Four Member Service RepresentativeReadiness Strategiesto Contend with the Affordable Care Act

Changes.Fear.

Hope.Uncertainty.

Confusion.Questions.

With all of the confusion and misinformation surrounding the ACA, the contact center is

taking on an increasingly important role as the primary knowledge resource for many managed care providers.

INTRODUCTION

Managed care providers are transitioning from a “let’s wait and see what happens” mindset to the definitive reality and associated preparations for the new healthcare system brought forth

by the Affordable Care Act (ACA). These organizations are quickly evaluating and assimilating these changes as new laws come into effect. There is an enormous amount of complexity surrounding the ACA from all perspectives – government, business, and citizens.

With all of the confusion and misinformation surrounding the ACA, the contact center is taking on an increasingly important role as the primary knowledge resource for many managed care organizations. There are millions of people being added to the system. Many of these people must buy health insurance for the first time and may have little to no knowledge of how the system works. Pharmaceutical, hospital, healthcare insurance and medical services companies that span this massive industry are relying on the contact center to serve as the frontline to the many questions related to the ACA, its many complexities and evolving policies and laws. While a number of these companies have been able to set up self-service channels such as Web and online portals to handle the tremendous influx of inquiries, the number of calls into many of these contact centers has skyrocketed. In response, managed care providers are rapidly increasing staffing levels to handle the high volume of calls to these service centers.

As these companies add significant numbers of new member service representatives (MSRs), it is critical that they have a strategic plan for fast-tracking these new employees so they are trained in the most efficient and effective way possible. This is not easily done. Here are four tips and ideas to consider for fast-tracking MSRs so they are trained and have the tools available to deliver a world-class service experience.

Complex Desktop Agile Desktop Simplified

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Desktop complexity can hinder MSR performance.

An agile desktop aggregates key policy information for easier access.

OPTIMIZE THE DESKTOP

Even before the ACA emerged, managed care providers struggled with MSR onboarding. Most of this was attributed to desktop complexity. Most MSRs are required to work in multiple disparate applications and systems to perform basic functions, like locating policy information, state regulations, or other mission critical data. From a training perspective, requiring MSRs to learn numerous different back-end systems that are disconnected and non-intuitive drives up training time. As a result, the MSR spends more time in training on each system, and is not on the floor answering calls.

How can you simplify the desktop and make the interaction between the MSR and member a more pleasant and efficient experience? Consider an agile desktop solution that aggregates all of the key policy information into a single view. This allows you to continue to use your legacy systems, while simplifying and streamlining the user interface and information presented to the MSR, so they spend less time navigating systems and more time answering the caller’s questions. Eliminating system complexity and simplifying worker processes enables MSRs to work smarter, engage more effectively and have the right information at the right time, transforming the member interaction and transaction at the desktop.

READINESS STRATEGY 1

Tier 1 Contact Center

BEFO

REAF

TER

300 Callsper day

300 Callsper day

Tier 2 Contact Center

200+60 Callsper day

250+15 Callsper day

Back Office

200+80 Service requests per day

250+20 Service requests per day

Escalation60 calls

Escalation15 calls

Escalation80 calls

Escalation20 calls

• Reducing escalation numbers• Increasing throughput• Increasing customer experience• Increasing worker engagement

8 Processes Automated12 Processes OptimizedSO

LUTI

ON

INTELLIGENT CROSS-TRAINING

Everyone has to start somewhere, and most MSRs start by handling only the most basic types of inquiries. However, there are often opportunities to expand the skill set of these tier-one MSRs by implementing process automations that intelligently guide newer MSRs through more complex processes. The alternative is to have tier-one MSRs handle only the most basic of inquiries and then transfer everything else to an escalated, tier-two group or a back office. This common practice increases transaction volumes, and significantly increases the elapsed time for transactions. Instead, we recommend cross-training the tier-one MSRs, and using intelligent guidance to usher them step-by-step through the more complex processes.

