Presbyterian Health Transforms the Customer Experience in Healthcare

By Joe Heinen

December 2009 / January 2010

Presbyterian Health in New Mexico has made customer service the focus of a transformational effort that may serve as a model for similar enterprises throughout the country.  Presbyterian Health is New Mexico’s largest provider of healthcare, a private, not-for-profit healthcare system with annual revenues of over $2 billion.  Founded in 1908, it operates seven hospitals, 25 clinics, and serves more than 700,000 customers.  In addition, Presbyterian Health also offers a healthcare insurance plan. 

The medical care provided by Presbyterian has been consistently rated top notch by independent rating firms who regularly survey consumers on their preference of hospitals, doctors, and facilities.  But medical care is only a part of the customer experience.  In delivering customer service, Presbyterian faced challenges that are not limited to the healthcare industry.  These included multiple organizations and difficulty in navigating a complex set of organizational silos, such as navigating insurance, scheduling, billing, and appointments.  Presbyterian wanted to improve the level of its customers’ satisfaction when they interacted through its contact centers and throughout the customer experience.  This meant taking a fresh look at all aspects of the process.

“In healthcare there is a great deal of built-in complexity and a variety of programs, such as Medicare and Medicaid, that require certain training and skill sets, so it is challenging to be able to quickly route inquiries and consolidate customer service to make it easy for the consumer,” said John Johnson, director of customer service for Presbyterian Health.  “When our members think of Presbyterian, they value the community aspects of healthcare, including local staff and doctors.  But we also wanted to create an environment where the customer experience was the same across the entire enterprise,”

Presbyterian had many different locations where calls were handled, which created a fragmented service experience.  A single call might require multiple transfers or the customer calling back in.  Many inquiries would require help from different functional areas, such as billing questions, scheduling appointments, and coverage issues.  Their goal was to centralize customer service where appropriate but to retain local access for tasks that were best handled outside of the contact center. 

Through its contact center, Presbyterian has a staff of 130 representatives across multiple centers.  With locations around the state of New Mexico, Presbyterian has regional hospital facilities and primary care clinics with staff located in smaller communities.  And with regional sites, which are community-based, it is important to members to have staffing from their community handling their calls. 

Presbyterian took a complete view of service center improvement as part of an enterprise transformation effort, including such key technology-driven efficiencies as enabling multiple contact channels, proactive customer contact, leveraging virtualization, and driving business process improvements.  In assessing itself, Presbyterian found that one of its biggest challenges was to create a single customer service system that supported a variety of customers needs, including flexibility, simplicity, personalization, and efficiency. 

“Our intent was to create a more seamless, ‘One Presbyterian’ view of customer service so the customer didn’t feel they were dealing with so many different organizations,” Johnson explained.

Within the Presbyterian customer service center, they undertook a project to integrate three main areas that comprise about 75 percent of the customer service volume coming into any customer service area in the company: 

• Patient financial services, which handles physician and hospital billing
• Member services, which supports members from the health plan that is owned by Presbyterian
• Primary care scheduling for primary care clinics

Even in areas where they sought to increase the use of self-service and automation, Presbyterian focused heavily on improving the customer experience and access at the same time.  All of its efforts followed a rigorous Six Sigma design process, with closely monitored and measured results.

First, they gathered customer feedback of expectations.  The customer needs were straightforward and included requests such as:

• “Answer my call quickly.”
• “Let me choose how I contact you.”
• “Have the right person answer the call the first time.”
• “Don’t waste my time when I call.”

After its initial assessment, Presbyterian identified dozens of areas for potential improvement.  For example, while much of its brand promise to consumers was based on the idea that there is “One Presbyterian” that can meet all of their healthcare needs from insurance to medical care, they had grown to have more than 100 unique phone numbers that their customers needed to navigate depending on their needs. 

Presbyterian wanted to simplify matters and create a single point of access, incorporating the Web, self-service, and assisted service which could operate as part of an integrated system.  To do so, they catalogued each of the business processes associated with hundreds of customer interactions.

After capturing and categorizing their business processes, Presbyterian used software to create business rules for virtually any contact type, including eligibility, claims, physician assignment, plan questions on over 100 plan types, co-pays, scheduling physician appointments, payments, balance inquiries, and physician inquiries.  To ensure consistency, each business process could be deployed once but would drive interactions across multiple customer systems, from the Web to voice self-service.  After that, the team re-designed many of the processes and was able to reduce the number of steps by 46%.

Presbyterian also implemented workforce management to ensure that its staffing was optimized across 25 different sites.  Using skills-based routing, they were able to identify the right resource for each incoming call and route the caller accordingly.  In addition, if hold times grew too long, Presbyterian offered any incoming caller the opportunity of automatically scheduling a return call, which allows a customer to choose the time and location where they want their call returned.

A proactive contact capability can initiate outbound voice calls, such as issuing an appointment reminder.  Using IP technology, Presbyterian can use a single platform to route calls anywhere, as appropriate.

The results were so strong that Presbyterian Health was chosen as one of the world’s top innovators in customer service by an international group of industry experts in the fourth annual Customer Innovation Awards, sponsored by Genesys, an Alcatel-Lucent company.  Presbyterian was selected because it had one of the best customer responses and, at the same time, produced tangible business benefits.  The result was an integrated customer care system that brought together a complete range of technologies, including the Web, live agents, automated voice, patient options for scheduling proactive call-backs from key contacts, and business processes. 

The panel of analysts judging the awards noted that Presbyterian had one of the strongest improvements in customer satisfaction, as well as showing significant business benefits through ROI and efficiency.  For example, while seeing a 218% increase in self-service options and an 8% increase in uptake for automated systems, Presbyterian also saw customer satisfaction increase by 44%.  Overall they saw an 18% increase in efficiency, taking into account both assisted and automated assistance.  Along with the increase in customer satisfaction, Presbyterian has seen significant cost savings because of efficiencies and business process improvements.

While the improvements to its system cannot erase the challenges in healthcare, they can still have a huge impact on customer loyalty and satisfaction.  Presbyterian’s experience shows that with the right blend of technology and initiative, any organization, even one under tight cost constraints, can dramatically improve the customer experience while still showing cost savings.

As vice president of marketing at Genesys, Joseph Heinen is responsible for corporate branding, marketing communications, and public relations, as well as strategic ROI and benchmarking programs.  Prior to this, Mr. Heinen held positions in the company as vice president of strategic marketing, vice president of product marketing, and vice president of vertical markets.