Two trends in member services are about to collide

By Merit Smith
Vice President
Director, Health Care Practice

Trends are funny things. They seem to have a life of their own. Many times one trend seems to make use of a prior trend. One thing adds to another and extends the impact of a prior development. Trends evolve in ways like Mark Twain defined history – one thing after another.

Think about how service operations are internationalizing. Have you ever called your credit card company to resolve a persistent service problem and found yourself talking to someone half a world away? Chances are quite good that you will resolve the problem (at least until next month). And chances are also quite good that you won’t dwell too long on all the things that came together when you and the customer service representative were talking.

Some of the trends beneath such a phone call are so long-term and large that they are almost global or historical in their sweep. Here’s such an example: The evolution of English as a language that truly spans the globe and allows conversation between two people with vastly different backgrounds and situations. Other trends that helped create your international service experience are technical in nature. The Internet and satellite-enabled telecommunications technology bring your phone call, your bill and the service representative’s screen to pop together twelve time zones away.

Underneath a simple international service experience is a complex web of trends that interacted in a way to create the experience. The “simple” experience is really not simple at all. Many things had to happen to create the simple experience. Simple service well delivered isn’t simple. Such is the nature of trends when they come together.

Some trends don’t flow together in neat and intellectually tidy ways. Sometimes they collide; they just smash into each other. And the result is very untidy or unpredictable.

I think the managed care industry is about to experience one of these collisions. Let me explain.

Over the past several years, managed care plans have spent hundreds of millions of dollars on “self service.” This isn’t a surprise. In an industry where an in-bound phone call might cost $6.50 and a self-service interaction costs fifty cents, it is easy to see what might happen. (For our purposes, “self service” means using the Web or interactive voice response units.)

Now, having built the infrastructure for these self-service transactions, health plans worry about how quickly their clients are adapting (or not adapting) to their new means of delivering service. The long-term result really isn’t in doubt: Service will move over a period of time to the more efficient and lower-cost channel. The types of service interactions that will move into the new channel are the least complex work that a customer service representative performs, such as dates, numbers, and when (or if) things happened. The routine, low-value information exchange that is the stuff of customer service will find itself being resolved via self service rather than by someone in New Delhi.

Meanwhile, outside of this trend is another emerging trend. The service content coming into member services units is changing. Self service is eliminating low-complexity calls, and improvement in the quality of service is also “drying up” many other low-value calls. The calls that remain are more complex and involve untangling things that have gone wrong. Remaining calls are longer. There is much less reading of a screen to a member. A call now may frequently involve correlating information into a pattern and then using the understanding of the pattern as the basis for a higher-value customer exchange.

The collision I see has a lot to do with another change in call content hitting customer service units. Just as health plans are busy fielding self-service capacity, they are also busy bringing account-based products to market. Here’s the simple idea behind the rush to account-based health care products. The central problem in American health care is the rate of growth in health care spending. If a member was spending their own money on health care, they just might spend less. So the new idea in controlling health care costs is to put discretionary health care purchases under the control of the member. Create a member account, put some money in it and make the member responsible for how they use it. The logic is simple: your money, your health, your problem. Great idea, one well founded in common sense and economic theory.

The problem is that members don’t have a clue about managing their health and money. Health plans are placing the most difficult burden, the great un-resolved problem that some of the smartest minds in America haven’t been able to solve, on the shoulders of members. Now I personally have great faith in the ability of average Americans to understand complex problems and create their own workable solutions to them. But I also know that they will need some help along the way. So if you are an executive responsible for a health plan call center, get ready.

I’ll bet you created your call center budget on the assumption of fewer calls per thousand members. And shorter talk time, too. And of course fewer CSRs will be needed as self service kicks in. Right. Now take this reality check. Create a pie chart of “call reason” for each of the fourth quarters for the last three years. Do you see a lot of change in the composition of the calls coming into your center? If you do, think about what it means. If you don’t see too much change, don’t get comfortable. Your data might be categorized too broadly to see important underlying trends. “Claims questions” don’t really tell you what you need to know.

If you are a typical health plan, I’ll bet your organization has plans to sell a variety of products that have individual account features. These features will drive up your call volumes, lengthen your call times and challenge your CSRs with more coaching and counseling calls rather than simple data exchange calls. Your economic model of customer service (your budget) might be quite unconnected from what is likely to happen in your call center as it begins to service the new products.

The trends related to customer service delivered via a self-service model are about to collide with the evolving information and educational needs of members who are beginning to use the next generation of products.

Can you see this collision in your future? What should you do? Without knowing the details of your situation, I can’t claim to have a solution for you. I would suggest that an important starting point is to begin to have an honest, focused dialog between the management of your customer service units and the product developers. If you are changing the product, you may also be changing the information needs of the members who will use it. Your customer service unit needs to understand this potential problem and begin to reflect it in their plans and operations.