering WAS test

• Determine who is calling– Gerry Linden

• Determine what is role of person calling– Lab Tech / Nurse Coordinator

• Determine next action items to work on– Send specimen kit to confirmed address

Case Study AA09001828 – Website Snapshot

Case Study AA09001828 – Website Snapshot – continued

• Based in Northern Virginia area• Three practices• Four Physicians• Not accustomed to ordering genetic testing• Not a “Center of Excellence” location

Case Study AA09001828 – Pre-sale – follow-through – CRM Log

• 3/4/2009 3:27 PM 5 minutes Call ReceivedWAS Testing

• Call received from Gerry• indicated that will be sending paperwork with

patients• will draw patient on Tuesday

Case Study AA09001828 – Pre-sale – follow-through - financials – CRM Log

• 3/4/2009 4:17 PM 10 minutes• Call Received WAS testing• Call received from mother of patient name given• 703-815-3561• Patient name given• DOB: 4/23/1991• AETNA ID: W1201 43172• Group: 630891-10000• Providers # 888-802-3862• PO Box 9612804 El Paso, TX• will call back mother

Case Study AA09001828 – Pre-sale – follow-through – financials – Insurance Determination

Case Study AA09001828 – Pre-sale – financials – Insurance Determination – follow-up

• 3/4/2009 5:06 PM 10 minutes• Call Completed WAS Testing• Spoke with Mother name given• send pre-auth info to Home Fax• Fax 703-815-5441

Sample received on 3/18/2009

Case Study AA09001828 – Pre-sale – financials – Final Issue

• 3/23/2009 1:21 PM 10 minutes• Call Completed• AA09001828 - billing issue Spoke with mother

of patient• took CC information• VISA XXXX 1548 exp 02/12

After accession has been provided refer to FULL accession only in ALL transactions

Case Study AA09001828 – Sample in-process

Case Study AA09001828 – Report Release

• Report released on 4/26/2009• 1 Disease-causing published variant found• Need to provide list of references in relation to

disease variant

Case Study AA09001828 – Report Release – follow-up

• 4/27/2009 2:48 PM 10 minutes• Call Completed AA09001828 - report - follow-up• Spoke with receptionist• transferred to Dr. Dobrzynski receptionist• Spoke to receptionist• possibly speak with Dr. Dobrzynski• spoke with Dr. Dobrzynski• [email protected]

Case Study AA09001828 – Report Release – follow-up - continued

• Goal is to follow-up with Doctor• Provide Medical Director direct line to physician

directly– Indicated to Doctor that Medical Director can follow-

up with any questions• Provide list of variants which have been published– Direct links to Pubmed

• There is never a discussion about the results of the report

Case Study AA09001828 – Report Release – follow-up - continued

• 4/28/2009 10:56 AM 10 minutes• Call Completed• AA09001828 - report - follow-up• Spoke to receptionist• transferred to Gerry Linden• << on hold for some time >>• spoke with Gerry• asked to send results to patient immediately.

Case Study AA09001828 – Timeline

• Took 44 days from initial inquiry to final follow-up• Not continuous work – need to take diligent notes to

ensure continuity in process

Case Study - AA09001711

• Experienced Cardiologist with prior ordering history of genetic testing – Robert Bonow

• Physician is in Chicago area• Cardiologist works closely with Nurse

Coordinator Edith and Administrative Assistant Angela

• Cardiologist’s group utilizes e-mail extensively• Example of Index and Respective Family Testing

AA09001711 – Physician Practice Hierarchy

Physician

Nurse Coordinator

Administrative Assistant

Important that all members be informed of all on-going actions

AA09001711 – Physician Practice HierarchyClient Services View

PhysicianNurse Coordinator Administrative Assistant

In terms of Client Services, all members are equal

AA09001711 – Physician Practice HierarchyClient Services View

Physician1. Full decision maker2. Extreme Time

Restraints3. Decent-to-Full

understanding of clinical versus genetic diagnosis

Nurse Coordinator1. Partial-to-Full Decision

Maker2. Limited Time Restraints3. Decent understanding of

clinical versus genetic diagnosis

Administrative Assistant1. Limited Decision Maker2. No Time Restraints3. No understanding of clinical

versus genetic diagnosis

Client Services exploits each office member to their fullest

Case Study – AA09001711

• Index Patient is located some distance from physician’s office

• Patient has several clinical issues to warrant genetic testing for greater understanding

