You Can’t Always Get What You Want… or Can You?

By Jim Ball

A recent Accenture survey found that nearly 50 percent of healthcare customers are willing to pay more for quality customer service. Yes, you heard it right. Consumers are looking for and demanding quality customer service from their healthcare insurers. Quality and service are fast becoming the criteria that determine success.

What Customers Are Looking For: For most traditional call centers, the only option to reduce overhead is to minimize the one-to-one customer experience by increasing the use of technology. However, the Accenture survey shows that increased use of IVRs, driving members to use Web self-service platforms, and other non-voice options result in increased customer dissatisfaction.

Customers are frustrated with long hold times, unfriendly or unhelpful representatives, and having to repeat information. New technologies, like automated phone attendants and live online chat help, have made it faster and simpler for customers to resolve issues. But, 44 percent don’t believe these advances have improved the level of service within the past five years.

According to the survey, health insurers are failing at the most critical task, providing the personalized experience that customers crave. The gap between customer expectations and insurer performance measured as much as 50 percentage points. Respondents said it is critical that representatives are knowledgeable and well-informed, available outside of standard business hours, quick to reach and solve problems, and able to deal with issues independently. Unfortunately, less than half of customers are satisfied with their insurers’ current ability to meet these expectations.

Reality Collides with Service: Today’s reality is based on slashed budgets and increased service demands, which seem like a no-win scenario. The expectation is “do more with less.” The question is, how? The time is ripe for innovative “out of the box” or “out of the center” solutions that meet or exceed quality, service, performance, and cost. In response, healthcare companies are turning to outsourced employee-based virtual work at -home solutions to provide everything they and their customers need and expect.

The Virtual Solution: Market research from Frost & Sullivan and Datamonitor shows that healthcare organizations currently outsource more than 30,000 (or 20 percent) of their call center agent positions. By 2013, the outsourced figure is expected to exceed 42,000 positions. Due to privacy concerns and regulatory barriers, nearly 75 percent of these outsourced positions will be based in the U.S.

Historically, large brick-and-mortar facilities have been used, but more companies are looking outside of that box for a solution that provides higher quality and performance. More than one-half of healthcare organizations plan to dramatically increase their deployment of home-based professionals because the virtual model offers benefits not available inside their current “brick-and-mortar box,” such as:

  • Recruiting without boundaries: Recruiting from a large nationwide talent pool enables access to the top two or three percent of customer service professionals.
  • More experienced and qualified workforce: The typical work at-home employee has 15 to 20 years of experience, which decreases time to competency and significantly improves customer satisfaction and performance metrics.
  • Lower operating costs: A scalable virtual workforce offers the ability to ramp up and launch approximately 75 percent faster. Sophisticated virtual workforce management tools allow scheduling in 15-minute intervals, allowing for real-time staffing adjustments to accurately match changing call volumes.
  • Improved operational efficiency: Virtual work at-home solutions have proven to be 30 to 40 percent more efficient. Call metrics consistently perform within the top two metrics.

Case Study: How the virtual employee-based at-home solution is solving one organization’s needs:

The Company:The company is a multi-billion dollar global health services organization dedicated to helping people improve their health, well-being, and sense of security. Its subsidiaries provide an integrated suite of health services, including medical, dental, behavioral health, pharmacy, and vision care. Additionally, they provide group life, accident, and disability insurance. The company employs over 30,000 individuals, maintains sales capability in 30 countries, and has approximately 66 million customer relationships worldwide.

Business Challenge:The company was extremely interested in the employee-based virtual at-home model as an alternative to their current brick-and-mortar approach. They wanted to see how it worked and whether or not it could be a viable alternative for their business. “To get their feet wet,” the program started small to see how the virtual work at-home employee model compared to its own centers.

Originally, the project encompassed voice only calls with 50 full-time employees beginning in March 2010. The sole purpose was to handle overflow volume for their existing traditional call center facilities with inquiries about dental claims. There were two call types and two types of callers. The pilot group took calls from providers, and members split 50/50 for eligibility and claims inquiries.

Success Strategy: The employee-based virtual work at-home model won – without trouble. Service exceeded all expectations. The ability to recruit, hire, train, launch, and manage the program in a 100 percent virtual environment provided a more educated, mature workforce. Employees were experienced in the healthcare industry, which reduced time to competency and increasing first call resolution.

By developing the philosophy of “next call resolution,” focus is placed on answering all of the caller’s immediate questions, as well as anticipating any additional questions. This resulted in fewer repeat calls, as well as reduced costs for the company and less frustration for the caller. Because of this quality experience, the client restructured the way they handle calls.

Originally the client only wanted to meet their unrealized customer satisfaction goal of 3.75 (based on a scale of 1 to 5) they had set for their own brick-and-mortar operation. Instead, they were able to increase satisfaction to 4.57 within the first month, delivering a one-to-one personal experience. Because of this effective solution, the program rapidly expanded to handle the majority of calls for eligibility and dental claims from both members and providers. By the end of the year, the program expects to handle 50 percent of their calls for medical claims, in addition to the existing calls for dental claims from both members and providers. The program will employ over 200 full-time virtual at-home employees.

Will an Employee-Based Virtual At-Home Model Work for You? As more companies are looking for innovative solutions to reduce operating costs, they are moving toward the virtual home-based employee model. These professionals handle more complex call types and focus on productive customer interactions. The entire employee lifecycle can all be conducted within the virtual environment. It is because of this seamless integration that allows these professionals to be an invisible extension of the organization, and it shows in performance results. As you are evaluating next year’s budget and expenses, you might want to take a closer look at the virtual at-home employee model to see if it can help you do the “impossible.” Experience shows that you can get what you want and what your customers expect.

Jim Ball is one of the pioneers of the work at-home employee-based virtual call center model and served as co-founder of Alpine Access in 1998. He currently serves as a consultant and works with the senior management team as the company expands to offer services in new lines of business.

[From the October/November 2011 issue of AnswerStat magazine]