3 questions health plans must ask their BPO call center
Healthcare plans have a tough mandate: to consistently deliver an empathetic and effective service to members that drives satisfaction and retention.
Often, you’re supporting a hugely varied membership—not only in terms of health, but also demographic, literacy, mobility and socioeconomic privilege.
Each presents their own unique obstacles—and individual decisions are the difference between life-saving, life-changing or even life-threatening outcomes for your members.
So it’s crucial that healthcare member services outsourcers can deliver an experience that matches the industry’s standards of compliance rigor, understanding and empathy, pound for pound.
When the stakes are this high, you need to ask hard questions of your healthcare call center. How can you get a true sense of an outsourcer’s ability to provide the standard of support your members need?
Here are three simple but powerful questions you can ask.
1. Do they consistently deliver empathetic value?
Most traditional customer experience BPOs perceive value as quickly resolved disputes and low average handling times.
While these metrics are important, there’s another equally important aspect to a truly valuable member experience.
For members with mobility or geographical issues, health illiteracy or a lack of the financial means to access the right treatment, success takes many forms.
Value means different things to each of them.
You need to understand how your healthcare call center approaches the individual needs of each member.
Are member profiles suitably organized and managed to account for the full range of scenarios regarding their circumstances and potential health outcomes? Advanced customer service agents may need to prepare and train for dozens, if not hundreds of potential member interactions.
We’ll talk more about service agent performance in a moment—but first, it’s key to clarify whether your healthcare outsourcer operates on a model of value-based care.
Effective, empathetic member experiences do more than resolve individual incidents: They consistently deliver value across every interaction, from onboarding to ongoing member engagement.
With this model, healthcare BPO moves from a cost center to a value-driver, connecting people to the medication and support they need—whatever form that takes.
For example, if an elderly patient needs regular physical therapy but lacks the language skills to get the most from appointments, could your healthcare outsourcer design a solution to resolve the problem?
Or put another way, what if bilingual agents could act as a go-between for patients and caregivers when needed?
Truly effective outsourced member care accounts for every aspect of the member experience. The service care doesn’t just prevent disease progression. It’s also about believing in taking that extra step to make life easier for your members.
Now let’s look at the kind of people you need to make that happen.
2. Do they have the right people in the right places?
Often, “the right person” is a catch-all term that means different things to different companies—so let’s get specific.
Many healthcare plans need support across their contact services—including follow-up, revenue cycle management, coordinating treatment and communicating post-patient discharge instructions.
It’s a minefield of interpersonal and highly regulated work with potentially extraordinary consequences.
So for advanced healthcare BPOs, the right agent needs a deep investment in patients’ well being combined with technical competence in the most demanding scenarios (what we call Relationship-based Outsourcing™).
How does that manifest?
First, a sense of ownership. Healthcare call centers are known for high staff turnover—unsurprising given the stress and lack of empowerment. The best healthcare agents have skin in the game because they’re invested in the cause.
And that could be going the extra mile to deliver truly valuable care to an individual member.
Healthcare is a human-centric practice, with often emotionally fraught interactions. Can callers expect a familiar and trusted voice on the other end of the line?
Equally, the right agents take an active role in optimizing the operational side of the call center. Whether that’s ensuring member data is up to date and accurate for future outreach or working to minimize friction points for the caller journey—ultimately freeing up more staff to help more members.
It’s hard to bridge the gap between members and their healthcare. It’s why the key to truly empathetic member experiences lies in effectiveness—and the best agents consistently execute while seeking to evolve a better BPO operation.
Which leads us to our final question…
3. Does their culture make all this possible?
In this compliance-heavy arena, it’s easy for complexity and process friction to dictate the member experience.
Healthcare call centers empower the right people through the right processes. We’ve spoken about the role advanced agents play in shaping the environment around them—does your BPO update workflows, scripts and shift times to fit constantly changing and state-specific regulations?
Members expect seamless interactions—and the best healthcare call centers provide consistent experiences because they embrace the shifting landscape as opportunities to adapt and evolve.
Managers should incentivize their teams to review and provide feedback on training and processes. Does your BPO have an iterative mindset that looks for ways to improve?
Purely numbers-driven BPOs promote individuals based on transactions. Relationship-based Outsourcing values shared knowledge and learning across teams. In fact, these BPOs often incentivize it.
Holding agents accountable to outcomes beyond numbers and empowering them with the tools to do better are hallmarks of value-based care.
The best healthcare BPO blends people, processes and technical knowledge into a consistent value-driver—for you and your members.
By interrogating your outsourcer over these principles, you’ll be in a strong position to consistently deliver value-based care to every individual member and attract new ones in the process.