Tagged in healthcare payers


How Busy Healthcare Call Centers Benefit from Customer Service Outsourcing

July 12, 2018


Influenced by the high-touch, high-quality customer service they receive in retail, today’s healthcare members expect prompt results and top-notch customer service. Since healthcare is a major expense for families, members expect even higher rates of service and hassle-free support. Properly meeting these expectations requires expertise and investments of time and money, so many healthcare call centers are turning to customer service outsourcing, reaping the benefits of knowledge and readily-available resources.

  1. Manage volume spikes for increased member satisfaction

There are countless call center factors that impact member satisfaction. At the top of the list are hold times, accuracy of information, IVR/call routing effectiveness, and handle time to answer basic questions. Open enrollment is a good example. It’s a stressful time for members, particularly those new to healthcare. It’s also a member’s first impression of your company and sets the expectation for future interactions. Customer service outsourcing during open enrollment can help you utilize additional subject matter experts in the short-term to help with this spike in call volume, keeping members happy and looking forward to their relationship with you.

  1. Increased flexibility for internal staff

Outsourcing part of your customer service, particularly for FAQs and low-tier questions like in-network PCP options, frees up your more experienced staff to handle members with complicated concerns. Segmenting your front-line provides more flexibility in scheduling and handle time. It allows your lower tier calls to get answered quickly while also giving your staff the time to properly address less frequent though more nuanced and complicated calls.

  1. Improved outbound communication

Most healthcare companies offer exclusive member benefits like gym reimbursement, telehealth vendors, and even online wellness portals. These benefits can help shape a healthier member pool, which can help reduce healthcare payouts over time. They’re also great topics for outbound communications to your members to get them enrolled in these programs and to provide updates about new features or policies. This “extra-mile” effort can make a difference in retaining members and in increasing awareness for the benefits that set you apart from your competitors. Plus, if you’re involved with Medicare, it can help increase your star rating.

  1. Reduce stress related to temporary employees

Recruiting, hiring, and training temporary healthcare call center employees can take up a lot of your HR and management teams’ time. Customer service outsourcing vendors are experts in finding agents with the skill set and industry experience you need. They’re used to the ebbs and flows of the call center environment and already have pools of qualified applicants they can pick from to create achieve service results through the right staffing configuration for your anticipated call volume and call complexity.

  1. They’re subject matter experts

A good outsourcing vendor does more than just staff your phone lines. They provide insights on how to improve your call handling and escalation processes, revamp scripts for more productive communication, update your customer service handbook, and deliver cost-effective, reliable technology your members crave.

Customer service outsourcing can provide the extra help you need to connect with your members in meaningful, effective ways. Members who feel valued and respected by their healthcare companies are more apt to select your plans in the future, take advantage of preventative programs and other member benefits, recommend you to their friends and family, and are more willing to build that all-important and hard-earned trust that’s so critical to healthcare decisions and member lifetime value.


Featured Image: Shutterstock/ideyweb

NOPLG Recap: ACA Changes a Top Concern for Healthcare Payers

April 30, 2018


April once again brought Windham to the National Other Party Liability Group (NOPLG) Conference, hosted in sunny Scottsdale, AZ. A top concern among healthcare payer leaders this year was, of course, the impact of big changes to the Affordable Care Act (ACA) made late last year. Though payers braced themselves over the winter for the changes, now with 2018 fully underway and a clearer picture of actual impact available, payers are assessing what other changes they need to make, specifically in preparation for open enrollment later this year. Legislative changes to ACA are set to impact payers in four major ways:

  1. Raised premiums

Citing desire to give subscribers more choices when selecting health plans, the individual mandate and cost-sharing reductions (also known as subsidy payments) were stricken from the ACA in 2017. These subsidies were one of the ways payers were able to offset the costs of required discounts offered to moderate-income subscribers. Though the subsidies are gone, the discounts must continue to be offered.

With the ACA’s individual mandate repealed under last December’s passed tax bill, starting in 2019, individuals will no longer face a tax penalty if they don’t enroll. A rising fear is that healthier people will opt not to enroll in healthcare plans leading to destabilized risk pools.

Payers must now determine what the best course of action is for them to reduce losses associated with these changes. Increasing premiums is an obvious and likely option. Premiums could increase as much as 30%.  Some may also weigh whether it’s more advantageous to drop their individual health plan offerings from state exchanges where poverty levels (and healthcare discounts) are highest. However, this can increase financial strain on the remaining payers, forcing them to raise premiums or also drop out of the exchange. This could leave some states without any options for individual plans–particularly those states with higher poverty and unemployment or underemployment rates.

  1. Short-term coverage acting as long-term coverage

The executive order signed by President Trump last October, in part, increases the length of time association health plans (AHPs) can cover individuals. Once structured as short-term coverage, the executive order allows AHPs to be bought and used as a long-term alternative to regular health plans. It also allows for individuals to pay for AHP coverage with health reimbursement agreements like HSAs.

