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Kathy Ashby Merry knows only too well how minor consumer problems can transform into tales of woe rivaling any woe-filled Country & Western song. After laboring 20 years in the health insurance customer service vineyards, in roles ranging from customer service rep with a regional HMO to senior vice president of service operations for Anthem Blue Cross and Blue Shield, Merry has heard it all before. Companies claiming that they have the answer to customer service technology are singing a familiar tune. But using technology effectively to deliver solid service and problem resolution can take matching the creativity of a country music songwriter with the techno-savvy of a Bill Gates. It's a tall order and one that the health insurers have a long country road to travel before outpacing other industries. “The use of technology in health insurance customer service has a lot of catching up to do," she said. “Today, our customer service technology is characterized by intrusive processes, paper claim forms and long cycle times. Compare that to the transparency of the process at the local gas station. You scan a card at the pump. The information on your card it transmitted to a satellite 20,000 miles in orbit, back to Earth and the credit card company’s server, which verifies credit availability, then back to the pump, which now is authorized to dispense gasoline. You’ve just witnessed about 30 transactions within a few seconds, all of them totally invisible. “The question we have to ask ourselves is why health insurance claim and customer service processing is so far behind that standard in speed and transparency,” she said. “Our goal should be complete transparency, coverage modeling techniques geared to give us the information we need up front and then real-time processing with all lag times gone.” Medical technology far ahead of insuranceAccording to Kathy, the health insurance industry is only about 30 percent of the way toward that goal, while medical technology is so far ahead on the technology spectrum that its advances resemble science fiction. “Medical technology is light years ahead of the processing functions in the health insurance industry,” Merry said. “It has gone beyond healing and curing to the point of creating new life forms. Advances in medical technology have mapped every characteristic of the human genome and are on the threshold of being able to alter genes to change the development and course of diseases." The ability to virtually end the likelihood of many diseases, not to mention the ability to determine who might be susceptible to future illness while still in the womb, will no doubt spark a variety of ethical debates on many levels. But the contemporary challenge facing the life and health insurance industries is how both – especially health insurers – might close the gap with other industries in the application of technology to bring about enhancements in customer service. "How is it that our systems can be so far behind when the insurance industry uses technology for so many tasks," Merry said. "We already automate transactions in many areas to reduce paper, reduce cost and free up people to do a better job of interacting with customers. We have been successful in pushing many simple transactions to self-service mode, using voice mail and the Internet. In effect, we have radically redesigned many service interactions, in theory improving service dramatically." Yet, in a recent customer survey, insurance consumers identified the biggest issues they have with insurance industry service. Life and health customers consistently pointed to claim delays, denials and not getting consistent answers about coverage and policy terms. Property and casualty customers also identified claim delays as an issue as well as disputes about valuations. "In the claim process, the industry average in adjudicating claims when all of the information is available and in good order is a matter of seconds about 50 percent of the time," Merry said. "If we can do it in 50 percent of the cases, we should be able to do it in 99.5 percent of cases. We already have the technology to eliminate delays related to claim denials due to the need for more information. We also have the capacity to move complex claim adjudication logic farther up toward the front in the claim processing chain to enable us to make decisions more quickly. "The overall goal is arriving at the best outcome for the least cost," she said. "The technology is there, so why isn't it happening?"
Demand changeAccording to Merry, the answer is simple – no one is demanding it loudly enough to overcome the organizational inertia that wants to keep doing things the same as always. "Within a lot of organizations, 'what's the return?' is the first question that comes up," Merry said. "Will it make more money for the organization and will it get us more customers? In this case, competitive threats tend to be the most effective motivators. In a free market, the demand for a product or service is usually what works the best. That's how the health insurance industry ended up offering open access HMOs and consumer-driven healthcare.” Merry's message to consumers and to customer relations professionals who serve them – DEMAND technology applications that will move industry service to the next level. "Make your vision clear and communicate it up through the organization," Merry said. "Educate others about the need for these solutions and enlist their help. Then just stick with it. This is the way of the future and our customers are expecting progress on these fronts. Again, they are comparing the level of speed and service they experience every day at the gas pump with how quickly we can respond with answers on a claim. It's not fair, but that's our competition. "For example, there is simply no reason for a customer to have wages garnished because a medical claim has not been processed and paid to a provider in a timely manner," Merry said. "There is also no reason why we should still be sending out statements that say 'This is not a bill' and just above the words 'pay $128.' It's confusing and it should stop." Focusing on 'high value' callsMerry noted that improving the industry's ability to deal with simple, run-of-the-mill questions in a timelier manner will benefit insurers by freeing up resources to focus on issues that are more difficult. "The most common question we all get is 'where is my claim?' – which is a very low-value transaction," she said. "If we can use technology more effectively to eliminate 25 'low-value' calls for every 'high-value,' more complex call, we will be way ahead of the game." In the final analysis, Merry noted that what customers really want is someone to give them answers they can understand as quickly and efficiently as possible. Increasingly, the companies that are the most adept at using technology to deliver that kind of service are going to be the winners in the competitive battle. CONTACT INFO
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