One additional point here is that as new ACA regulations are mandated, contact centers must be compliant to these standards. Intelligent guidance can also be used to help contact centers maintain compliance with new ACA regulations by enforcing adherence to new processes immediately after they are introduced.

READINESS STRATEGY 2

OPEN DASHBOARD

CUSTOMERINFORMATION

SIEBEL CLAIM APPLICATION

MEMBERSHIP

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Group #

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Copy Source

Line of Business

Effective Date

Plan ID

Standard Short Description

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Project Details

JANE-0123456789-0

0123456789

CloneSearch OS-000

HMO

ER Visit

HMO FEDERALLY QUALIFIED-PLAN03OV$5, SG$5/OP50, ALY$5, ER$50, PAD$250MIN$OP$25/SA15, OOP$1500/3000

Standard OSQ*03****N

04/23/14

QHP

First Name Jane

Last Name Automation

Policy # 0123-456-789

Contract ID # 0123-456-789-IN

Street

City

State

Zip

1101 Michigan Ave Date of Claim 04/16/2014Type of Claim

AllID AllMC Type MedicalCovered

$250 Rule ID CP5OSCopay AmountLogansport

IN

46947

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READINESS STRATEGY 3

THINK SEAMLESS… AND AGILE

Regardless of the amount of planning and preparation, there are still many changes and uncertainties related to the ACA that force you to be on your toes at all times. With each new regulation, contact centers must be prepared adapt their systems to provide MSRs with the tools they need to either communicate or capture accurate information.

The key to success is providing MSRs with the resources and information needed to accurately and immediately respond to inquiries. Using intelligent taskbars that integrate to back-end systems to quickly capture contact information or automating copy and paste tasks from system to system make MSRs more efficient during the call, and automating post-call notes eliminates time-consuming wrap-up. When changes need to be made to the back-end systems, the intelligent taskbar can still maintain its familiar look and feel. In this manner, new regulations and procedures can be easily assimilated without requiring wholesale changes to existing technology infrastructure or additional MSR retraining.

Having a trusted technology partner that provides these flexible and agile technologies allows managed care providers to adapt and extend existing technology assets to align with the rapidly changing business needs.

How are you engaging your MSRs?

Establish Effective Rewardsand Recognition Programs

Encourage MSRFeedback

Cultivate a CollaborativeEnvironment

ENGAGE, ENGAGE, ENGAGE

Onboarding and staffing new MSRs is time-consuming and costly, so once you have trained them, you want to keep them. Unfortunately, most contact centers generally run at a 35% per annum attrition rate. The key to minimizing attrition is to focus on MSR satisfaction and engagement – so it is important to establish a collaborative culture at the start of onboarding so employees know their feedback is important.

Of course, this means that there really must be a collaborative culture and MSR engagement must be a critical part of your service strategy. Is the MSR empowered to act on behalf of the company to solve a caller’s issue? Do employees have the tools necessary to perform all of the work activities required? Are these tools optimized for maximum performance? Does the company ask for employee feedback on a regular basis? Is there a system for communicating the success of new programs and publicly praising the employees that suggested them? These are all critical questions when considering MSR engagement as part of an overall member service strategy. Recent studies have shown that as employee engagement increases, so does service quality. Therefore, establishing and encouraging a strong dialogue with contact center employees should be an important part of the training and onboarding experience.

READINESS STRATEGY 4

CONCLUSION

As the fog lifts off the horizon and the ACA becomes a clearer picture for everyone, organizations are having to adjust and adapt as policies and laws evolve into this very different system of healthcare. While this evolution plays out, managed care providers must continue to strive for operational and service level excellence. Creating strategic training and onboarding programs to successfully ramp up MSRs to staff these centers is a mission-critical corporate initiative. By implementing these four aspects of the onboarding experience, MSRs can spend less time navigating complex systems, paperwork and bureaucracy, and more time helping the caller and delivering excellent service.

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