• Patient’s mother recently passed away

Limited Family Pedigree

AA09001711 (index)

AA09001829AA09001963AA09001966

AA09001711 – Sample Reception- operation communications

• 2/9/2009 3:55 PM 0 minutes E-mail Attachment Subject: Sample rec'd today

• Hi Al,• Please contact Dr. Bonow’s office regarding index patient name ,

DOB: 6/12/76.• Dr. B. checked off reflexive test, 190350, and kinda marked the

PRKAG2 and LAMP2 genes (so perhaps he also wants the metabolic panel?).

• Please confirm by phone or e-mail.

• Thanks!• Liz

AA09001711 – Sample Reception

• Sample received from Dr. Bonow on 2/9/2009• Communication received from operations during in-

processing procedure• Needed to verify testing information before entered

into LIMS system• Critical information (verify test code) otherwise

problems for LIMS system• Client Services can inquire about issue directly or

provide information to salesperson to provide scenario for more sales and client interaction

AA09001711 - Payment Issue – Salesperson notes

• 2/12/2009 11:54 AM• Dr. Bonow will speak with the family name

family about the $2000 deductible and he or they will call me back. Dr. Bonow indicates the family is particularly concerned with young patient name's sister and assumes they will pay if needed. Also, the test code Dr. Bonow wants for patient name is 190350. Bonow is very happy with CRLG

AA09001711 – Payment Issues

• Salesperson spoke with patient on 2/12/2009• Communicated with Client Services that

patient understands payment responsibilities• Sample initiated by Client Services on

2/12/2009• Turn-Around Time Clock initiated by LIMS

system

AA09001711 – Sample Status Inquiries

• Patient’s health situation critical• Numerous inquiries both by telephone and e-

mail about status of patient’s sample

AA09001711 – Sample Inquiry continued

• 2/24/2009 1:54 PM 0 minutes E-mail SentSubject: Correlagen Diagnostics: AA09001711 status

Hello Edith-In regards to patient blinded patient name, there are

seven remaining amplicons of the 113 performed. I anticipate the report should be released to you by the beginning of next week.

Please feel free to contact me with any additional questions.

Sincerely,-Al

AA09001711 – Sample Inquiry continued

3/6/2009 12:05 PM 0 minutes E-mail Attachment Subject: Correlagen Diagnostics: AA09001711 status anything yet?? Edie

Edith A. Pacheco, RNLead Cardiology NurseBluhm Cardiovascular Institute of NorthwesternTel 312.695.1796

AA09001711 – Preliminary Report Release

• In process of sample analysis, critical mutation found in gene analysis to warrant early preliminary report to raise caution to ordering physician.

• Understanding must be provided to all that final report to add to preliminary report, but will not change outcome most likely.

AA09001711 –Preliminary Report e-mail

• 3/6/2009 1:20 PM 0 minutes E-mail Sent Subject: Correlagen Diagnostics: AA09001711 status

Hello Edith-I have a preliminary report today which I will send to you

immediately to your (312) 695-1434 number. I anticipate the remainder should be available next week.

Sincerely,-Al• Same e-mail sent to all three members of physician team

AA09001711 – preliminary report – related references

• 3/9/2009 2:44 PM 0 minutes E-mail Sent Subject: Correlagen Diagnostics: AA09001711: TNNT2 c.487 References

Dear Dr. Bonow-As per request of Edith Pacheco, please find enclosed references foryour review. The reference sheet has dynamic hyperlinks to therespective PUBMED publications for your access.Please feel free to contact me with any additional questions orrequests.

