By Mark Nathan
In the last decade or so we’ve seen dramatic improvements in customer service call center performance across a wide swath of industries. As a consumer, it’s far easier to troubleshoot your cable service, clear up confusion about your cell-phone bill, or change your flight today than it used to be.
But try calling your health insurance company, even for something simple like updating your address, and you’ll feel like you’ve traveled back to 1999. Long hold times and endless apologies from customer reps, who can’t find the information you need, remain the norm in health insurance call centers.
Saddled with Old Technology
This is largely because those call-center workers use antiquated technology. More specifically, they’re juggling an array of databases, each of which needs a separate login, and many of which require separate terminals. Those long hold times and frustrating delays are a direct result of the time reps spend jumping between screens, logging in and out of different databases, and, in some cases, walking across the room to find what they need.
A customer rep might have to log into one system to find a doctor’s account information, another to look up specific policy details, and a third to understand the insurer’s arrangement with the hospital system the doctor works for. Tougher questions about procedures that need special authorization or involve complex agreements with large health systems might send the rep spelunking into unfamiliar systems they only access every few months.
This doesn’t happen in most industries, which over the last decade have upgraded to automated systems. Natural-language chat bots and other virtual solutions today handle many basic customer requests, which reduce call center traffic. And when customers do call, reps typically access integrated databases through a single screen. This is true even in industries like cable and utilities, which not long ago battled the same issues that plague health insurers today.
The Challenge of Upgrading Technology
For insurers, upgrading call center technology and systems has proved challenging and costly. The challenge lies in the way insurers’ databases have been assembled over the years. Many were brought together through acquisitions or built by various outside companies in response to a specific need or regulatory requirement. This hodgepodge has left insurers dealing with outdated physical directories. The result is that simple updates, like changing an address, must sometimes be done on paper. The systems can’t be electronically integrated, and the cost of replacing them is prohibitive.
But the status quo has its own costs. Often insurers pay exorbitant licensing fees that haven’t been renegotiated for years. Training customer reps to use multiple systems, some of which are anything but intuitive, is also expensive. And there’s another expense associated with those creaky systems: the fines assessed against health insurers when they give their members inaccurate information.
Antiquated customer service at health insurers also creates systemic costs. When you can’t figure out what exactly your policy covers you might just go to the emergency room when you’re sick. That’s a drain on the hospital’s resources and the insurance company’s bottom line.
And beyond that, insurers are missing a prime opportunity to help their members save money by staying healthier. Insurers know when we’re due for an annual physical and when our prescriptions need refilling. They can tell us where the nearest urgent-care clinic is, so we go there instead of the ER. Better customer service would not only be reactive—answering our questions when we go online or call—but also proactive, providing us with prompts and reminders to take actions to keep us healthy and save us (and them) money.
Pursue a Single-Screen View, Single-Login Solution
This is entirely possible, and it doesn’t require ripping out all the legacy systems and databases that plague health-insurance call centers today. Instead, insurers should focus on implementing technology that integrates the data in their disparate systems into a single view that every customer rep can access. That would give them a single login and a single interface to work through when seeking information about a customer.
Moving to a single-screen view, with all the databases connected on the back end, would end the time wasted logging into and out of different systems, switching screens and running around the call center trying to find accurate information. It can be done through an application programming interface (API)—software that connects to all the existing systems—without building new or different databases.
This would result in dramatically shorter hold times, fewer fines for misinforming customers, and happier, healthier members. It would also lay the groundwork for more advanced customer communications, like chat bots and artificial intelligence. So, before you can finish typing “find a doctor” in the chat box, the software suggests a cardiologist near you, because it knows you have high-blood pressure based on your prescription records.
All this is possible if we start by putting a single screen in front of every customer rep in the call center. It’s an elegant solution to a complex problem—and that’s exactly what technology should do.
Mark Nathan is founder and CEO of Zipari, a consumer experience software company for health insurance. He’s worked in insurance for the last twelve years, and prior to that worked at consumer-oriented companies including Apple and Disney, after serving as a robotics engineer for NASA.