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published 03-5-2019
CX Best Practice Award Winnerfor Continuous Improvement Process
Regence Blue Cross Blue Shield Plans
CX Best Practice Story - Continuous Improvement
Regence Blue Cross Blue Shield Plans
Company Description
Cambia Health Solutions is dedicated to transforming health care. We are a family of more than 20
companies working together to make the health care system more person-focused and economically
sustainable for people and their families. Our solutions empower more than 70 million Americans
nationwide.
Cambia has six health plans in four states in the Pacific Northwest that provide insurance to more than 2
million people. We have a top rating in FCR in the BlueCross BlueShield Association. Through bold thinking
and innovative business practices and technology, Cambia delivers solutions that make high-quality health
care more available, affordable and personally relevant for people.
Contact Center Description
Locations:
Burlington, WA; Lewiston, ID; Medford, OR; and Tacoma, WA.
Contact Types: Inbound and outbound calls, emails and chats related to benefits, eligibility, doctor
referrals, claims, and pre-authorizations
Customer Types
Members, providers, caregivers, other insurance companies, brokers/agents
CSR Headcount:
328 CSPs (Customer Service & Provider Service Professionals)
Contact Channels Offered (including Inbound and Outbound):
Inbound and outbound phone calls, emails, website, in-person, IVR, social media
Hours of Operation
Customer Contact Center: Mon-Fri 5am-8pm PST, Sat 8am-4.30pm PST
Provider Contact Center: Mon-Fri 7am-5pm PST
Contact Volume
3.5 Million annually – Phone, Chat, and Email
Pain Points Program Synopsis
Putting the customer first and valuing our employees is the focus of our Health Plan Operations division.
Our Pain Points Program empowers employees to solve problems they come across in their daily
operations. Relying on the belief that those who do the work are the ones to best improve it, we’re using
this model to create a culture of continuous improvement within our organization.
We developed an easy-to-use format for employees to submit problems they identify as they do their jobs.
Each functional area such as claims, membership, and customer service have an Improvement coach to
partner with employees and other resource representatives to assist them through a structured problem-
solving process to relieve problems and make improvements. Ongoing improvement and successes are
communicated throughout the division and across the larger organization to showcase our commitment to
our customers and employees.
Since implementing the program in December 2017, we have resolved 90 Pain Points!
Background
In November 2017 our Health Plan Operations Senior Vice President started focused efforts via side-by-
sides and meetings with frontline leaders to learn what issues they and our customers faced. He generated
conversations about how we made issues a priority and achieved results. He supported us to work with
other teams to remove barriers.
We measure experience from the voice of the customer. In our service teams, we have integrated this
culture by using surveys, primarily SQM and speech analytics tools to measure opportunity and success
from that perspective. We also have set KPIs that are focused on our members perspective to measure the
performance of experience on a frontline individual level, to a leadership level expectation. This focus from
the service area generates the importance of identifying concerns from our customers' perspectives. We
know the best feedback is from the people we serve.
Our closest connection internally to customer feedback is our frontline teams who work through the
processes and interacting with our customers every day. We have used many different facets to gather
feedback and focus work. In gathering all the opportunities, we recognized that to get the best value in
solving issues it would be best to invest in a dedicated person or team to give focused time to drive effective
and sustained improvements. The first Improvement Coach was established in the Customer Service team
in December 2017.
Development
In January 2018, Health Plan Operations leadership prioritized pain point identification and resolution as a
strategic initiative, which included cross-departmental leadership from areas such as Health Care Services
and Provider Services. By February 2018 each Health Plan Operations team dedicated an Improvement
coach to its department. Improvement Coaches were selected based on their subject matter expertise such
as data and reporting, systems and tools, and project management. Initially, each division’s improvement
coach worked individually within his or her own department to create a separate process improvement
program, but we quickly saw the benefits of creating an integrated, cross-departmental team dedicated to
this work.
This cross-departmental team known as the Health Plan Operations Pain Point Team came together to
design the program and support ongoing coordination and infrastructure. This team deployed change
management and process improvement best practices to ensure employee engagement, leadership
commitment, and effective problem-solving.
Methodology
The main components of the Pain Point Program consist of: Identify and submit an opportunity, Triage
opportunities to prioritize next steps, Partner with those closest to the opportunity, Solve opportunity using
a structured problem-solving model.
We embraced PDSA (Plan-Do-Study-Act) as our process-improvement model for solving our opportunities.
This model ensures that we avoid solving symptoms but address the root causes.
Implementation
Once the program was designed, we communicated to frontline staff through road shows, emails,
presentations and staff meetings across the Health Plan Operations team, informing them of a new way to
identify and submit opportunities they find in their daily work. As submissions came in, the Health Plan
Operations Pain Points team triaged and prioritized opportunities and partnered with submitters to solve
using PDSA.
Also, as submissions rolled in and opportunities were solved, ongoing communication such as Pain Point
updates, celebrating Pain Point submitters went out to frontline employees to encourage continued use of
the program.
Pain Point Story: Accident Report Calls
Near the beginning of the development of the Pain Point Program within Customer Service, a significant
consumer experience problem was submitted. Many of our customers were facing a long delay to get their
accident report form reviewed and claims processed. This was due to a higher volume of claims near the
end of the year. Regence’s process required all accident report details to be worked by a smaller claims
team, and this caused a bottlenecking of tasks.
Customer Service partnered with the claims department to brainstorm solutions to this workflow problem.
It was determined that a large majority of tasks assigned to the claims team were simple "no accident" tasks
from customers calling Customer Service, while a smaller number of tasks were truly accident-related and
required investigation.
The two departments worked together to develop a process in which our Customer Service Professionals,
with the oversight of our Customer Service Resource Desk, could review and process "no accident" phone
calls from customers instead of passing them to claims.
After a few tweaks and adjustments, a new process was in place that led to greater satisfaction for our
Customer Service Professionals, better First Call Resolution for our customers, and a claims team that
could now focus on complex accident cases with a greatly reduced inventory.
This Pain Point is a great example of how most problems our customers or employees encounter are
interdepartmental, and the Pain Point Program facilitated the discovery, analysis, and resolution of a
significant consumer problem.
Summary
• Of the 90 completed pain points, 53 were direct customer impacts, 21 focused on employee
satisfaction, 10 were for providers, four for employers and two for producers.
• Delivered excellence to our customers by choosing the right problems to solve first by looking at NPS
impact and the largest volume of people impacted.
• Empowered and developed our people by training and partnering with frontline staff and supervisors to
solve problems and make improvements.
• Strengthened our operations area by using a proven problem-solving model PDSA to make
improvements.
• Improved relationships across business areas through collaborative problem-solving.
• Positive feedback from frontline employees regarding the program, communication and having an
open-door process to share pain points.
• Promoted a culture of continuous improvement by sharing best practices with other departments, which
resulted in the creation of Pain Point Programs across the enterprise.
• Our SQM Results in 2018 have improved from 2017.
We continue to refine and streamline the Pain Point Program through employee feedback and regular
process checks.