How one insurer improved customer service amid exchange struggles

Nevada insurers are having a difficult time attracting and retaining members. The state was hit hard by the recession; it has the highest unemployment rate and a large number of employers closed their doors or eliminated insurance coverage. 

Add to the fact that Nevada boasts one of the worst-performing exchanges and you get a sense of the major headaches facing health plans there. "I can't even begin to put my arms around how big the challenges have been," Lisa Dettling (pictured), director of customer service at Saint Mary's Health Plans, told FierceHealthPayer in an exclusive interview.

Despite those challenges, the Reno, Nevada-based payer found an opportunity to improve member services policies and infrastructure, which led to happier members and employees as health exchange implementation kicked in.

"The world is changing and there's not much we will be able to do about it. The key to good customer service is getting that information in front of your staff in an effective way and quickly," Dettling said.

The insurer created a way for staff to organize information (instead of binders and sticky notes). It also allowed the customer service teams to spend more time on the phones, as prospective exchange members frequently are not familiar with how the health plan system works or some of the terms like explanation of benefits. The customer service team now has a per diem position, a trained individual to cover the call center on employee vacation and sick days.

St. Mary's customer service changes highlighted the fact that having access to the right information at the right time was essential to driving the business and satisfying customer experience during the tumultuous exchange rollout.

"If you're a health plan today and you don't have a system in place to make sure everyone has the same information at their fingertips, quickly and consistently you absolutely must find a tool," Dettling told FierceHealthPayer.

Nevada's troubled exchange also forced Dettling and her team to develop a new workflow on the fly that better handles prospective and new members who, when they finally reached St. Mary's customer service reps, were crying and yelling after being on hold with the Nevada Health Link for five or six hours.

Thanks to member feedback from consumers frustrated with the state exchange--such as one member who was grateful that St. Mary's answered the phone in 19 minutes--Dettling said she realized the insurer couldn't just send consumers back to the never-ending exchange phone tree. 

So St. Mary's created different documents it would complete for each member and then used a tracking mechanism to get the information--such as the names of members they heard from and their concerns--back to the state exchange.

"It gave our team something to do when they got an upset caller and the caller could feel like somebody has finally has heard them, 'I know they have a document and their forwarding it and tracking it,'" Dettling explained.

Soon the insurer had hundreds of people on the tracking reports, soothing member concerns and making the most of a difficult exchange experience.

"Had we not done that when we did, I just don't know how out of control it might have gotten," Dettling said.