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.
Let's face it -- we're in a health care emergency for which there is no single remedy. Employers are crying uncle, but health care's economic grip seems as tight as ever.
However, help is on the way, and it's right at our fingertips. E-tools are quietly revolutionizing how we integrate medical care, so employers, providers, employees and health insurers can work together to create a transparent, unbroken communication link.
It's no secret that employees are being asked to share more of the costs and responsibility for their health care, and for their health. Accordingly, there is an increasing need for consumers to be better-informed decision-makers. As consumers become more price-conscious, they are motivated to find ways to save money, and they need reliable information.
Computer software programs that can communicate diagnostic and educational materials to physicians and patients help managed care organizations intervene early and manage patients, and their diseases, better.
Let's use Joe, a new employee of Company X, as an example. Joe has insurance that covers catastrophic medical events and preventive care. He also has asthma. Because Joe is responsible for the cost of physician visits, he wants to avoid the doctor's office as much as possible.
Avoiding asthma attacks will not only make him feel better but will save money by keeping him out of the emergency room. So how does he find out more about his condition?
Many health insurers have, or soon will have, medically approved online libraries available to members like Joe to help research conditions and find practical ways to manage them. Even more compelling is the fact that Joe will be able to use interactive tools to communicate with his health insurer.
For example, he can complete an online health risk appraisal -- a survey that can help identify his risk for certain diseases -- and receive personalized risk information and suggestions for next steps.
Joe will also be able to go to his health insurer's Web site to change his physician, research medical quality data on area hospitals or check his account for status on his claims. In the future, Joe will be able to go to his health insurer's site to use a variety of financial tools that will help him see how much money he's spent on deductibles, for example, so he can track his medical expenses. These services are available 24/7, so Joe can get the information he wants whenever he needs it.
E-tools also offer secure portals to help physicians access up-to-date information such as co-pays, coinsurance and deductibles, and process claims more quickly, leading to more timely payments.
As a result, Joe's health insurer is able to provide better customer service because Joe no longer has to call every time he wants information, his physician has easier access to information she needs for processing payments and the insurer's staff has more time to handle complex issues and offer more substantive assistance to its members.
Company X is pleased because Joe is healthier. He knows how to manage his condition and hasn't had to go to the emergency room because of an asthma attack. He feels better at work and is more productive. And, because Joe is one of many employees who have used these tools, Company X sees an increase in the overall health and productivity of its work force.
Joe's physician is happy because he has fewer payment delays. He and his staff spend less time processing paperwork and can concentrate on what they do best -- providing quality medical care to their patients.
Last, but not least, Joe is engaged in his health care and is healthier because of it.
Laurie Westfall is chief operations officer for Care Choices, a nonprofit health care organization and a subsidiary of Trinity Health. Care Choices HMO is ranked first in Michigan for clinical excellence in health plans, according to the National Committee for Quality Assurance. Reach Westfall at (248) 489-6944 or email@example.com.