Trends in Healthcare Contact Sector
1 Jan, 2006
By: Rhonda ProctorIn this edition of Profile we begin focus on issues in the healthcare industry. To gather the information, we spoke with two leading industry consultants, both of whom have extensive experience working with clients in the healthcare field --Bill Durr, principal solutions consultant and Oscar Alban, principal global market consultant, both with Witness Systems.
CP: The healthcare industry is facing continuing challenges, what in your opinion, are the top challenges that it will face in 2006, and why have these become so pervasive in the industry?
Durr: The new Medicare Senior Drug Assistance program coupled with generally rising healthcare costs present new challenges and opportunities for healthcare contact centers. Consumers are unhappy with rising costs and are also confused about coverage options and how to work effectively with their insurers. In response, private insurers and the federal government are busy creating new programs and options.
Alban: Right, and remember, baby boomers are now approaching retirement age. This means that there is going to be potentially a huge portion of the population who will be part of the Medicare/Medicaid program, specifically the Drug Assistance program. There will be a big change in the way that both government operated contact centers and outsourcers will need to invest in on-going training programs. All parts of Medicare/Medicaid are complex –but especially the Drug Assistance program. CSRs are going to have to know it inside and out. And, any contact center in the healthcare industry must realize that due to the fact that they will need to invest more in hiring and training, they cannot afford to live with 20 percent, 30 percent or higher attrition rates.
Durr: The impact of these drivers on healthcare contact centers is causing an increase in transaction volumes. CSRs are not only required to understand an ever-expanding array of healthcare products and services, but unfortunately, consumers are often confused, upset and even angry when calling. This creates added operational problems for contact centers that tend to drive up costs.
CP: So, Medicare D is dramatically changing the healthcare landscape -- how’s it all going to shake out?
Alban: Medicare D is a new animal and the contact centers are feeling the pain of this new change. Perhaps as time goes by and people become more comfortable with what Medicare D is all about the initial questions will decrease. However, one of the big changes that these contact centers are going to have to make is to “mine” the calls that they have recorded in order to determine the deficiencies. This information needs to be given to the people who administer the program in order to continue to refine the product. This could be invaluable and actually could help to make the Medicare D program streamlined and effective.
CP: How will these centers become equipped to handle such challenges?
Durr: Like many challenged contact centers, those in the healthcare industry are looking to expand consumer self-service capabilities in order to take some of the load off of the CSRs. IVR systems with speech recognition and friendlier web sites with better content can make a big difference in center workload.
Alban: I agree with Bill that self-service must be expanded in order for the healthcare sector to meet the needs of their customers. However, one of the biggest complaints, especially from elderly consumers, is the use of poorly designed IVR systems. Healthcare firms are going to have to evaluate these tools from the outside in. Too often these systems are designed to support internal needs, not necessarily the customers needs.
Durr: Perhaps a bigger challenges is to improve the skill and knowledge of the CSRs. In order to keep costs under control, more centers will be taking a look at e-learning knowledge clips, short and to-the-point sessions that can be scheduled into a CSRs workday without jeopardizing service levels and stretching queue times. Because there is such a steep learning curve for healthcare CSRs, the frontline management teams face increased pressure to find ways to retain experienced CSRs. Creating a competency-based career path and providing essential supervisor coaching and mentoring are on-going challenges as well.
CP: Do you think mantra, “the customer is king,” stills rings true in the healthcare field today?
Durr: I think the customer is always the king – without customers there is no company – but that doesn’t mean they always get what they want or that they are never wrong. One of the responsibilities healthcare centers and CSRs have is to inform and educate the customer about the coverage, the cost and the required administrative processes that in order ensure a smooth experience. And when a consumer cannot get what they thought they were entitled to or should get, the CSR is the person who has to explain the situation factually and without stoking emotions. It’s easy for both parties to feel bad after such an interaction but that doesn’t mean the company doesn’t care about the customer.
Alban: I think this is a problem in the health insurance part of the healthcare sector. Too many times the customer is viewed as guilty until proven innocent. This mentality is going to have to change. First of all, most elderly consumers have a hard time understanding the verbiage attached to the Medicare/Medicaid programs, for example, so when they call they don’t really know what they should be asking. All they know is that it doesn’t make sense to them. The confusion factor is huge. The Medicare program is going to have to take the view of a private sector company and earn the trust and the business of its customers every day. This is going to be a huge departure from the traditionally bureaucratic approach that has been taken from government agencies. That means they are going to have to put an honest to goodness Quality Assurance program in place that includes identifying trends of customer dismay and handle on-going customer loyalty measurements. In the private sector companies measure customer loyalty in order to keep customers from going to the competition, however, Medicare has a captive audience, so this is going to have to be a leadership shift starting at the top.
CP: With multiple points of customer contact, do you think that healthcare industry risks loosing their “personal touch?”
Durr: It’s a mistake to believe that every interaction between a consumer and their healthcare insurance provider needs to have a personal touch. Often, all the consumers really need is a quick and accurate answer. Most of the time, consumers only really demand to speak with someone who is knowledgeable and easily reached. Whether the CSR uses the consumer’s name three times in the conversation doesn’t really provide a personal touch. Being personal in healthcare ought to simply mean that the records ought to be complete, accurate and easily accessible to the CSR so that the transaction can be completed in a single interaction.
Alban: The healthcare sector has to realize that they are dealing with a cross-generational customer base. They have baby-boomer, generation X, and generation Y. The IVR or the web for self-service could intimidate a baby-boomer. On the other hand, with a Gen X or Y person, the web may be OK, but the self-service web better be customer-friendly, which could be tough due to the complexity of the subject. For that reason the IVR and self-service web site should be owned by the contact center not marketing or some group in IT.
CP: Any thoughts on what we’ll see on the regulatory front in the next 12-18 months?
Alban: It is hard to tell what is in store from the regulatory side, however, what we do know is that there seems to be a trend toward tighter regulations. This is especially true with the introduction of the Medicare Senior Drug Assistance program. All it’s going to take is one person getting burned and the story getting on a national news program. The congress will jump all over it and err on the side of more regulations. The best medicine --no pun intended-- is for healthcare companies in general, but especially their contact centers to regulate themselves. They need to identify potential areas of risk and fix them before they are told to do so.
CP: Beyond Medicare D, what do you see as the most important challenge facing healthcare call centers in the years ahead?
Durr: Avoiding over-specialization among the CSRs even as the coverage plans, terms and conditions multiply in number and grow in complexity. Having too many skill groups in a center raises costs and makes forecasting and scheduling particularly difficult. Finding the time for the CSR’s ongoing training to counter this trend will also be difficult.
Alban: One of the main challenges facing is how to keep costs down. Contact centers offer one of the best platforms for uncovering the root cause issues related to this. Everyday, these centers hold the world’s largest customer focus groups, all of the people calling in and expressing their opinions in addition to asking their questions. They need to think about why they record some of these calls. Yes, they record them in order to review how their CSR’s are interacting with their customers, but more importantly they should be recording these calls to find out what the customers are saying …to find patterns in what customers are saying, identifying process breakdowns and root cause issues. This information is invaluable to Medicare. There should be Medicare Program Managers living in these contact centers dissecting this information and feeding it to the people in Washington who have the power to make the necessary changes moving forward.
