Technology is great, isn’t it? With inventions like computers, e-mail and voice-activated telephone systems, technology has made our lives much more efficient. In fact, our society is becoming so advanced that it’s a wonder we bother hiring people any more.
Okay, I’m being facetious. Anyone who’s spent any amount of time dealing with some of our wonderful new technology — like telephone menu systems, for example, pines for the days before they were invented.
That’s why, when it comes to health care services, some health benefits management companies are finding that sometimes the difference between adequate health care and great health care is a time-honored approach — talking to a human being. In fact, when they implement programs consisting of proactive phone calls to members, they’re seeing their customer satisfaction ratings increase.
The Consumer Assessment of Health Plans (CAHPS) survey, for example, which measures customer satisfaction, is motivating many health plans to find ways to improve member services in a very competitive market. CAHPS is a service of the Agency for Healthcare Research and Quality, an organization that provides evidence-based information on health care outcomes, quality, cost, use and access.
The personal touch
Personalized member outreach programs aim to improve customer service, as well as member health, by having person-to-person phone conversations with members about their needs. The rationale is, if members feel comfortable with their plan and understand the services, they’re more likely to take advantage of programs that keep them healthy. Employers know that healthier employees are less of a drain on medical resources, have lower absenteeism levels, and are more productive at work.
This personal approach is used as a way to connect with new members as well as those who are enrolled in health management programs, such as: asthma, heart disease, depression, diabetes care, tobacco cessation and weight management. In the case of new members, for example, a person may receive a call from a customer service representative who welcomes him or her to the plan, explains how the benefits work, conducts a short health risk assessment and answers any questions. This not only helps new enrollees feel good about their health plan, it gives them an opportunity to ask questions and reinforces the message that their health plan is motivated to keep them feeling well. Another benefit is that the mini health risk assessment is a way (in addition to claims data) to identify members who should receive a follow-up call from a registered nurse and be enrolled in a health management program.
These health management programs include members with chronic conditions requiring more in-depth care. Members benefit from calls made by registered nurses — sometimes known as “health coaches.” In many cases, the nurses have master’s degrees and many years of experience in various clinical settings. These calls focus on educating members of programs that will help them manage their condition(s) so they feel better and stay out of the hospital.
There are several advantages to this personalized approach, because consumers who understand their health care plan make more informed decisions about their health care options, increase their chances of being healthier, communicate more effectively with their doctors, and take advantage of plan services because they know what is offered.
There are also many advantages for the health plan, including:
- Early identification of members who have chronic diseases and other health care needs, so they can be enrolled in programs to keep them healthy.
- Immediate member feedback helps the plan improve services and products.
- Improved customer satisfaction.
- Ability to steer members to the Web to process routine requests. This has the benefit of freeing-up customer service lines to help those with more complex cases.
The results have been very positive. For example, many plans with tobacco cessation programs are beginning to see that this personal approach leads to quit rates exceeding the national standards (12 percent to 20 percent).
These kinds of successes are showing up quantitatively in improved member satisfaction scores, and health plans are taking note. In an increasingly competitive industry, these results carry a great deal of weight with employers, consumers and other health industry watchdog agencies.
If there’s a moral to this story, perhaps it teaches us that although new technology certainly has its role in improving the health care system, sometimes a low-tech solution, like an old-fashioned telephone call, has its place, too.
LAURIE WESTFALL is chief operations officer for Care Choices, a nonprofit health care organization and a subsidiary of Trinity Health. Care Choices HMO is the top-rated plan in Michigan and 12th out of 257 commercial plans in the nation, according to U.S. News & World Report and the National Committee for Quality Assurance.