Like with the repeal of the individual mandate, this provision could destabilize individual market insurance by unbalancing risk pools as healthier people are more tempted by AHPs because of their lower costs and they don’t necessarily need essential health benefits (EHBs) that less healthy subscribers do.

  1. Medicare reimbursement obstacles rise

Though not directly tied to the changes the ACA saw last year, the changes have increased challenges for Medicare payments and reimbursements, putting additional strain on payers and consumers alike. Overcoming these obstacles begins with better Medicare screening and educating patients on the benefits of supplemental insurance. It also requires providers to be more in sync with payers’ goals by facilitating more sustainable and accurate appointment registration to collect essential bill and payment processing information while also committing to timelier patient follow up.

  1. Increased subscriber confusion and questions

Many subscribers still don’t fully understand what these changes mean for them and their families until they receive an estimate for service or a bill. That can translate to more calls to customer service, especially as open enrollment approaches. Picking an outsourcing vendor who stays up-to-date on these kinds of legislative changes can make all the difference in explaining coverage and costs to existing and potential subscribers to ensure they’re selecting the most appropriate health plans for their needs.

While these changes aim to increase competitiveness and to give people who buy their own insurance more options to choose from, some of them are forcing payers to reevaluate costs and plan coverage in order to remain profitable. Still, more changes are expected throughout the year as spending bills and budgets are reviewed, so it’s become essential for payers to monitor impact on subscribers and to find better ways of educating them on the changes.


Featured Image: Shutterstock/GoodStudio

6 Ways Payers Can Improve Open Enrollment Customer Support

September 29, 2017

With rising healthcare costs and plan options growing more complex, healthcare subscribers are looking for easy, simple answers to the questions they ask open enrollment customer support every year. When their favorite retail and tech brands offer expanded and proactive customer service, they expect the same qualities from their health plan providers.

To stay competitive, it’s imperative that healthcare companies rise to meet this challenge. Try out these tips to delight new and existing members with friendly, efficient service they can expect all year round.

  1. Change the way you think about open enrollment

Instead of thinking of open enrollment as your busiest time of year, think of it as your first impression. To members, especially new ones, your support during open enrollment sets their expectations for the rest of the year. A frustrating or poor first impression carries over to their next interaction, and research shows that it takes 12 positive customer service experiences to make up for one bad one.

  1. Appeal to millennials

Keeping millennials happy is essential for long-term growth. Not only are they a powerful (and younger) purchasing segment, but they have an unprecedented influence on others’ purchasing decisions—including their parents and social media followers. Plus, millennials are twice as likely than any other generation to act on advice they find online, according to the Healthcare Finance Administration (HFA), and they place reputation above all other selection criteria.

  1. Personalize the experience

Predictive technologies can help you use customer data to transform and elevate the customer experience, particularly in self-service instances. Integrating these technologies with your website, they can customize an individual’s visit by offering up other relevant information based on the customer’s clicks, scrolls, and search terms. Minimize someone’s research efforts and you’ve made them very happy. It might even prevent a lengthy call to your open enrollment customer support line.

  1. Update your IVR

Often, an IVR’s routing tree looks great from above at an operational level, but when you get on the caller’s level, cracks in functionality and experience appear. A big offender? Lingo-heavy menus and self-identifying options that your average customer, especially someone seeking coverage for the first time, doesn’t understand. This leads to a high volume of poorly-routed calls that your busy agents have to then re-route. Then, your customer gets put on hold again waiting for the correct department. It’s not efficient and it doesn’t delight.

A good IVR should be designed for easy use by your most novice caller. Reduce customer effort by using simple, layman’s terms when you can and always make it easy for callers to reach a live representative.

  1. Forecast and staff up

Everybody agrees that healthcare is complicated and waiting on hold is frustrating. Ensuring callers get the accurate information they need in a timely manner means scaling your staffing to accommodate peak call volume times. Invest in workforce technologies that help you forecast needs so you can recruit and hire beforehand.

Or, if you need a little help without incurring all that additional overhead, consider outsourcing. Whether you need temporary help to manage a high call volume or longer-term assistance, you can onboard a reputable call center partner in as little as 30 days.

  1. Compliance refresher

More calls mean a greater chance of compliance slip-ups or infractions. Before open enrollment comes, provide refresher compliance training to your internal customer support staff (and external vendors, too). Ensure everyone understands the importance of compliance, especially HIPAA, and how agents should speak to callers with compassion and patience when discussing private and very sensitive health information.

Delivering poor customer support, especially during open enrollment, can wreak havoc on your customer lifecycle, strangling lifetime value and creating deeper revenue and retention issues for your team and company down the line. Show members at the start of their engagement that you value and respect their time and you’ll build the foundation for a long and mutually-beneficial relationship.