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7 Strategies to Help Health Plans Deliver Great Member Service—Even When Staffing Can’t Match Demand


You may have seen the signs at restaurants and retail stores lately, asking for patience when it comes to service levels. But health plans can’t simply hang a sign on a door and hope for the best. Members can’t (and shouldn’t) put medical needs on hold, and they’re probably not interested in labor shortage woes when something as important as health is at stake. Meanwhile, health plan member satisfaction is more important than ever.

Pandemic or not, customer service staffing challenges are not going away. There will always be organizational change, crises and turnover, and competition in recruiting—at the same time that consumer expectations and needs shift.

A recent Verint study found that nearly 90% of business leaders surveyed said managing the workforce to meet the growing volume of customer interactions is one of their top concerns. Other major concerns voiced were overcoming silos for a unified view of customer engagement, using customer feedback to improve the service experience and creating lasting relationships with customers.

The good news is there are actions health plans can take to help remove pressure from their teams while providing service that keeps members satisfied. And today’s labor shortage might be just the impetus your plan needs to rethink how member support is delivered.

Here are some ideas we gathered from our Carenet Health engagement experts, including VP of Client Success Stacie Stoner and Director of Solution Development Monica Zapata, to inspire your next steps.

#1      Lean on automation and self-service.

This strategy is a go-to tactic for a reason—it works. You likely have several automated processes and opportunities for your members to self-serve already. Yet our clients often find there is a lack of member awareness of those opportunities. We recommend re-evaluating your self-service selections to better understand if they’re easy to find or buried, intuitive or complicated to use.

It also never hurts to re-evaluate member service steps and the tools and platforms you use internally. How can you make those tools work harder? Are there still manual steps within new digital interfaces that could be automated? Are there new AI/machine learning capabilities available? Could new service workflows speed up process steps?

Consider calling your account representatives assigned to each of the customer relationship management (CRM) and other engagement systems you use and push for their thoughts on workflow and services automation.

#2      Reconsider channel use—and consumer choice.

When resources are tight and service demand is high, taking a hard look at your channel use can be valuable. Lower-cost channels may be good options for shifting some of your member service interactions and redirecting some types of incoming member support needs.

This could mean contracting with a technical writer or UX expert to boost your online member services’ FAQs and help content. It could mean using interactive voice response (IVR), email, portal communications or text/SMS messages to proactively guide members to that content.

It could also mean investing in, or amping up the use of, AI-powered chatbots or other types of natural language processing (NLP) solutions, including intelligent virtual assistants. AI tools are becoming more and more sophisticated and can be complementary to live chat and phone interactions.

Consumers want channel choice. Provide as many pathways as possible in your IVR, so members have a say in how they engage. An option like virtual hold (callback initiation) allows callers to hold their place in queue without waiting on the line. Alternatives like this demonstrate that you value your members’ time.

#3      Optimize those 1:1, live phone interactions.

Human-to-human member support by phone will always provide a level of personalization, compassion and service that’s difficult to replicate. It’s also still one of the fastest ways for members to get their questions answered and issues resolved. (It’s more efficient in problem-solving than typing, according to several studies, including  this one.)

The key is to make sure your plan is continually looking for ways to improve the efficiency of those phone interactions—preferably in near-real time. Providing easy-to-use personal dashboards for team members is important, as is driving consistency in the engagement process. We suggest investing in additional training and coaching early and often.

Reserve your human resource capacity for those members who not only desire it but need it. For additional insights on engagement optimization, check out this infographic.

#4      Use your data.

The more your service teams know about the individuals they’re speaking with, the faster and more effective they can be. This requires that teams have access to complete and up-to-date member data. Also during live interactions, use every opportunity to capture and update as much information as possible.

Remove the engagement silos while solving for data integration, and you’ll see operational optimization become a reality in a short period of time.

#5      Eliminate ambiguity for members.

When resources are outnumbered by member needs, precision matters even more in terms of ensuring members know where to go for the quickest, best answers. Consider: Do most of your members know how to get the information they need on the first try? Do they know where to click and what number to call? Have you recently surveyed members to know how you score in this area?

Website and other communications tools often rely on members to understand industry and organization jargon, or to have time and patience for unclear navigation. If directions and information are vague, or difficult to find, your members will go to your overburdened live service teams every time. Tightening up the ambiguity can make a substantial difference.

We suggest performing a comprehensive but speedy audit. The audit can provide a solid grasp of how you’re communicating about service touchpoints. In a perfect world, a focus group of members will be used to collect findings, as well.

#6      Leverage flexible external teams that adjust to volume as needed.

If wholly outsourcing your member services’ operations on a permanent basis isn’t an option, consider working with an external health plan engagement partner to step in when seasonal or other high-demand periods put extra stress on your resources. Your workforce management processes can likely predict volume and help you proactively prepare for changes in demand, rather than simply reacting to unexpected long response times that frustrate members.

When co-sourcing, consider keeping low-volume, high-complexity demands with your internal teams. Look to external partners to help with high-volume, low-to-medium complexity member needs.

#7      Don’t push your teams too far.

Perhaps the most important tip we can provide as an engagement organization that relies on the excellence and passion of hard-working teams is to stay on top of service volumes and team bandwidths.

In other words, know what your teams can handle, and what they can’t. Direct sufficient resources to attacking burnout before it affects team and organizational health. It’s critical that you not wait too long before taking action to relieve unsustainable workloads.

Customer service, especially in the world of healthcare engagement, takes a special skillset. It also requires confidence, mental clarity and purpose. As a health plan, your goal should be to do all you can to support the individuals who speak on your behalf to those you ultimately serve.

How can we help?

Carenet Health can provide a wide range of options to help your internal teams during times of high demand, from co-sourcing strategies to innovative channel approaches. Please reach out if you’d like to discuss your needs in detail.