South Portland call center eyes growth

SOUTH PORTLAND — The start of the new Supreme Court session this week has thrust “Obamacare” into the spotlight, given the fear – or hope, depending on your point of view – that the plan will be declared unconstitutional. But Jeff Forbes, chief executive officer of South Portland-based SironaHealth says the only thing in danger is the law’s mandate that all Americans buy health insurance.

That’s good news, he says, because other parts of the law explain why his company is expanding.

Last month, SironaHealth grew by one-third, increasing to 17,832 square feet the space it leases in the building that houses its corporate headquarters, at 500 Southborough Drive. The company plans to hire 20 non-clinical workers for its medical call center by year’s end, and even more in 2012.

“It’s hard to predict what will happen, because all of the markets for what we do are new, evolving markets, but I would anticipate that we could easily hire system developers next year,” said Forbes. “And, of course, as you expand your base of workers, you need an organization large enough to manage what’s going on, especially given the very sophisticated quality program we have in place.”

It’s all thanks to Obamacare  – or, the Patient Protection and Affordable Care Act (ACA), as its formally known.

The program seeks to save money is by creating a “hospital readmission reduction program.”  Through a carrot-and-stick approach, the law would reduce all Medicaid payments starting March 23, 2012, to hospitals with a “higher-than-expected” readmission rate for heart attacks, heart failure and pneumonia (more illnesses may be added in 2015), but also provide $500 million through five years to help hospitals keep their patients from rebounding back into a hospital bed. The law also makes allowances in several areas for a “shared savings program,” under which, starting Jan. 1, health-care providers can be named an “accountable care organization” and get a piece of whatever pie the feds say was saved by cutting the number of preventable readmissions.

“There’s a huge segment of the health-care industry that’s at stake, financially,” says Forbes.

Indeed, a Dartmouth Atlas report released last month found that nearly 1 in 5 Medicare patients makes a return trip to the ER within 30 days of discharge. The U.S. Centers for Medicare and Medicaid Services pegs the cost of what it calls “avoidable readmissions” at more than $17 billion per year.

SironaHealth’s primary product is a “triage service,” which hospitals, insurers and private practices use to try and limit emergency room visits. A “non-clinical worker” answers a call, taking information and, if necessary, transferring the call to one of the registered nurses SironaHealth has on call in 22 states. The idea, says Forbes, is to provide “preventative and appropriate medical services” to people whose condition does not really require an immediate trip to the ER. That helps the bottom line in states like Maine, he says, where 92 percent of people on MaineCare (the state’s version of Medicare) take advantage of emergency-room benefits.

But as hospitals get on board with the affordable care act, SironaHealth is beefing up its “post-discharge service,” a program in which its workers will call recently released patients to make certain they understand their medication requirements, discharge instructions and recovery regimen.

Forbes predicts many medical centers, lacking an ability to launch call center of their own, will want to hire someone to help manage their Medicaid population.

“If you look at that potential market,” said Forbes, “my conservative estimate is that it amounts to a minimum of $200 million a year. Now, how much of that we can capture, I don’t know, but what the act is trying to do is to not let these people fall through the cracks. It wants hospitals to intervene early, take care of any problems and always have health-care services available to deal with situations, rather than continue to do what puts money in people’s pockets under the fee-for-service model, which is to wait until somebody is a train wreck, sending them back into the hospital.”

SironaHealth was born in late 2008 from the wreckage of Intellicare, a medical call-center founded locally in 1997. In 2005, the company sold to PolyMedica, owners of Liberty Medical, the firm most people know for the Wilfred Brimley TV spots touting home-delivery of diabetes supplies. Most Intellicare employees got repurposed to Liberty projects and, in 2007, the entire company was snapped up by Medco, which wanted a piece of Liberty’s 1 million diabetes patients.

Once the dust settled on that merger, Medco decided it had what it wanted, and opted out of Intellicare’s phone-care triage service.

“Initially, they thought they’d sell the business,” said Forbes, “but in 2008, if you remember, the world was crashing, so they decided, ‘It’ll be too hard to do that, let’s just shut it down.’”

In hopes of preserving Intellicare’s 250 jobs, including his own, Forbes joined with 13 other employees to buy the company assets, launching anew as SironaHealth, a name coined by marketing director Daniel Day. Sirona, said Day, is the Celtic goddess of health and healing.

“We wanted to make sure the new identity reflected what we had been doing for many years under the Intellicare brand,” he said.

Medco retained 50 workers and 50 had to be laid off, but the 2009 SironaHealth re-launch managed to save about 150 jobs. Today, the company employs 172. It’s primary advantage, said  Day, is that SironaHealth uses its own, proprietary software.

“That gives us a huge edge,” he says, “because as these new federal programs come about, we have the ability to adjust not only to how we train our people, but how our systems operate, to make sure that the process, the reporting, the whole thing, is buckled down from end to end.”

Day says that because SironaHealth recruits nurses from across the nation, all of whom work out of their homes, the company is not hurt by Maine’s nursing shortage. By contrast, says Forbes, the company benefits from Maine’s job shortage.

“One of the problem Maine has is hiring young people, there’s just no jobs out there,” he said. “But here we have jobs and opportunities – it may not be the job many envisioned when they were in college. I came from manufacturing myself and wasn’t in health care at all until 10 years ago – but they are good jobs, with benefits and plenty of opportunity. Almost everybody in this company was promoted from within.”

For its front-line service reps, Forbes says SironaHealth is looking for great communicators, with strong empathy skills – the kind of person, he says, “who you’d want dealing with your mother in crisis.” It also helps to be bilingual, especially if the second language is Spanish.

“We typically find those high-caliber candidates in Maine, which is why we like to recruit in this area,” said Day.

 “People like to say we’re a call center, but what we really are is a medical services company,” said Forbes. “We just happen to use the phone. The reason why we exist today, even before the Affordable Care Act, is because we take costs out of the health-care system.”