Sincerely,-Al

AA09001711 – related references

AA09001711 – related references - comments

• Acrobat document which has list of references which have direct access to Hyperlinked PUBMED references per variant found

• Provides a higher lever of understanding for physicians to instantly research publically available literature

• Document is not specific to patient• Document is specific to references in literature only

– no internal data (blinded or not blinded) is provided

AA09001711 – preliminary report – Action-Reaction

• 3/9/2009 1:14 PM 10 minutes Call ReceivedAA09001711 - family testing

• Call received from Edith Pacheco• indicated mother of patient has deceased from possible

HCM - however unsure• needs to know if perform testing on deceased human tissue

or blood• will provide blood from deceased• Salesperson will provide special family pricing to all members• Edith to make several photocopies of requisition forms for

family distribution.

AA09001711 – family testing logistics

• 3/16/2009 4:02 PM 5 minutes Call ReceivedAA09001711 - family testing

• Call received from Lake County Coroner's Office Deputy officer name

• 847-377-2200• mentioned had whole blood - frozen blood - collected

in plastic vial - sodium fluoride as preservative – • prevent clotting• has multiple DNA standard cards• would be able to provide some blood

AA09001711 – family sample reception

• 3/18/2009 2:50 PM 0 minutes E-mail Sent Subject: Correlagen Diagnostics: partial patient name

Dear Dr. Bonow-Thank you for choosing Correlagen Diagnostics as your geneticslaboratory service provider. This e mail is confirmation that we have received your specimen(s) dated3/18/09, and we are in the process of reviewing the documentation andspecimen as instructed. We will contact you immediately in the event weare missing any required documentation or if the sample provided is notadequate for testing. The corresponding accession number given to yourblood sample is AA09001829.

Please feel free to call our Client Services Manager, Al Gunduz, at781-647-0604 x261 with any additional information you may need orquestions you might have.

AA09001711 – report inquiry• 3/26/2009 12:22 PM 0 minutes E-mail Attachment Subject:

Accession #: AA09001711• Hi AlWe received a fax copy of the genetic report for accession # AA09001711.Dr. Bonow would like to know if this result really is the result of thepatient's deceased mother or more results for the patient himself?ThanksAD Angelene Delk Administrative Assistant to Robert Bonow, MDBluhm Cardiovascular Institute of Northwestern

AA09001711 – report inquiry - response

• 3/26/2009 12:33 PM 0 minutes E-mail Sent Subject: Accession #: AA09001711• Good Morning Angelene-The patient report that arrived yesterday is the final report to patientpartial patient name. The initial report sent on March 9th, 2009 was the preliminaryreport sent by the Medical Director due to the significance of thevariant found.

The sample of the patient’s mother is accession #AA09001829.

Please feel free to contact me if you have any additional questions.

Sincerely,

-Al

Al Gunduz | Manager, Immunology and Client Services | CorrelagenDiagnostics, Inc. | 781-647-0604 x261

AA09001829 – logistics background

• Patient AA09001829 is deceased and does not have effective insurance coverage

• Issue of sample testing payment is in question• Initially determine from insurance of deceased

that if coverage possible• Learned coverage termed at date of death

AA09001829 – payment inquiry

• 4/13/2009 1:04 PM 10 minutes Call Received

• AA09001829 - payment issue• Received call from son of patient

(AA09001711)indicated no coverage for patient

• offered $100.00 deal• provided M/C XXXX 2973 exp

AA09001829 – family testing

• 4/28/2009 9:19 AM 10 minutes• AA09001829 - family testing• Call received from patient name given• sister of AA09001829• left VM• provided phone 847-212-5166

AA09001829 – family testing – further inquiry

• 4/28/2009 9:56 AM 15 minutes• Call Received AA09001829 - family testing• Call received from patient full name given• sister of AA09001828• DOB date given• BC/BS NY• ID EQP80090655• Group 294572A11• # 800-582-4489• PO Box 5009, Middletown, Ny • Husband name with different surname given

AA09001829 – testing logistics

• Call received from Nurse Edith• Indicated wanted to simplify paperwork• Indicated to Edith will provide specialized

paperwork specific to this family’s variant only.• Sent 3 Specimen Kits with specialized

paperwork

AA09001829 – family testing – other sister

• 4/28/2009 12:48 PM 15 minutes Call Received AA09001892 - family testing• Call received from patient ‘s sister• 314-469-5922• not aware of results for AA09001892 - DOE 1/31/2009• provided address• Patient name given13215 Hawkshead CourtSt. Louis, MO 63131• DOB date given• UHC• ID: 903631475• Group: 714084Subscriber: patient • # 877-842-3210• Providers Address: SLC, UT

AA09001829 – family testing e-mail• 4/28/2009 5:28 PM 0 minutes E-mail Sent Subject: Correlagen Diagnostics:

AA09001829 - family testing• Hello Edith-

The first two family members have contacted me about family testing.You should received the package I sent tomorrow (if not today) with thespecial forms specific to this family. I have provided insurancecoverage information to you for the first family member scheduled tovisit your office next week.

