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PAINS
Low enrollment
Broker management
issues
Low customer
retention
Inaccurate reporting
Quoting
and underwriting delays
Marketing
campaign issues
Competitor tracking
Low productivity
Increasing claims
costs
Increased expenses
Billing issues
Profit losses
Merger difficulties
Multiple offices
and branches
Internal communications
Excessive paperwork
Decrease in
service quality
Other
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PAIN DESCRIPTION:
Customer service is the area of greatest weakness in overall enrollee
satisfaction, even though HMOs have direct control over their customer
service staff, regardless of the HMO model.
For instance, according to New Jersey HMO Performance Report, the
percentage of members who said they had no problem finding or understanding
written information, getting needed help from customer service,
and completing paperwork was on average 63 percent among eleven
HMOs rated. The national average of the National Committee for Quality
Assurance (NCQA) is 64.5 percent. It means that more than 35 percent
of clients are not satisfied with the provided customer service.
Managed Care Organizations launch Quality Improvement programs,
conduct studies and surveys, invest in Quality Assurance, and go
through expensive NCQA ratings to prove to customers their excellence.
In Managed Care business, good name and reputation mean increase
in membership and larger profits. MCOs cannot afford to neglect
their service quality.
Often, the right software system makes all the difference in the
healthcare customer service quality.
From Aetna Annual Report: "We moved nearly all of our HMO members
onto a single technology platform, which will help us to operate
more efficiently… At our service centers, statistics show that
handling of customer calls improved significantly, despite a 25
percent increase in call volume."
PAIN ANALYSIS:
NCQA issues the State of Managed Care Quality Report compiled from
data submitted to the Quality Compass from over 350 health plans,
covering over 60 million lives, measured against rigorous standards
in the areas of: customer service and addressing member concerns,
providing high credentialing standards of providers, responding
to member and practitioner issues, and listening to and addressing
feedback of new members.
The report gives an insight into the dissatisfaction with managed
care customer service:
- 15 percent of respondents have problems with paperwork for their
health plan;
- 42 percent reported having problems getting necessary information
from their plan's customer service department;
- 43 percent reported problems in either finding or understanding
the information contained in their health plan's materials.
Managed Care Organizations have a growing need for improvement
in these areas.
HMOs can have more control over the situation by regularly analyzing
Customer Service performance measures reports. You should keep track
of at least the following measures:
- Customers served per month
- Average number of complaints per month
- Number of emails processed per month
- Average wait time per call
- Number of one-and-done calls per month
- Average time per group enrollment
- Average time per account installation
- Customer satisfaction rating
HMOZ helps provide better service to groups and members during
the enrollment process. HMOZ improves internal procedures to set
groups up on membership and claims systems and provide ID cards
to the members on a timelier basis. In addition, booklet inserts
can now be issued to members to reflect mid-year benefit or eligibility
changes rather than reissuing entire booklets. New member education
becomes more efficient: welcome calls are made to new members to
provide education about the health plan policies and procedures,
explain the benefits, and answer questions. Welcome letters are
sent to those members that were unreachable by telephone.
Case study: Customer Service improved by
new Call Center System
Minnesota-based HMO provides health-care
services, insurance, and HMO coverage for over 660,000 members.
The organization's member service representatives are a critical
point of contact for members with questions about coverage and
care issues. In 2000, member service reps fielded more than 1
million calls. Just seven years earlier, the same number of reps
handled between 198,000 and 200,000 calls at an average length
of 4 to 4.5 minutes per call. At the same time, their access to
information was insufficient.
In the mid-nineties, reps relied on information from their legacy
mainframe system, other single-point systems, and numerous reference
publications to answer questions. Their cubicles were crowded
with volumes of reference sources for answering questions. As
part of its desire to provide improved member services and better
internal communication, HMO needed a new, integrated system to
facilitate information exchange between all internal departments
and eliminate duplication in job functions. A custom-built system
was implemented to address these issues.
Today, the service representatives still spend an average of 4
to 4.5 minutes on each call, however, now they answer more questions
in that time, resulting in fewer repeat calls and more satisfied
members. Service representatives provide members with more accurate
information, and staff throughout the network spend less time
adding and updating information. More than 1,000 HMO employees
now have access to the system, including the HMO's 100 service
representatives.
Most HMOs still need a customized system that would allow the entire
company, especially member service representatives, to access vital
customer service information and details on members' insurance plans.
ADVICE:
HMOZ state-of-the-art business information system gives you the
ability to deliver excellent customer service to members, providers,
employers, brokers, and other benefits consultants.
HMOZ tracks a wide variety of enrollment and renewal info, plan
designs, quotes and rates, member and broker data, leads and prospects,
opportunities, and outcomes measures through an automated information
system, enabling MCOs to conduct historical comparisons, trend analysis,
and ongoing quality improvement.
Not coincidentally, all HMOZ clients got positive ratings by NCQA.
One Demo is better than a thousand words, and one Solution
Audit is better than a thousand demos. We encourage you to follow
our CRM proverb and take advantage of this opportunity.
Click on one of the three links below to continue your HMOZ research.
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