Technology Helps Customer Care Teams Close Gaps in Care

At its best, customer service does more than respond—it anticipates needs and preemptively addresses concerns. Technology is helping health plan customer care teams address member concerns right from the start.

When a customer calls an Elevance Health-affiliated health plan customer care specialist, their medical history, health plan, and claims data appear on the customer service agent’s screen to help the agent begin to engage with the member’s needs and priorities.

With this real-time information, care specialists have an idea of why the person is calling and can be better prepared to help them. It’s a different level of interaction than in the past, said Charles Barrios, staff vice president of service experience at Elevance Health.

“Instead of having a transactional experience, where the person is calling about one thing, we’re creating a more high-touch, predictive and proactive relationship. We’re elevating the experience, in real time,”

Barrios said. He said people have grown to expect this level of personalization in other parts of their lives much like the way people who use television streaming services expect to be offered more of what they like to watch, and want their health plan to meet that expectation too.

How personalized customer service can close gaps in care

Members usually have a priority concern when reaching out to their health plan’s customer care team. It might be getting a replacement ID card, finding a primary care physician, or asking a question about their health plan benefits.

So as the customer care specialist is addressing the caller’s primary concern, the specialist is also prompted by alerts on their computer screen that are based on the member’s unique information to further inform the discussion.

Examples of gaps in care

If a member has a history of osteoporosis, an alert might tell the care specialist that the member is due for a bone density test. The specialist can bring up the topic, offer to help schedule a test, or simply urge the member to talk to their doctor about scheduling and managing their healthcare.

If a member is living with diabetes, there may be an alert for a 6-month follow-up with their doctor. Or an alert that indicates they need assistance refilling prescriptions could prompt the specialist to ask if there’s anything keeping the member from getting a consistent supply of medication.

There are also prompts related to breast cancer screening, colorectal cancer tests, vaccine reminders, and preventive care, so any barriers can be addressed. The alerts can also identify repeat callers and help the specialist understand whether they are managing a recurring issue.

Why personalized customer care is important

“We want to figure out why this member is having to call in so routinely for support,” Barrios said. “It’s easier for the associate to have important data points at hand. If there's any deviation in their medical history, like someone hasn’t picked up their medication or hasn’t refilled, the associate would ask about it and offer to help complete the task. So we might bring up the mail-order process, or offer to help with transportation.”

If a member expresses financial concerns, the care specialist might mention the Housing Flex Fund, which helps members with rent, utilities, moving expenses, and other housing-related costs.

Health plan members respond positively

Internal reviews and feedback from members show the added assistance is helpful. Darlene Linan, a

director of customer care, said members like the timely reminders. They also appreciate that their health plan is being more proactive about managing tasks a member might overlook or miss.

Results show care gaps are being addressed, especially in the areas of breast cancer screening, diabetes annual retinal exams, and diabetes A1C tests. There are improvements in colorectal cancer screening and the proactive management of osteoporosis.

One member thanked a customer care specialist for resolving an ongoing billing issue and then expressed delight that she didn’t have to take any further action. “Your representative quickly accessed the claim information and payment, and then asked if she could contact the provider for me to get them updated so I wouldn’t be sent further statements,” the customer wrote.

Customer care teams and member services representatives using the technology find it useful

Kassandra Childs, a manager in customer care, said the technology helps specialists make sure nothing gets missed during a conversation. “[Closing these gaps in care is] part of our performance metrics, so we continuously discuss it in our team meetings and one-on-one coaching,” she said.

Childs said care specialists make sure to listen carefully first to the member and then decide how and when to address the alerts that appear on the screen.

“We like to say we provide a white-glove, concierge service to our members,” Childs said. “We take pride in that.”

Graciela Villanueva, a director in customer care, said members have noticed the difference in the service they’re receiving. “We can better advocate for them because of the tools we have. We have the support and the background to better navigate the concerns and get to a good, quick resolution,” she said.

Barrios said every member's journey is different and this technology helps provide a smoother, easier experience. “Ultimately, it’s about ensuring that our staff has what they need to be able to delight our members every time we interact with them,” he said.

Matching top-notch customer service teams with improved technology that personalizes the member experience is one way Elevance Health is working to make a consumer-centered health system a reality.