“do you have a green card?” and other contact center challenges

By Merit Smith
Vice President
Director, Health Care Practice

In the early 1990s I became the Operations VP for a HMO joint venture that would evolve into the largest commercial HMO in the country. We delivered back room service (claims, member, provider, eligibility, revenue and health services) for 19 regional HMOs. One of them, a San Diego HMO, was rapidly growing in terms of membership—and service problems.

As the new VP, I resorted to a time-honored management technique: wander around with a cup of coffee and ask dumb questions. As I talked to the San Diego HMO staff, I noticed that the tension and frustration level was much higher than in the other units. And one of the odd things I heard was that San Diego members are rude. For the life of me I couldn’t think of any reason why people in San Diego would be any ruder than, say, people in Cincinnati or Denver. But it seemed like rudeness was one of the puzzle pieces.

After drinking more coffee than was healthy, I learned what I could from talking to people. So I went to stage two in my discovery process. Stage two involved wading through mounds of data. But before the data arrived I found a tape of member services calls from the unit. Here is what I heard in the first call:

Caller: I have a problem with my health insurance with your company.

CSR: Oh, I’m sorry. Let me help you. Are you in the HMO or the PPO?

Caller: I don’t know.

CSR: Do you have a green card?

Click, followed by dead air.

We had cleverly color coded members’ ID cards: blue for HMO and green for PPO. A “green card” meant a PPO member in our service center. But a “green card” meant something entirely different in San Diego.

In a way, it’s a funny little story. But it wasn’t funny to the members we were unintentionally insulting. Nor to the staff who had been carefully trained (and relentlessly audited) to ask an “obviously” dumb question. But the story also tells a lot about why running a contact center is such a challenge.

Running a contact center is a complex business that requires integrated and balanced skills. Both management and the staff must have core competencies in call processing, managing service encounters and transaction processing. Not enough of one, or too much of another, will result in problems. In the green card story, we were so focused on our transaction processing that we couldn’t hear what was happening in the service encounter.

And in today’s world, finding this problem is even harder. Not only is the technology for call and transaction processing even more complex, but the service encounter may be even more transcultural than in my simple story. The caller could be in San Diego and the CSR in Hyderabad. Now find the problem!

Recently I was swapping contact center stories with a friend who runs contact centers for a hospital chain. When he heard this story he pounded on the table and said:

“That’s exactly the problem! Every day I get someone wanting to sell me a ‘solution’ to one part of my problem. The telecommunications vendor has a ‘telephony solution.’ The system vendor has a ‘CTI solution’ that will triple CSR productivity. The staffing company has a ‘work force solution.’ And some other fellow wants to outsource it to the other side of the world. Whatever happened to thinking like an operations manager rather than a ‘solution vendor’?”