published 03-5-2019

CX Best Practice Award Winnerfor Continuous Improvement Process

Regence Blue Cross Blue Shield Plans

CX Best Practice Story - Continuous Improvement

Regence Blue Cross Blue Shield Plans

Company Description

Cambia Health Solutions is dedicated to transforming health care. We are a family of more than 20

companies working together to make the health care system more person-focused and economically

sustainable for people and their families. Our solutions empower more than 70 million Americans

nationwide.

Cambia has six health plans in four states in the Pacific Northwest that provide insurance to more than 2

million people. We have a top rating in FCR in the BlueCross BlueShield Association. Through bold thinking

and innovative business practices and technology, Cambia delivers solutions that make high-quality health

care more available, affordable and personally relevant for people.

Contact Center Description

Locations:

Burlington, WA; Lewiston, ID; Medford, OR; and Tacoma, WA.

Contact Types: Inbound and outbound calls, emails and chats related to benefits, eligibility, doctor

referrals, claims, and pre-authorizations

Customer Types

Members, providers, caregivers, other insurance companies, brokers/agents

CSR Headcount:

328 CSPs (Customer Service & Provider Service Professionals)

Contact Channels Offered (including Inbound and Outbound):

Inbound and outbound phone calls, emails, website, in-person, IVR, social media

Hours of Operation

Customer Contact Center: Mon-Fri 5am-8pm PST, Sat 8am-4.30pm PST

Provider Contact Center: Mon-Fri 7am-5pm PST

Contact Volume

3.5 Million annually – Phone, Chat, and Email

Pain Points Program Synopsis

Putting the customer first and valuing our employees is the focus of our Health Plan Operations division.

Our Pain Points Program empowers employees to solve problems they come across in their daily

operations. Relying on the belief that those who do the work are the ones to best improve it, we’re using

this model to create a culture of continuous improvement within our organization.

We developed an easy-to-use format for employees to submit problems they identify as they do their jobs.

Each functional area such as claims, membership, and customer service have an Improvement coach to

partner with employees and other resource representatives to assist them through a structured problem-

solving process to relieve problems and make improvements. Ongoing improvement and successes are

communicated throughout the division and across the larger organization to showcase our commitment to

our customers and employees.

Since implementing the program in December 2017, we have resolved 90 Pain Points!

Background

In November 2017 our Health Plan Operations Senior Vice President started focused efforts via side-by-

sides and meetings with frontline leaders to learn what issues they and our customers faced. He generated

conversations about how we made issues a priority and achieved results. He supported us to work with

other teams to remove barriers.

We measure experience from the voice of the customer. In our service teams, we have integrated this

culture by using surveys, primarily SQM and speech analytics tools to measure opportunity and success

from that perspective. We also have set KPIs that are focused on our members perspective to measure the

performance of experience on a frontline individual level, to a leadership level expectation. This focus from

the service area generates the importance of identifying concerns from our customers' perspectives. We

know the best feedback is from the people we serve.

Our closest connection internally to customer feedback is our frontline teams who work through the

processes and interacting with our customers every day. We have used many different facets to gather

feedback and focus work. In gathering all the opportunities, we recognized that to get the best value in

solving issues it would be best to invest in a dedicated person or team to give focused time to drive effective

and sustained improvements. The first Improvement Coach was established in the Customer Service team

in December 2017.

Development

In January 2018, Health Plan Operations leadership prioritized pain point identification and resolution as a

strategic initiative, which included cross-departmental leadership from areas such as Health Care Services

and Provider Services. By February 2018 each Health Plan Operations team dedicated an Improvement

coach to its department. Improvement Coaches were selected based on their subject matter expertise such

as data and reporting, systems and tools, and project management. Initially, each division’s improvement

coach worked individually within his or her own department to create a separate process improvement

program, but we quickly saw the benefits of creating an integrated, cross-departmental team dedicated to

this work.

This cross-departmental team known as the Health Plan Operations Pain Point Team came together to

design the program and support ongoing coordination and infrastructure. This team deployed change

management and process improvement best practices to ensure employee engagement, leadership

commitment, and effective problem-solving.

Methodology

The main components of the Pain Point Program consist of: Identify and submit an opportunity, Triage

opportunities to prioritize next steps, Partner with those closest to the opportunity, Solve opportunity using

a structured problem-solving model.

We embraced PDSA (Plan-Do-Study-Act) as our process-improvement model for solving our opportunities.

This model ensures that we avoid solving symptoms but address the root causes.

Implementation

Once the program was designed, we communicated to frontline staff through road shows, emails,

presentations and staff meetings across the Health Plan Operations team, informing them of a new way to

identify and submit opportunities they find in their daily work. As submissions came in, the Health Plan

Operations Pain Points team triaged and prioritized opportunities and partnered with submitters to solve

using PDSA.

Also, as submissions rolled in and opportunities were solved, ongoing communication such as Pain Point

updates, celebrating Pain Point submitters went out to frontline employees to encourage continued use of

the program.

Pain Point Story: Accident Report Calls

Near the beginning of the development of the Pain Point Program within Customer Service, a significant

consumer experience problem was submitted. Many of our customers were facing a long delay to get their

accident report form reviewed and claims processed. This was due to a higher volume of claims near the

end of the year. Regence’s process required all accident report details to be worked by a smaller claims

team, and this caused a bottlenecking of tasks.

Customer Service partnered with the claims department to brainstorm solutions to this workflow problem.

It was determined that a large majority of tasks assigned to the claims team were simple "no accident" tasks

from customers calling Customer Service, while a smaller number of tasks were truly accident-related and

required investigation.

The two departments worked together to develop a process in which our Customer Service Professionals,

with the oversight of our Customer Service Resource Desk, could review and process "no accident" phone

calls from customers instead of passing them to claims.

After a few tweaks and adjustments, a new process was in place that led to greater satisfaction for our

Customer Service Professionals, better First Call Resolution for our customers, and a claims team that

could now focus on complex accident cases with a greatly reduced inventory.

This Pain Point is a great example of how most problems our customers or employees encounter are

interdepartmental, and the Pain Point Program facilitated the discovery, analysis, and resolution of a

significant consumer problem.

Summary

• Of the 90 completed pain points, 53 were direct customer impacts, 21 focused on employee

satisfaction, 10 were for providers, four for employers and two for producers.

• Delivered excellence to our customers by choosing the right problems to solve first by looking at NPS

impact and the largest volume of people impacted.

• Empowered and developed our people by training and partnering with frontline staff and supervisors to

solve problems and make improvements.

• Strengthened our operations area by using a proven problem-solving model PDSA to make

improvements.

• Improved relationships across business areas through collaborative problem-solving.

• Positive feedback from frontline employees regarding the program, communication and having an

open-door process to share pain points.

• Promoted a culture of continuous improvement by sharing best practices with other departments, which

resulted in the creation of Pain Point Programs across the enterprise.

• Our SQM Results in 2018 have improved from 2017.

We continue to refine and streamline the Pain Point Program through employee feedback and regular

process checks.