1. Improved Member Engagement
In 2014, the client was looking to meet the evolving market demands of value-based care, with a complete commercial segment
revamp of their member engagement processes, starting on the front lines of voice service delivery. At that point, the client was
well familiar with HGS’s 14-plus years of operational intelligence and innovation, and had a firm understanding of the breakthrough solutions we provide. As a result, HGS was selected as the preferred partner for this service excellence
pilot. HGS was with the client at the table during the early stages of the development of this business excellence model. With four decades of extensive expertise and experience, we were able to bring to this program development our healthcare knowledge expertise across commercial and government ealthcare segments, as well as our overall extensive experience working across geographies to build and establish standardized processes, uniformity of tools and methodologies, and continual improvement.
For two years, HGS and our partner worked closely to co-create a business excellence framework centered on the mission of globalized service excellence, with a Unified Customer Engagement® across channels and along the lifecycle. Employing HGS’s design thinking innovation and consultative approach, we provided the cross-training and skillset focus to drive for higher SLAs and a premier, precedent-setting service excellence. We designed a complete revamp of all operational processes— working with the client to analyze those service elements that critically affect service delivery. What were the strengths, weaknesses, and opportunities in hiring? What is the ideal profile for agent fit? What training improvements were needed to optimize CSAT, member retention, and—at the core of it all, agent performance and engagement? HGS worked closely with our client, sharing our own
business excellence expertise, to assess voice of the customer feedback, ask the right questions, and then provide the solution consulting for a program designed to specifically meet excellence objectives. The final program mission was to better advocate for members’ optimal health by helping them get the most from their benefits, building trust, and always providing a clear path to care.
This HGS service excellence team officially took calls on December 27, 2016. The Pilot Voice Services Team was evenly divided between two locations in Manila, Philippines and comprises one Operations Manager, two Shift Managers, two Team Leads, two Training Managers, two Line Trainers and 20 CSRs. At the heart of our business excellence model are key solution features, to support an agent that advocates striving to help members optimize their benefits:
Ultimately, with these premier service excellence features, HGS has provided customer-centric focused excellence that is transforming this client’s member engagement, for a more B2C market leading approach.
Client ROI for this program has been immediate. The Business Excellence Model Team’s performance has been outstanding from day one, with improvements in AHT, FCR, and CSAT. For example, year-todate quality reached 99.45% in only five months, while HGS drove CSAT to 96.9%, for a 50% reduction in dissatisfiers. Another critical outcome that showcases the source of the positive outcomes for the client? At the five-month mark, agent attrition is 0%.
2. Process De-coupling
In mid-2015, the client, impressed with our grasp of operational efficiencies, sought our help in another area of their business: a
proof of concept on Medicare Part D. They already trusted our claims management expertise, and they understood firsthand that, with our deep domain knowledge of both commercial and Medicare market segments, we were well versed in the stringent regulations and compliance of government healthcare programs. Ultimately, this client was looking for a more effective process and better use of costly clinical resources as part of their drug labelling and authorization process. Their existing process was burdened with turnaround time (TAT) issues, inconsistent accuracy, and a cumbersome need to source, recruit, and train highly paid clinical resources for a short period during open enrolment each year. For our PoC, HGS leveraged our Bangalore and El Paso locations to employ trained (but unlicensed) resources with pharmacy claims knowledge to follow a 24x7 process that decouples initial call
triage and fax labelling from the actual clinical authorization process. With our proprietary workflow solution, HGS handles each provider/member interaction with the appropriate level of trained resource (clinical and non-clinical), thereby making the most cost-effective use of both high-cost clinical and lower-cost non-clinical resources. HGS has also re-engineered the working hours and locations on a “follow-the-sun” model to ensure adherence to strict regulatory requirements for TAT on all transactions. In addition to TAT and cost improvements, HGS’s decoupled approach solves for the critical—and often overlooked—issue of incorrect drug form
labelling, which can result in non-compliance with CMS audit, lowered CAHPS rating, and possible federal sanctions. HGS’s key role in the Med D drug review and authorization process has included:
With a flexible, decoupled process that provides for optimal process timing and effective resource allocation/utilization, the ROI was immediate for our client and included better turnaround time (25% improvement), significantly improved accuracy and consistency, substantial cost-savings (greater than $1 million per year), and reduced need for expensive clinical personnel. HGS was
also able to drive a 60% improvement in call average handle time (AHT) from initial estimates and trigger a mutually successful gain-sharing program. This program was designed to incent the client and HGS teams to work hand-in glove toward improving the Med D drug approval/denial process. As a result of the level of success HGS demonstrated in this PoC, the client chose to transfer all this
work from multiple vendors and in-house sites to HGS, prior to the upcoming open enrollment season. The client has been so impressed with HGS’s performance that a bid has been extended to adapt this process to the client’s commercial business.
Looking ahead, the client is seeking to build on HGS’s toolset and unlimited partner approach. There is potential for HGS to assume more utilization management, clinical intake, and medical necessity responsibilities, in line with the client’s growing population health management focus.