By
Layne Holley
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Date Published: April 15, 2010 - Last Updated August 22, 2018
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Comments (1)
Serving Tennessee for more than 60 years, Independent Licensee of the BlueCross BlueShield Association and not-for-profit BlueCross BlueShield of Tennessee (BCBST), Inc. offers health plan coverage and insurance products to nearly three million people across the state and five million people nationwide. Headquartered in Chattanooga, the organization is the state's largest health plan company, paying 65 million claims and more than $17 billion in benefits annually.
BlueCard is a national program under BCBST’s commercial units that enables members of one “Blue” company to obtain healthcare services while traveling or living in another Blue company's service area. BlueCard is responsible for linking independent Blue Cross companies across the country, and employs some 80 dedicated contact center agents who field over 400,000 incoming calls per year. The problem was that playing the middleman for a diverse set of BCBST service area providers was a tough—and expensive—role.
Like many contact centers – and certainly like others within the healthcare insurance industry –BCBST’s BlueCard division faced the growing challenge of minimizing operations costs as service complexity and call volume increased.
BlueCard Director of Operations Maria Darras says she and her team noticed that average handle time (AHT) at the BlueCard center was spiraling upward. “We knew we needed to understand why call volume and average handling times (AHT) continued to exceed the average at alarming rates.” AHT for the overall BlueCross BlueShield of Tennessee organization was 9-10 minutes, whereas the BlueCard group’s AHT grew to an average of nearly 17 minutes – more than 70 percent higher. It became increasingly clear that proactive action was needed to address the upward trend.
While BlueCard had the ability to analyze AHT, it could only do so at an aggregate level. BCBST employed inquire tracking with agents coding calls. Darras and her team could choose from several ways to attack the rising AHT – from added training and improved agent scripts to developing necessary online applications – but BlueCard could not pinpoint which solution mix would address the issues. “Although we had a general sense of what was driving up call volume, we simply did not have the tools required to dig under the surface,” she says.
In other words, BlueCard couldn’t identify the reasons customers were placing their calls in the first place. Without this ability to proactively identify trends and understand the root causes behind customer issues, the BlueCard group had limited understanding regarding what would reduce its call volume, improve service metrics such as first call resolution (FCR) and boost operational efficiency. “We needed to gain visibility into our contact center issues in order to reduce unnecessary operational costs. It became clear that if we were going to keep up with growing service complexity and industry challenges, we needed to upgrade our business intelligence and customer care capabilities.”
Activating IT for the Call Center
Darras’s team needed help, and they found it within the company but outside the center. “Our telephony folks were familiar with the technologies that were out there,” Darras said. She took their recommendation to seek out information on speech analytics.
Nexidia was one of the first providers Darras talked with -- BCBST had already talked with other companies that had experience with the speech analytics provider.
“Our telephony folks extracted calls to Nexidia and worked with BlueCard to build queries. We talked through what we were looking for – in frequent discussions, almost daily – and our staff working with Nexidia’s analysts helped us identify key issues,” Darras said of the process that helped BlueCard move forward with speech analytics and, ultimately, Nexidia’s QuickStart OnDemand hosted solution.
Finding the Root Cause of High AHT and Call Volume
With the hosted solution in place and able to access Nexidia’s Enterprise Speech Intelligence application, which can integrate with multiple call loggers, BlueCard was able to see reviews and analysis of metadata. Together with the BlueCard team, the Nexidia analyst quickly understood the topics customers were speaking about, and what operational triggers were causing specific customer calls.
Once they had the ability to conduct deep analysis, the team was surprised to discover that AHT was being driven up by many incoming provider calls indicating they had sent BlueCard medical records that could not be found in the system.
BlueCard agents could not easily locate records due to a simple process issue. Missing provider cover letters were preventing records from being automatically imaged into the appropriate system for future retrieval and routing. With this knowledge, BlueCard was able to identify those providers who were not sending their medical records appropriately and alert them to review the appropriate filing protocol.
The speech analytics solution also alerted the BlueCard team to the need for specific types of training for its customer service associates. To improve FCR and better group claims and assign them to the appropriate agents for follow up, BlueCard needed to provide clearer training to its agents on the classification of specific call types. “When new service associates transition to floor, there’s always trouble with feedback. Now, we can sample real calls for live examples, such as pricing on particular claims,” Darras added.
BlueCard also identified areas of improvement for its website. BlueCard’s new speech analytics solution helped highlight the fact that the billing offices did not always receive important paper remittance advices that would be helpful in later conducting a claim status online. As a result, BlueCard improved self-service options by enhancing its website to provide a link to the relevant remittance advice each time a provider updated a claims status.
Rolling Out Speech Analytics To the Enterprise
“After we deployed QuickStart, we analyzed some of the findings and potential savings. We were able to identify a potential benefit for the entire BCBST enterprise — we’d be able to see the true reasons for calls to all centers,” said Darras. BCBST is currently rolling out the solution to other departments, such as Membership, Member Benefits, Provider Service Organization, Medicare Advantage, Medicaid Admin and Medicare.
“We’ve identified so many uses for this solution that we have to keep a priority list of issues,” said Darras. “We now have a dedicated project analyst to lead the effort between team members.”