MEMBER SATISFACTION

Systematically Analyzing Operations to Improve Overall Satisfaction

This plan found that the organization and processes that worked so well in a small HMO were no longer functioning as the plan grew. It particularly felt the need to increase overall member satisfaction.

With the availability of standardized satisfaction survey instruments, the plan was not only able to compare its performance to benchmark, it could reliably track year-to-year performance on areas related to overall satisfaction.

The plan set about understanding how it could influence areas most closely tied to overall member satisfaction. It formed a high level team consisting of the CEO and the director of customer service, together with representatives from health services, claims and communications.

The plan sought to target overall satisfaction for all members. It used HEDIS, and then CAHPS specifications to survey the specified random samples of its membership. The plan used an external vendor for all of its surveys.

MANAGING MEMBERSHIP DATABASES This plan encountered problems common in mailed surveys: returned mail and wrong addresses. As a result, the plan made a concerted effort to improve its membership database. It initiated a new work process in which phone numbers and addresses were verified during routine calls. It added a process to send returned mail to employers, soliciting their help in getting correct addresses. The plan recognized that a good membership database affects many activities. Its maintenance can save resources at a time when organizational resources to support QI may be scarce.

The plan selected as its performance measure the percentage of members answering that they were somewhat, very, or completely satisfied with the plan.

Baseline performance, using 1996 data, showed 78 percent of members to be satisfied. The plan compared its performance with a benchmark of 86 percent, derived from national results from NCQA's annual member health care survey.

The plan analyzed the survey questions to identify areas for improvement. It focused on six questions as under its control and correlating highly with overall satisfaction:

• Types of services covered
• Information about eligibility and coverage
• How claims were handled overall
• How quickly claims were paid
• Quick response to questions or a problem
• Information about cost

In addition, the plan discovered that customer service representatives needed to frequently transfer calls to other departments, such as health services. Without proper training, the customer service representatives could not handle these calls, but the constant transfer of calls to health services had created a new barrier: poor working relations among the departments.

In addition, customer service personnel reported having limited interaction with the claims service center, located in another state. Their time was being consumed with a backlog of correspondence and refund checks. A program to give a welcome call to every new member was consuming much personnel time, and its effectiveness had never been measured.

The plan started by moving customer service out from the operational control of the CFO, and establishing its own director level position. The performance priorities in the department were changed from speed of answer to quality of service.

The customer service and claims departments began coordinating a series of monthly in-service programs. Members of other departments gave 30-minute lectures about their areas of expertise.

The plan held certificate-of-coverage training sessions each week. This allowed customer service representatives to understand what benefits were being sold, and to anticipate what questions would be asked.

FREEING UP RESOURCES The plan performed a survey of members to determine the effectiveness of the welcoming call program. When asked, only 20 percent of members actually remembered receiving the calls. The plan replaced the labor-intensive welcome call program with a welcome card program. Each member now received a friendly postcard indicating that they should have received their member materials and ID card. The postcard gave them customer service numbers to call if there were any problems.

Additional weekly classes were held on customer service. Representatives collectively discussed ideas on how to improve service.

Besides freeing up existing resources, the plan added an administrative support position to the customer service department.

The plan established a structured training program for new employees. It called for more monitoring and evaluation of telephone contacts.

The first remeasurement was based on data from 1997, showing that the number of satisfied members had increased to 82 percent.

Using a chi square analysis, this improvement was not shown to be statistically significant (chi square value 0f 1.34, p = 0.25).

The plan felt that members now received better cost information, better answers to questions and problems, and answers more frequently on the first call. But it still needed to impact the member concerns that correlated highly with overall satisfaction. It Fe that five of the six areas it had originally targeted were still concerns:

• Types of services covered
• Information about eligibility and coverage
• How claims were handled overall
• How quickly claims were paid
• Quick response to questions or a problem

The plan realized that it had not implemented any strong interventions affecting a member's ability to access eligibility and coverage information. This information was only available during working hours. Customer service representatives often did not even have eligibility information when answering a member's call.

It had also not addressed how claims were being handled at the out-of-state claims service center. Exact procedures for processing claims were not completely documented. When incorrect group benefits information was loaded onto the claims system, a complaint was the only way to detect the error.

The customer service staff was still buried under a backlog of refund checks, adjustments, and administrative correspondence.

The plan hired an additional administrative support person. It hired a full-time trainer. It added two claims liaison positions. One began to improve 4aims processes to immediately decrease the backlog of provider refunds, mistaken payments and overpayments. The other audited the loading of group benefits information into the claims system, with the goal of reviewing and correcting all group data. A coordinator was assigned to complaints and appeals. An additional staff member was devoted to updating members' addresses and handled returned mail.

Members were given access to eligibility information through an automated voice system. They could get information at all hours, and order ID cards through this system.

The customer service representatives were trained on a computer system that gave them immediate eligibility and benefit coverage information. Their telephone system was given a major upgrade, allowing them to automatically add staff to the call queue when call volume exceeded dedicated staff capacity.

A microfilm reader/printer in the customer service department allowed the claims liaisons to view information submitted to the remote claims department.

The second remeasurement used CAHPS survey data from 1998 showing that the number of satisfied members had increased to 85.5 percent.

This represented a statistically significant improvement over baseline (chi square = 5.33, p .02). Although the plan had improved its overall satisfaction, and nearly met its benchmark, it realized that it needed to continue to identify areas for improvement.

Based on specific CAHPS survey questions, the plan focused on two member issues:

• Problems finding or understanding written materials
• Help when calling customer service

Complaint data focused the plan on the accurate transfer of eligibility files to its vision vendor. The plan responded with monthly file transfers to the vendor.

The phone system uncovered a rising abandonment rate, necessitating another phone system upgrade.

The plan has expanded efforts to make member guides and certificates of coverage more readable, established e-mail access to customer service for members, and established monthly service metrics for each department.

Repeat measurement in 1999 shows sustained improvement, with an 85 percent satisfaction rate. This initiative focused the plan on using a team approach and a ''plan, do, check, act" process. This activity remains an important service initiative, as well as spawning new clinical and service activities.