Improving Your Plan’s Future Operations Through a Look Back into Your Members’ Experiences

Open enrollment is over, and as we move through the first quarter of 2017, all kinds of problems bubble up to the surface ‒ cancelations that didn’t process are identified by frustrated members, questions on the Annual Notice of Changes not received or not read are talked through, members enrolled with doctors who are no longer in the network become calls of desperation as care is needed. Do any of these sound familiar?

The philosopher George Santayana is credited with saying, “Those who cannot remember the past are doomed to repeat it.” In Customer Service, this is a critical truth. Oftentimes, the past is not examined, changes are not made, and the same mistakes occur year after year. Here are three keys to using the past to improve the future:

Skimming the surface to identify trends – From a recent issue of the Nature Geoscience journal, “Valuable metals like gold, copper, and platinum reach the Earth’s surface from deep underground by floating up on vapor bubbles.” If this information didn’t rise to the surface on vapor bubbles, it would be harder to mine these heavy metals. Just as valuable are the complaints that are received from our members when they experience difficulties using plan benefits. Is your system flexible enough to have ad hoc call documentation reasons should a potential trend be identified? Is your Customer Service staff able to raise potential trends? If they raise those potential trends, what happens then? Does your plan have a documented process and workflow to utilize that information to identify root causes and work with other departments to find solutions? This information is as valuable as gold if used to refine processes and make improvements.

Dredging the bottom to find hidden treasure Every year, treasure hunters find the remains of shipwrecks at the bottom of the ocean. It isn’t easy to excavate the treasure and bring it to the surface, but they have a refined process to locate the shipwreck and bring the remains to light.  Health plans need processes to identify their own internal shipwrecks and the subsequent treasure of information they include. Do you have a review that looks for key words that identify unclassified complaints? Is there a review of vendor call data to determine any tends that were not identified? There is a wealth of data in call logs showing identified points of failure. Failing to utilize this information is disregarding something that could turn your members’ experiences from the Titanic to the QE2.

Missing opportunities in identifying issues – Many products had an original purpose far from their current purpose when a byproduct was identified. Playdough, for example, was created to clean wallpaper and would be used to roll over soot-covered wallpaper before vinyl wallpaper was invented. Today, it is a staple of childhood play. Health plans need to continually become more efficient. One way to do that is to identify how you can create byproducts or multiple uses for existing functions. Who at your organization listens to customer calls? Quality most likely scores calls. Grievances and Appeals may listen to the original calls. Supervisors may listen to the calls. Are these individuals trained to identify misclassifications, hidden concerns, and unidentified trends? If not, your organization is missing out on a valuable byproduct to improve your organization.

Many calls handled by customer service involve past member experiences. Ensuring your customer service staff is top-notch and has the tools to perform at the highest level for every call is critical to your plan’s success.   The ability to track trends and identify missing opportunities will provide a treasure chest of information to improve your organization and your member’s future experiences.

Gorman Health Group’s experienced Operations team can work with you to evaluate your program to identify opportunities for a brighter more productive and efficient future.   We’ve been in your shoes and know your struggles and how to move beyond them.  No one can change the past, but we all have the ability to influence our members’ future.

For more information on this topic, join us April 26-27 at the Gorman Health Group 2017 Forum in New Orleans. My team and I will discuss data mining customer service calls, improving compliance and operational efficiencies, vendor assessments, and more! Register here.




Gorman Health Group’s Summary and Analysis of the 2018 Medicare Advantage and Part D Advance Notice and Draft Call Letter is now available. Download now >>

The Gorman Health Group 2017 Forum Conference Brochure and Preliminary Agenda Is Now Available! Download it now to see the topics we have in store for you at this year’s event. Register now for the Gorman Health Group 2017 Forum, April 26-27, 2017, at the JW Marriott New Orleans.

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