Helping Clients Improve Member Engagement and Retention through Intuitive Contact Center Workflows

Background

As we support providers who take on full risk, we will have to develop more member-facing tools, and the Contact Center solution is a step in that direction. The client in question is sharing responsibilities with the plan for servicing member queries, which historically has been the role of the payer. They are getting requests from members of this plan—some of which they cater to, and the rest they transfer to the internal teams or the payer for further processing.

Additionally, Covid-19 has propelled the digitization journey of the healthcare industry across the world. Providers were compelled to forge digital strategies to manage the new dynamics of member-provider relationships.

Members started expecting a more prompt and digitally driven remote service experience from their providers. Large volumes of in-person visits were replaced with telehealth appointments, and providers’ customer support services were inundated with multiple calls from members. The pandemic’s effects emphasized the importance of a highly configurable Contact Center application in the healthcare ecosystem that can respond swiftly to sudden and unforeseen changes.

Problem Statement

In mid-October, we decided to add a new Contact Center application into our existing application suite for patient relationship management. To work on this exciting and complex problem, a new cross-functional team at Innovaccer was formed to develop and deliver a highly configurable Contact Center solution for one of our key customers within the challenging timeframe of 20–25 days.

Use cases solved

Member engagement – catering to grievances, incentives, provider appointments, surveys, etc.

Member information management – storing member health plan information, categorizing reasons for inbound calls

Call center workflow management - implementing outreach wellness campaigns, generating worklists for outbound calling, tasking ability across multiple departments

Performance tracking – tracking metrics (number of calls, response metrics, rep performance) through curated dashboards

During the initial product discovery phase, we realized that the core of any Contact Center solution is a ticketing system that displays existing patient information and captures other related information required to resolve patient requests. These tickets are logged by a Contact Center representative (over a phone call) for different purposes, e.g., registering member grievances, requesting changes in personal information, inquiring about member benefits. Once these tickets are created, the tasks are communicated through alerts or reports to downstream department members, who will act on and close the tickets.

Approach

Following the true Agile principles, the Innovaccer team interacted with the potential users on a frequent basis—helping them identify the pain points that need to be addressed on priority and the potential risks that should be flagged and mitigated in the very initial phases.

A ticketing system to deliver a solution that can be scaled for any potential customer was developed through a configurable central framework to manage and push evolving customer requirements on the fly. Leveraging the developed framework, we were able to cater to several business’ critical customer requests within a 10- to 15-minute time frame.

To help reduce the customer feedback loop volume, solution wireframes were demoed to users in our initial discussions. This lean approach instantly validated the product hypothesis and user experience that our design team had intended to create for potential customers.

To enhance the scalability, we leveraged our robust platform capability model that brings the much-needed flexibility, in addition to its basic set of capabilities, allowing us to scale at 10X speed. Power-BI dashboards were one such platform capability that unlocked great value for our customers by providing key metrics, such as total tickets logged, call reasons, statuses, etc., on day zero.

What is coming next for the Contact Center?

Integration into a Patient Relationship Management solution: Contact Center will seamlessly integrate with care management, patient outreach, and other applications to track member engagement across different workflows.

Calling integration for out-bound and in-bound workflows: Contact Center representatives will be able to connect with members through a Computer Telephonic Integration (CTI) system merged with the application. We also plan to add omnichannel communication and skill-based routing of calls, bolstered by data gathered from historical calls.

Dashboards to track performance metrics: Built onto the current basic call tracking, these specialized dashboards add business-specific capabilities such as issues resolved in the first call, SLA adherence for business critical issues, call abandoned rate, etc.

Why Innovaccer for Contact Center?

We offer numerous key differentiators, which bring additional value and distinguish our offerings from those of our competitors:

Deep understanding of the healthcare industry – expertise in working with 25K+ providers across 1,000+ geographies, comprehensive knowledge about the nuances of member-facing and call center workflows.

One-stop shop for integrated call center workflows – catering to all call center functions (inbound and outbound calling, logging notes, transferring tasks) from a single app, allowing convenient and easy-to-use functionality.

Seamless integration with other applications – our application seamlessly integrates with care management, referral management, and patient outreach apps to create a panoramic view of each member, helping to track member engagements and solve for overlapping use cases (e.g., care manager tasking, provider search, member surveys).

Seamless CTI integration – the system is merged with existing CTI platforms, allowing phone number recognition.

Access to unified patient records – the already integrated patient (member) data on our platform is utilized and augmented by reps.

Contact Center was built with the care teams in mind, and how we can help them in delivering right guidance and ensuring better patient satisfaction. We look forward to your feedback as we create a unified solution to ensure higher patient satisfaction and engagement.