Contact Center Optimization. August 22, 2012

Transcription

1 Contact Center Optimization August 22,

2 Agenda Overview of Session Speaker Introductions SVC Inc. Gabriel Systems, Inc. Briljent, LLC Discussion/Questions and Answers (Q&A) Contact Information 2

3 Indiana s Call Centers Division of Family Resources (DFR) DFR Call Center Eligibility determination System of Record 3,500 agents/users Medicaid HP Call Center - 35 agents 1,500 calls per day Multi-purpose call center serves: Providers, members, pharmacies, etc. Maximus - Enrollment Broker Call Center 27 call agents Department of Insurance (DOI) DOI Call Center Six agents Currently, call centers do not have interoperability.

4 Health Information Exchange (HIX) Call Center Vision Provide seamless interoperability with the eligibility and enrollment systems Developing a HIX call center creates opportunities for improvement in current call center structure HIX call center will be focused on the user experience Call routing Interactive Voice Response (IVR) New or repurposed call center Evaluating at the architectural level Contingent on options offered by the vendor community

5 Call Center Challenges Capacity planning Estimating call volume Estimating call time Impact of over-the-phone applications New program with many unknowns Conformance to law Language requirements Americans With Disabilities Act (ADA) compliance Interpret current guidance; some uncertainty around pending federal requirements Coordinate Call centers operated by different vendors Call transfers Different staff expertise Different performance goals

6 Goals for Exchange Call Center Optimize the user experience Ensure comprehensive training of call agents Transfer calls between all existing call centers with a core set of information Callers should not have to repeat basic information Leverage automatic call routing to reduce required transfers Optimize assets and resources Cross-train Increase awareness of the new model Continually monitor and continually improve

7 Contact Information Seema Verma, MPH President, SVC Inc. 485 Bolderwood Lane Carmel, IN Office Main:

8 Impact of Ineffective Call Centers on Day-to-Day Medicaid Operations Loss of productivity for key Medicaid staff (Subject Matter Experts [SMEs]) due to having to handle calls that should have been resolved by call center staff Complaints to Legislature, Commissioner/Secretary s Office, the Centers for Medicare & Medicaid Services (CMS), and the Governor s Office Creates administrative burden on providers Claims are denied or paid incorrectly Eligible members may not get needed care, and incorrect information may create unnecessary eligibility appeals Ultimately impacts the credibility and reputation of the Medicaid Agency 8

9 Solutions to Improve Medicaid Call Centers Utilizing key Medicaid SMEs to provide quarterly training to full call center staff Paradox: The same people who are impacted the most by an ineffective call center will have to do additional work to train the call center. Concern: How can we use the key Medicaid staff who are already over-utilized to train? It will just put us further behind. Response: Initially, it will put the staff and agency further behind; but, the Return On Investment (ROI) will be quickly realized. Initial Results: At first, the SMEs will receive more phone calls; but, the increase in phone calls will come from the call center instead of members and providers. 9

10 Solutions to Improve Medicaid Call Centers (continued) Utilizing key Medicaid SMEs to provide quarterly training to full call center staff Ultimate Results: As the Call Center staff become more comfortable answering questions and resolving problems, less phone calls will be received by SMEs, resulting in greater productivity. Logistics: Who will attend to the call center during the training? How do we free up the SMEs to do the training? Utilize state holidays and weekends to do the training: President s Day, Veteran s Day, etc., and most states have unique state holidays such as Patriot s Day in Massachusetts. Most vendor call center staff will not be off on state holidays; so, this will not result in additional cost. 10

11 Solutions to Improve Medicaid Call Centers (continued) Utilizing key Medicaid SMEs to provide quarterly training to full call center staff Why can we not just train the trainers and let them train the call center staff? SMEs can answer almost any question. This provides immediate answers to the entire group instead of a parking lot response. It also allows the SMEs to hear about unknown issues that may impact payment or eligibility. Trainers are still needed to train those staff who begin in between the quarterly training sessions. Consultants are still needed to write and revise scripts, training manuals, and to assess the call center for areas of improvement. 11

12 Solutions to Improve Medicaid Call Centers (continued) Share knowledge Set up monthly meetings/conference calls with the call center trainers, supervisors, Medicaid SMEs and Medicaid Management Information Systems (MMIS) staff. Keep a record of recurring calls and discuss them. It may indicate a system, policy, or operations issue that needs to be corrected. Discuss all upcoming policy and MMIS changes to proactively prepare the call center staff and assist in the creation of new scripts. Information and training directly impacts effectiveness. Call center effectiveness results in: Increased productivity of Medicaid SMEs. Reduction of claims payment errors. Greater access to care. Reduction in complaints. Less administrative burden on providers. 12

13 Contact Information David Schuster, Chief Operating Officer Gabriel Systems, Inc Horner Place SE Washington, DC Office Main: Direct Line:

14 Contact Center Agents Calls Agents s Written Correspondence Agents Web Chat Social Media Mobile Devices 14

15 1-800-MEDICARE Contact Center 15

16 Healthcare Reform Contact Center Needs Health Insurance Exchange Claims Health Information Exchange Medicaid Eligibility Providers Medicaid Managed Care 16

17 Contact Center Excellence Go beyond the ordinary and achieve brilliance Training Development Content Management Optimization Quality & Process Improvement Operational Procedures 17

18 Optimize Training Development Utilize the DMADDI (Define, Measure, Analyze, Design, Develop, Implement) model to develop training: Instructor-led classroom and Webinar Self-paced and Web-based Regulation-compliant (Section 508; Personally Identifiable Information [PII]; Protected Health Information [PHI]; The Health Insurance Portability and Accountability Act [HIPAA]) Performance-based learning objectives Training effectiveness - beginning and ending with meeting business requirements Benefits include the following: Reduce training costs Deliver measurable results Improve client satisfaction Improve employee retention 18

19 Learning Management System Maximize Use of Downtime Track and Maintain History Always Available Online and Offline Training Coaching Evaluation Reduce Skill Gaps Validate Learning 19

20 Optimize Content Management Consistent messaging through the following: Plain language call scripts Policy and regulation updates System release support Multi-language support Benefits include the following: One client voice (consistency) Improve call metrics First call resolution Average handle time Agent satisfaction rating Client satisfaction rating 20

21 Optimize Quality and Process Improvement Call Monitoring: Call handling performance Strengths and opportunities Special needs calls (text telephone [TTY]) Disclosure requirements Quality Analysis: Written correspondence reviews Customer satisfaction surveys Benefits include the following: Improve performance within call metrics/service level agreement Verify agents are meeting client expectations Reduce bottlenecks and streamline work flow 21

22 Optimize Operational Procedures Standardize: Consistent performance Works in both centralized and decentralized, or large and small models All agents use latest information Timely dissemination of information Job aids, desktop instructions, policy updates, bulletins Benefits include the following: Reduce operational costs Improve client satisfaction Improve call center return on investment Flexible staffing model 22

23 Discussion and Questions/Answers Is your call center an integrated call center/contact center, or are there specific call centers for different programs? Are your agents able to access accurate and current scripting in a timely manner? Is training updated and available through different modalities, such as self-paced, instructor-led, Webinars, or CoPs? Are you or your vendors already planning for training and scripting to handle the increased influx of patients, providers, and programs, to manage the customer s needs? 23

24 Learn More Contact us directly at We will get you in touch with our experts to see how we can be of assistance. 24

25 Contact Information Grace Chandler, MA, PMP Senior Project Manager Cathy Huff, Vice President of State Government Sales 6435 Castleway West Drive, Suite 115 Indianapolis, Indiana Office Main: Call Center Video: 25