Come Visit The Dark Side: Payer Customer Experience

I was running. The temperature was 86 degrees, and the humidity was not far behind.  Another degree or two and my body might emit a solar flare.  Nine miles into my run I was at the crest of a bridge that was closed for repairs, and I was leaning over the guardrail trying to catch my breath. To my surprise, a state policeman pulled over alongside me.

“What are you doing?”  He asked, a tone of concern in his voice.

Since I was trying to cross the bridge, I thought about asking the officer if his question was like why did the chicken cross the road, but he did not look like a chicken crossing the road kind of guy.

“Are you okay? You don’t look okay.”

“I’m fine. Why did you pull over?” I asked.

“We got some calls about a guy on the bridge who looked depressed. Are you thinking of jumping?”

“Jumping what?”

“Jumping off the bridge. Are you sure you are okay? You look depressed.” I saw that a small flotilla of various types of watercraft had begun to anchor some eighty feet below me.  The boat closest to me had unfurled a banner with the inscription, Epic: It’s Only Money.  The initials on the boat next to them spelled CMS.  The passengers on both of those boats were chanting “Jump, jump, jump.”  Was it something I said?

“I think I look like I just ran nine miles.” I placed my leg gingerly on the guardrail in an attempt to stretch my hamstring.

“Take your foot off the rail,” he commanded. “I was about to call for a helicopter in case we had to pull you out of the water. Are you sure you are okay?”

I was going to ask the trooper if his helicopter would give me a ride back to my house, but he didn’t look like a give me a ride back kind of guy. “May I continue across?”

“No, you can’t; the bridge is being repaired.”  The idea of jumping was looking better by the minute.

So…that was my day.

The CEO of a large health system left me a voice mail while I was running stating, “You are a refreshing thought leader and voice of reason in an industry with too few of each.”  That was kind of him, especially since I think many people find my op-eds to be more akin to someone in a crowded theater shouting the sky is falling.

Today’s op-ed is heavy on the Op, less so on the Ed.  The topic is one few people dare to tread.  It is not spoken of in polite company.

Health plan customer experience; Webster defines it as “An oxymoron.”

Now before you start throwing metaphorical tomatoes at your monitor, may we consider the evidence?  First, think about the last time you called your payer about something.  About anything. Chances are you has to psyche yourself up just to make the call.  Did you end the call thinking their business goal was to meet all of your needs?  Of course not.

There is a saying, “When they tell you it’s not about the money, it is always about the money.”  Payer television commercials, show Stepford-like families frolicking in a park.  Birds are chirping.  Kites are flying. Life is wonderful because that family’s has health insurance from such-and-such a firm.  When payers advertise how blissful life can be under their tutelage it is because reality has forced them to paint that picture.

Take for example the Medical Loss Ratio rule, the rule that generally requires health insurance companies to spend eighty-percent of the premium dollars they collect to improve healthcare quality.  Now ask yourself this—why was the rule created?  Was it because the payers were spending too much money improving healthcare quality?  Did someone say, “Whoa, you are paying way too much improving your customers’ health?  Save some of it for yourselves.”

Payers need us to believe they wake up each morning wondering “Who can we help today.”  If a single payer had that as their strategy they would own one hundred percent of the market.  If that was their strategy their call centers would need fewer agents because millions of customers would not be calling to dispute partially claims.  Instead, those millions of customers would be baking brownies for the payers’ employees and naming their children after their executives.

I was reviewing some call center performance data of one of the call centers of a very large payer.  Average call length of about two and half minutes. First call resolution of ninety-six percent.  Be still my heart.  My guess is for these numbers to be true, the average wait time probably exceeds the average call time.  Let’s be truthful.  By the time the average person works up the hutzpah they need just to dial their payer it takes them more than two and a half minutes just to stop shouting.

The most customer-friendly firms in the world do not have a first call resolution of ninety-six percent.  You can fool all of the people some of the time, but it seems a little silly to deliberately fool yourself.

The industry’s latest public relations push seems to focus on wellness, helping us all to stay healthier. Healthier people will file fewer claims.  They will still pay the same premiums.  Payers keep the difference.  You do the math.

Under the Affordable Care Act patients can pick their payers.  They can also unpick them.  With transparent pricing patients will view health coverage as a commodity.  Payers will be forced to learn how to spell churn with a capital ‘C’.

However, payers do have an undiscovered secret weapon.  Customer service.  Answering the phone is not providing customer experience—well, at least it is not providing a good one—it is an activity.  The battlefield for retaining health plan customers is going to be all about providing a remarkable customer. Or not.

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