The Health Insurance Challenge

Core challenge for health plans — Driving operational performance while meeting cost and compliance commitments is the core challenge for health plans.  Compliance is a serious issue:  health insurance is one of the most tightly regulated and monitored of industries, and health plans face serious consequences if they fail to meet their compliance obligations.  It is also highly a competitive industry, so improving customer experience scores (such as Member Touchpoint Measures) and finding ways to lower ongoing operational costs are top priorities.

Information overload — Plans have so many benefit schedules, provider agreements, policies and procedures that it is a tremendous challenge for employees to remember all the details required to do their jobs. This information changes often, overwhelming employees with information overload.

Desktop complexity — The member information and billing systems that agents need to use are both numerous and complex, creating an often chaotic work environment. Agents often have five or more applications open on the desktop at one time and need to be able to navigate them all, quickly and accurately.

Inefficiency and inaccuracy — Policies, procedures and benefit information today is scattered across multiple shared drives, intranets, procedure manuals, training materials, product brochures, sticky notes and email updates. Employees waste time searching for the correct information, or make errors by guessing and getting it wrong.

Effect on call centers

When agents struggle to find information needed to anwer customer queries your CMS survey scores are directly impacted:

• Accuracy and Accessibility scores plummet.
• Call times lengthen and call abandonment rates rise, making it impossible to achieve the CMS targets for Hold Time and Disconnects.
• Agents make errors and give out incorrect information, resulting in high CTM scores.
• Operational costs increase.

All this leads to increased agent stress levels and reduced CSAT scores.

Effect on claims operations
Without real-time guidance through the complex  claims processes and procedures financial performance suffers:

• Overpayments result from the incorrect application of procedures and policies
• Operating costs and backlog metrics increase as claims processors spend time looking for the right information
• Training time, training costs and time-to-competence are higher.
• Resourcing inflexibility occurs because staff cannot be multi-skilled quickly enough

The Health Insurance Solution

Provides real-time customer service agent and claims processor guidance

SupportPoint addresses these issues by delivering real-time, actionable guidance in the context of the task that an agent or claims processor is working on and their role within the organization.

SupportPoint provides all the process, policy, procedure, product, and systems guidance that your employees need to perform their work accurately, efficiently and consistently. With SupportPoint your employees get it right the first time, every time.

• Contextually relevant — SupportPoint identifies the employee’s role and where they are in the process, and it uses this context information to provide them with the most relevant, real-time guidance for the task at hand.

• Optimized for real-time support — Unlike intranets and shared drives, SupportPoint is built for guiding employees through complex insurance policies, procedures and systems. Information is always up to date and employees do not need to waste time searching for hard-to-find information. They are always just a click away from consistent, clear and actionable step-by-step guidance presented in a way that supports the task at hand.

• Implemented by the business, not IT — SupportPoint makes your employees more effective in using the systems you already have. Unlike a core system replacement or upgrade, a SupportPoint implementation is brief and requires minimal IT involvement, with pay back in 3-6 months.
• Offers domain expertise — The Panviva Professional Services team are the experts in gathering, consolidating, and communicating the health insurance policies and procedures with which employees must adhere. With our proven content development methodology and assistance from our expert consultants, your SupportPoint implementation will be up and running and delivering real value within a matter of weeks.

Provides rapid ROI — Return on investment from a SupportPoint implementation is typically achieved within six months or less due to the combination of:

• Minimal IT involvement in implementing the SupportPoint technology or in the content development and publication process
• Total control of the content development and publication process is in the hands of the owners of the business process
• Rapid adoption of SupportPoint by end users because it’s very simple to use and makes them more successful in their jobs.