If you could please attach the following forms with her paperwork, thiswill make the process smoother.Please feel free to contact me if you have any additional questions orrequests.Sincerely,-All

AA09001966 – family testing – receipt e-mail

• 5/12/2009 2:55 PM 0 minutes E-mail Sent Subject: Correlagen Diagnostics: Jan R. sample received Dear Ms. Pacheco-

• Thank you for choosing Correlagen Diagnostics as your genetics• laboratory service provider.

• This e mail is confirmation that we have received your specimen(s) dated• 5/12/2009, and we are in the process of reviewing the documentation and• specimen as instructed. We will contact you immediately in the event we• are missing any required documentation or if the sample provided is not• adequate for testing. The corresponding accession number given to your• blood sample is AA09001966.

• Please feel free to call our Client Services Manager, Al Gunduz, at• 781-647-0604 x261 with any additional information you may need or• questions you might have.

AA09001829 – family testing

• 4/28/2009 12:48 PM 15 minutes Call ReceivedAA09001892 - family testing

• Call received from patient other sister• Home phone number• not aware of results for AA09001892 - DOE 1/31/2009• provided address• provided insurance information• Indicated will be going to physician not in Chicago area

AA09001829 – family testing

• 4/29/2009 3:22 PM 10 minutes Call Completed

• AA09001829 - request to share information• Spoke to Angie Delk (coordinator of Chicago

physician)• indicated okay to share results with patient• will send e-mail confirming this.

AA09001829 – family testing

• 4/29/2009 3:28 PM 10 minutes Call CompletedAA09001829 - family test

• Spoke to receptionist Laurie• indicated nurse to contact me • fax send to 314-996-3268• ATTN: Dr. Mankowitz - nurse Gerri / Lisa

AA09001829 – family testing

• 4/30/2009 9:53 AM 10 minutes Call Received AA09001829 - family testing

• Call received with Gerri• [email protected]• ndicated to send list of references• indicated that patient has specimen kit & pre-paid

mailer• provided contact information• send list of references to Dr. Mankowitz and Gerri

Burke

AA09001829 – family testing• 4/30/2009 10:10 AM 0 minutes E-mail Attachment Subject: Correlagen

Diagnostics: AA09001829 / AA09001711 - related references• Good Morning Gerri-

• It was excellent speaking with you this morning about your patient Second sister . Please find attached references in regards to this variant.

• The references are interactive in that they automatically link to the• corresponding PUBMED webpage to review each publication independently.

• Please feel free to contact me with any additional questions or requests• on this matter.

• Sincerely,• -Al

AA09001829 – family testing

• 4/30/2009 3:40 PM 0 minutes E-mail AttachmentSubject: Correlagen Diagnostics: AA09001829 / AA09001711 - related references Thanks

• The sister, my patient will be coming in for a gene study.

• I would like to test her for the same gene.

• Can you please send us the paperwork and tell us how much it will cost the patientSample received on 5/8/2009 for second sister

AA09001963 – family testing

• 5/12/2009 10:30 AM 10 minutes Call CompletedAA09001963 - family testing - 314-469-5922

• Spoke to patient• not to be billed to insurance• VISA XXXX 6812 exp 07/11• final $100.00

Limited Family Pedigree

AA09001711 (index)

AA09001829AA09001963AA09001966

Grand Timeline

Grand Timeline - Full Information

Correspondence Count

• Number of Correspondences (phone, e-mail, fax) with each particular accession– AA09001711 (index): 97– AA09001829: 158– AA09001963: 11+– AA09001963: 18+

• Total as of 5/21/2009 for this family: 284