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By Christine Kowalczyk, COO, Support.com
Healthcare came late to business process outsourcing. Once, the industry broadly preferred to handle patient or member needs in-house, believing that no one else could prioritize care and security the way that payers and providers do internally. The Medical Loss Ratio provision in the 2010 Affordable Care Act, also known as the 80/20 rule, forced insurers to reexamine their administrative practices, however. Faced with the requirement to reduce administrative costs, insurers began looking for ways to optimize member services.
Driven by this requirement, the healthcare industry suddenly saw BPOs as an attractive option. In comparison to other categories of customer support, the seasonality of healthcare made healthcare member services advocacy extremely inefficient. BPOs could partially address these inefficiencies by centralizing operations and leveraging seasonal workers, cutting costs for payers and while delivering a differentiated member and provider service. That system has never been maximally efficient, however, and the pandemic has exposed its serious risks to business process continuity, data security, and care quality.
Healthcare member services advocate hiring is fundamentally inefficient
BPOs traditionally approach hiring healthcare member services advocates and Health Insurance Licensed agents for open enrollment periods the way they handle any predictable seasonal spike: they hire thousands of temporary seasonal workers. The bar for these roles, however, is much higher than for other seasonal customer support workers. Each advocate must be trained and licensed in every state where the plan is sold. This typically requires eight weeks of training, an exam fee, re-testing fees if necessary, and reciprocity fees for each location the contact center services. That amounts to two months of paid full-time work and thousands of dollars in fees before an advocate can even begin assisting healthcare plan members. Then, a mere three months later, all of these newly trained advocates are let go. Often, forty percent of each member services advocate’s time is spent on training and certification rather than member services. This cycle repeats every year.
The surface-level costs of annually recruiting, training, and licensing at scale are obvious, but there are deep hidden costs as well. As the healthcare industry has long recognized, patient and plan member services are fundamentally different from other forms of customer support. Healthcare member service advocates often deal with people at their most vulnerable, handling issues at the highly sensitive intersection of finance and health. Member services advocates need an extremely high degree of emotional intelligence and interpersonal skills – traits that are very difficult to identify and cultivate quickly to meet the short window of open enrollment
An advocate’s ability to master complex policy details has financial implications for the payers as well, who are liable for any misquotes. In a massive call center, it can be difficult to directly monitor and correct such mistakes in real time, allowing billable errors to go unchecked. Healthcare requires the very best of the customer support industry. The hiring practices and staffing churn of traditional BPOs, however, mean that talent and experience are constantly drained away.
Call center operations are suboptimized and risky for the healthcare business
Brick and mortar call centers may be more efficient than in-house member support services, but these facilities still face constraints to optimizing their operations. People commute to work at the call center. Worker schedules have to be built around that reality: workers can’t start and end their shifts during peak call times. As a result, call centers are generally staffed with enough people to handle peak call volumes throughout each workday. Brick and mortar call centers wind up over-staffed on off-peak days and hours, in order to avoid underserving members.
The upside of this redundancy should be continuity of operations, but the pandemic undercut that perception. At the onset of the pandemic, many brick and mortar call centers initially shut down. Eventually, most moved to a hybrid model with a significant portion of their workforce forced to work from home. An employee who’s hired for an in-person role but forced to work from home is often in a difficult position. They may not a have a suitable workspace, a secure network, or even the right temperament for home-based work. While this was a problem across many industry categories, healthcare was impacted more than most: many traditional brick and mortar BPOs had no mechanism for ensuring HIPAA compliance on the part of home-based employees. In the early stages of the pandemic, healthcare customers were trapped between accepting a high risk of HIPAA data security violations or facing massive disruption in their member support services.
Homesourcing is the next evolution of business process outsourcing
The early stages of the pandemic are well past, and the healthcare industry should not continue to accept emergency half-measures for healthcare member services staffing. Homesourcing is a BPO model that eliminates both the structural inefficiencies of brick and mortar call centers and the data security risks of ad hoc work-from-home, while ensuring business process continuity. Homesourcing is a model where all of an organization’s processes, training, platforms, and culture are optimized for home-based work. Homesourced customer support agents always work from home, in an approved environment, and are hired specifically for their capacity to succeed in that context. This confers several advantages for healthcare customers.
A homesourcing BPO can afford to be picky. Freed from geographical constraints, a homesourcing organization can screen and hire for both the level of self-direction required to work from home, and the interpersonal skills specifically required of member services advocates. Using techniques such as virtual group interviews, a homesourcing BPO can assess candidates’ performance in a context very similar to that in which they’ll interact with plan members. Drawing from a larger hiring pool, a fully homesourced BPO can recruit only agents with licensed certifications already in place, eliminating costly training and licensure processes, and decreasing the time to ramp. These custom-profiled agents can also provide a higher level of personalized care, drawing upon their industry experience. If a payer wants to service a plan locally to appeal to state legislators, a homesourced BPO can accommodate that. Recruiting statewide, they still have access to a much deeper bench of talent than a brick and mortar call center limited to a driving-distance radius.
Homesourcing BPOs not only have access to the best quality candidates – they also have the ability to leverage them more efficiently. Because home-based employees have no commute, it’s much easier for them to adopt part-time, flexible, or split-shift scheduling. As a result, mature homesourcing BPOs can dynamically align staffing schedules to call cadence. This scheduling optimization enables fewer home-based advocates to handle the same workload as many more advocates working in a brick and mortar facility.
A physically dispersed workforce doesn’t mean loss of oversight. In fact, a homesourced workforce can be managed more effectively than that of a large call center. Using virtual performance monitoring tools, supervisors can monitor member services advocate performance in real time and intervene proactively. Homesourcing BPOs can monitor call data in real time, giving mistakes no opportunity to become habits. According to best practices, the member advocacy team should also have daily video team huddles to ensure consistent service delivery across advocates.
Homesourcing also offers HIPAA compliant security even in a crisis like the COVID-19 pandemic. A homesourced organization doesn’t need to build security stop-gaps to continue operations; their work-from-home practices are secure by design. “Homesourced employees should have the highest device-level security on all devices, which should in turn be the only means of accessing customer data,” says Support.com CTO Kevin Ruthen. “We take steps to ensure that every expert’s anti-virus software is up to date. We can blacklist or whitelist the applications and websites accessible through an expert’s workspace.” Communications must be secure at the network level as well: all employee connections are highly encrypted and conducted via VPN and/or through a virtual desktop interface (VDI).
For HIPAA compliant organizations, remote security measures can go further. Advocates’ stations can be equipped with biometric identification tools to verify their identity. AI-based security programs can further verify that the advocate is working in an approved environment with no unauthorized people or devices present. If the camera detects a cellphone, notebook, or unauthorized person, the workstation can be automatically blanked and the advocate’s supervisor notified.
The pandemic exposed weaknesses in the brick and mortar call center model’s ability to effectively serve healthcare customers. In addition to relying on inefficient seasonal hiring practices and facing constraints caused by the realities of commuting, brick and mortar call centers were also not well positioned for a crisis, struggling with business process continuity and security as agents transitioned to work from home. By taking the next step from outsourcing to homesourcing, the healthcare industry can improve efficiency and ensure always-on operations without sacrificing either data security or member support.