For most consumers, health insurance and empathy go together like oil and water. But in a post-reform world where consumers have more choice, smart carriers are looking to differentiate in new ways to attract and retain members. One insurer recently approached the EIN about ways to fulfill their mission to care for members’ health by going beyond coverage and supporting members throughout their healthcare journey. With a member-focused vision championed by a charismatic physician leader, the carrier sought to create a different kind of health plan where members are treated as true partners.
Since call center agents have by far the most interactions with members and, therefore, the ability to strongly shape a member’s impression and loyalty to the plan, efforts to humanize the health plan experience started here. Agents needed to
Identify each caller as a person, not just a member,
Address both spoken and un-spoken needs, and
Create delight with each health plan member
Since plan members spanned a range of health insurance experience, health literacy, and emotional needs, the call center needed an approach that was at once standardized and yet tailored to caller need. This was achieved by adapting UCLA Medical Center’s “C-ICARE” framework for the health plan call center with an emphasis on covering callers’ needs while ensuring that phone interactions communicated empathy and managed expectations. This standardized service model focused on:
Introduce yourself and your role.
Communicate what you are going to do, how long it will take and how it will impact the member/subscriber.
Act with kindness and empathy.
Respond to immediate questions or requests.
Exit the call courteously with an explanation of what will come next.
Personas were a key asset for personalizing service by putting a story and face to the member on the other end of the phone. Personas are archetypal members with stories and narratives that help surface common issues and questions a member is likely to have – even if he or she is unable to verbalize them or is embarrassed to ask
For example, “Newbies” are health plan members who are newly insured and have low levels of health literacy. For this health plan, newbies were also likely to have children. The summary statement for a Newbie is, “I don’t know what I don’t know.” Newbies typically need to understand exactly what is covered by insurance without industry jargon, help finding a family doctor that is close by, and a phone agent who can anticipate and draw out their needs during a call.
“Always Statements” are sayings that should be said for each caller, during every interaction, to meet caller needs and ensure the ‘A’ in ICARE is completed effectively. In the case of the newbie, acting with kindness and empathy meant using statements such as,
I know this can be confusing…
We can set up a time to walk through this with you
Do you have a Primary Care Physician? Can I help you find one?
Did you know we have free services like …?
Through retraining of the call center staff, the health plan ensured that respect, empathy, and clear communication would frame member interactions. We’re confident that this kind of focus on the human experience will change the health insurance landscape for the better.