VisibleThread – Language Analysis Platform

The productivity paradigm within the healthcare industry

3 min read

Fergal McGovern

CEO & Founder

Member Experience - call center operations

Recently, we caught up with Jack Nelson, former Executive Vice President of Operations for CVS Caremark. Jack has over 25 years of experience working in the US healthcare industry. In his former role, he took care of Core PBM (Pharmacy Benefit Manager) Operations and is a dedicated member service champion. Jack has an impressive track record of driving progress within large-scale member service teams and call center operations. Throughout his extensive range of experiences, there’s one common thread between all his roles. The focus is on productivity. This blog is the first of three in a series exploring member experience.

Our first piece focuses on the dynamic between productivity and speed. Jack explained that throughout his extensive range of experiences, this tension has remained a common thread.

The need for speed

Imagine the scene. It’s a typical workday for Jack and his team. The call queue is buzzing. Members are on hold, waiting to speak to someone about the most critical and personal of issues – their healthcare. Many of them are in distress. Perhaps they are angry about a change of policy. Maybe they are sick, or deeply concerned about a loved one. Jack’s busy customer service teams are working tirelessly to meet members’ demands, getting through as many calls as possible. They handle thousands, or even tens of thousands, of transactions each day. It’s a high stake, fast-paced environment.

Every day, senior managers face the same challenges. Making the cogs turn more smoothly. Shaving off inefficiencies. Always thinking of the bottom line. Jack told us:

“The emphasis on speed permeates all the operational areas. The variable within different organizations is how much quality is also a factor in how you work. In my opinion, you need both. You need to move quickly, but you need to be able to deliver a really good quality experience. There’s probably a disproportionate focus on speed.”

The call center quandary…

And what if the call center volume creeps up even further? The leadership team have two options: squeeze staff, or compress demand. Most senior managers will consider:

  • Hiring more staff
  • Making current staff more productive. Reduce talk time. Increase the number of calls per day. Essentially, overworking their employees.

But Jack champions a different approach. He argues for compressing demand on why people are calling. And that requires a focus on quality right from the start of the member’s journey.

The quality approach

Just consider why people call their healthcare insurance providers. Perhaps a letter has fallen onto their doorstep, and they don’t understand it. This happens regularly. Last year, we carried out research into the readability of Medicare information. We discovered that 86.6% of insurers are not communicating effectively with those aged 65 and older. Insurers pitched their communications, on average, at a grade level of 7.4. For reference, the recommended grade level for optimum readability amongst this cohort is grade 6.

And Jack has seen this happen time and time again. Often, communications are written by a team of people who have no writing skills whatsoever. A claims or service team, for example. The result is a communication created without a thought for member/customer experience. Or how members will actually interact with it. As Jack says:

“You get very poorly constructed letters, you have grammar issues. You have punctuation issues, you have formatting issues. And, most importantly, you have clarity issues.”

So what does the member receiving the letter do? She panics and gets on the phone.

And the most frustrating part of this story is that this member’s claims questions would be so easy to address if only a holistic approach had been taken towards member communication. If insurers invested enough thought and time in crafting the right message, in the correct way. The member would then have a better chance of understanding its meaning and feel reassured. And what if she still had questions? She could be directed to a FAQ page online, perhaps.

A win-win solution for company and member