A leading US-based integrated pharmacy benefits manager (PBM)
Business need addressed:
- Customer service operations supporting the Medicare Part D (Med D) program was operating below mandated service levels
- Low customer satisfaction and threat of compliance failure affected revenues and increased the risk of liability costs
- Declining employee productivity resulted in cost escalations and affected margins
Implementation of a defect free measurement system, improved analytics and reporting through better data management, and proactive decision making helped the payer transform their Med D contact center operations.
- $4.2 million in business impact annually, of which $2 million is cost savings
- 43% reduction in call volumes and 18% reduction in average time needed to handle calls
- Better capacity planning enabled improved performance management and tracking, and proactive staffing and scheduling of call center employees
As the healthcare industry transitions towards consumer-centric models, improving convenience, service quality, and patient experience is critical to growth and success. Many healthcare organizations struggle with legacy processes and systems that fail to adapt to the empowered consumer, health reform imperatives, and a competitive marketplace, and are in need of urgent transformation. A leading PBM enabled such a transformation by reimagining customer service processes with technology and advanced analytics, driving improved efficiency, service performance and capacity planning.
This PBM’s call center operations supporting its plans covering Medicare Part D prescription drug program (Med D)1 benefits was under performing, and customer satisfaction was being compromised. Utilizing over 300 resources, the call center processes prior coverage authorizations, quantity limits, step therapy, non-formulary exceptions, and appeals for customers. Service levels of the center were much lower than the 85% SLA stipulated by the Centers for Medicare & Medicaid Services (CMS). Moreover, individual productivity of call center staff was suffering, as Average Handle Time (AHT) had risen by 30% over the prior six months. There was a lack of visibility into performance management metrics and no disciplined volume forecasting for staffing and scheduling, leading to reactive resource allocation. This increased the risk of unsuccessful CMS audits and dissatisfied consumers switching over to competitors’ plans, threatening revenue and profits.
Applying a domain and process lens to inform robust data management practices helped the company filter and organize relevant data from multiple sources that it had struggled to tap earlier. Advanced analytics helped generate insights for driving the following key interventions:
Increased self service
Analysis of call patterns and segmented customer behavior revealed a high percentage of calls for simple queries and tasks which could easily be handled by an automated self-service capability. User friendly phone and web menu options, combined with modified call process flows, ensured a high degree of query resolutions and call closures at the Interactive Voice Response (IVR) stage, thereby reducing operator handling time for calls.
Reduced call volumes
Improved upfront triaging of callers and membership, as well as standardizing of call flows, routed calls to self-service or alternative IVR and eliminated unnecessary operator calls.
Targeted skill-based call routing
Predictive analytics and capacity planning allowed effective, skill-based routing of calls to the most appropriate resource with the right level of knowledge for resolution.
Improved service levels
Standardizing the classification of call center agent activities and better reporting freed up nearly 50% of the supervisor capacity to help coach and mentor agents, significantly improving service level delivery. A comprehensive performance management model was developed that improved overall reporting and also included visual management reporting. Teams were able to monitor, quickly identify, and urgently rectify critical target areas for performance improvement.
Decreased touches and cycle times
Volume forecasts modeled from historical operating patterns allowed teams to establish realistic call handle times and shrinkage targets, thereby standardizing call cycle times and touches.
Genpact’s effective approach to contact center optimization, leveraging advanced analytics for greater operational insights, continuous learning, and greatly improved execution practices, enabled this PBM to realize $4.2 million in positive business impact annually, with $2 million in costs savings. By eliminating unnecessary calls and increasing self- service, call volumes were reduced by 43%.
With improved knowledge sharing and skills- based call routing, AHT was reduced by 18%. The company was able to establish more robust operational metrics, tracking, and reporting. Through a more reliable performance management and capacity planning model, the organization was able to instill greater discipline in fine-tuning service performance, and in staffing and scheduling to meet customer demands.
For more information, contact, email@example.com and visit, genpact.com/what-we-do/industries/healthcare-payer
- Medicare Part D (Med D) is a critical United States federal government program to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries.