• March 17, 2011
  • By Leonard Klie, Editor, CRM magazine and SmartCustomerService.com

Savings Follow BlueCross BlueShield to Tennessee

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BlueCross BlueShield of Tennessee offers health insurance services to more than 24,000 companies and 5 million people nationwide, including 3 million across the state. Last year, the insurer handled more than 66 million claims and paid out more than $11 billion in healthcare benefits.

Like many of BC/BS’s other local affiliates, BC/BS of Tennessee—which employs about 5,000 at its corporate headquarters in Chattanooga and regional offices in Jackson, Johnson City, Knoxville, Nashville, and Memphis—takes part in the national BlueCard program. It links independent BC/BS companies across the country and enables a member of one BC/BS company to obtain healthcare services while traveling or living in another BC/BS company’s service area.

BC/BS of Tennessee operates six call centers that employ roughly 250 people. The BlueCard group has 80 dedicated contact center agents, who field more than 400,000 incoming BlueCard calls per year. BC/BS of Tennessee recently combined the Provider Service Center with the BlueCard unit, so the call center now services providers for in-state and out-of-state members.

The BlueCard call center operates like any other at the company, but it had a huge problem with call handling times, which had spiraled out of control. Most calls to BC/BS of Tennessee last nine to 10 minutes, but calls to the BlueCard group were averaging nearly 17 minutes—about 70 percent longer.

“Our average handle times were very high, and we were trying to determine why and which calls were taking longer to handle,” explains Maria Darras, director of provider and interplan operations at BC/BS of Tennessee’s BlueCard group. But those efforts were not fruitful.

“Although we had a general sense of what was driving up call volume, we simply did not have the tools required to dig under the surface,” Darras says. “We needed to gain visibility into our contact center issues to reduce unnecessary operational costs. It became clear that if we were going to keep up with growing service complexity and industry challenges, we needed to upgrade our business intelligence and customer care capabilities.”

While BlueCard was aware of the problem, it was powerless to solve it. The group tried to better train agents, improve scripts, and increase its Web presence to allow members to handle some tasks online. But BlueCard could not find the right blend of moves to solve the problem. Also lacking was the ability to uncover the reasons for customer calls in the first place.

Lacking knowledge about trends and the causes, the group had a limited understanding of how to reduce call volume, improve first call resolution, and boost operational efficiency.

To try to meet the challenge, BlueCard in February 2009 implemented Nexidia’s Enterprise Speech Intelligence (ESI) software. The software was deployed through Nexidia’s QuickStart program, which leverages the Nexidia OnDemand hosted solution that helps organizations launch speech analytics more quickly and efficiently.

Using Nexidia OnDemand, BlueCard was able to access the full suite of capabilities in Nexidia’s ESI. Because ESI integrates with multiple call loggers, metadata was easily brought into the system to be reviewed and analyzed.

“We decided on Nexidia because of the ease of use,” Darras says. “The tool didn’t require analyst-level employees to obtain data and perform analysis. It was a simple solution that provided a lot of strong analysis and reporting.”

Once it could conduct deep analysis, BlueCard learned that calls from doctors indicating they had sent medical records that could not be found in the system were tying up phone lines. Agents could not easily locate records, and missing cover letters from doctors were preventing records from being automatically imaged into the appropriate system for retrieval and routing.

With that revelation, BlueCard identified the providers who were not submitting their medical records correctly and reviewed filing protocols with them. In addition, the Nexidia system alerted the BlueCard team that it needed to provide clearer training to its agents on the classification of specific call types. BlueCard also identified areas of improvement on its Web site, specifically with online filing of claims and paper remittances.

Since turning to Nexidia, BlueCard has reduced call-handling time by about 30 percent, to 12 minutes from 17, for a projected yearly savings of nearly $900,000. Call volume related to problems locating medical records has fallen 12 percent, leading to a projected yearly savings of more than $130,000. The total savings in those two areas has eclipsed $1 million in a few months.

Moreover, the group was able to avoid costs associated with hardware, software, and training, allowing for a higher return on investment. And with the solution up and running in a matter of days, BlueCard saw measurable, tangible results in weeks, rather than months.

The system deployment was smooth, Darras notes, adding that the solution has been easy to use, and BC/BS of Tennessee appreciated that it could be up and running with little overhead and no hardware or software purchase requirements. She also points out that Nexidia’s professional services team was easy to work with and always available to help.

“Nexidia’s support system was excellent during this time,” she says. “The only issue we have encountered since installation was on our end. We needed to update our Verint recorder. This caused us a few issues, but everything has been corrected.”

Based on the results, Nexidia’s professional services and BlueCard’s internal team built a strong business case for adopting Nexidia speech analytics companywide. BC/BS of Tennessee has given the green light to an enterprise license. All of the other call centers use Nexidia software, and additional rollouts of Nexidia speech analytics are planned for departments that handle membership, member benefits, provider services, Medicare and Medicare Advantage, and Medicaid. BC/BS affiliates in several other states are also looking to adopt the solution.

“We have had a truly excellent working relationship with Nexidia and feel the software is an asset to assessing our customers’ needs,” Darras concludes.

News Editor Leonard Klie can be reached at lklie@infotoday.com.

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