published 03-30-2018

CX Best Practice Award Winnerfor Continuous Improvement Process

Security Health Plan

CX Best Practice Success Story – Continuous Improvement Process

Company Description

Security Health Plan is a Health Insurance company based out of Marshfield, Wisconsin, and is

partnered with the ever-expanding Marshfield Clinic. Although we are not a national company,

our name is spread outside the state of Wisconsin. That is thanks to the policies we offer and,

most of all, the service we provide. We believe a member’s first and last interaction is with our

Customer Service department. Our highest method of contact is still by phone, although we do

make contacts by email and offer other routes for the member to find information via online

member portals or websites. Even with all the increasing uses of technology, the fact that the

phone contact method is the highest shows how amazing our team is at continually improving

with the times to provide exceptional, personal service to our members.

Security Health Plan Customer Service

Contact Center Description

Location

Marshfield - Wisconsin, United States

Call Types

Inbound and outbound calls related to benefits, eligibility, doctor referrals, claims, and prior

authorizations

CSR Headcount

54 CSRs

Contact Channels

Inbound and outbound phone calls, emails, website, in-person, IVR, social media

Hours of Operation

Monday to Friday, 7:30 am to 5:30 pm EST

Contact Volume

Approximately 270,000 calls per year

Background

The Security Health Plan, Customer Service department, has a simple view on continuous

improvement, promises kept, plain and simple. Even though we have achieved first quartile

ranking in SQM metrics, we are striving to be the very best in our industry. We believe this is why

we have seen sustained increases in all our SQM metrics. “Promises kept, plain and simple” is

our marketing tagline at Security Health Plan, and we take this to heart as we pride ourselves in

elevating our members’ needs above all others. This is also the promise we make to ourselves,

and based on the increases that we have earned, we have delivered on that promise! The process

that we use is a similar style of a closed loop improvement cycle to that of SQM: Identify, Develop,

Implement, Check, and Act (IDICA).

Within this motto and improvement cycle, we first look at the member from a multitude of different

touchpoints: member complaints, comments, appeals, and SQM survey results. We first Identify

the problem from the analysis of this information, since it is valuable in improving our member-

centric processes.

After identifying an opportunity to modify or initiate a new practice, we then go to our next step in

the cycle, Develop. In this step, we look for an alternative or improved process with the end goal

of resolving our member’s inquiries. While in this step we know that it can be hard to change, but

Identify

Develop

Implement

Check

Act

we have removed a particular phrase from our culture in line with the insightful wisdom of our

Marshfield Clinic Health System CEO, “We’ve always done it that way.” By removing this phrase

from our vocabulary, we have been able to increase the work that is done in the development

step of our cycle.

Once a viable development has been made, we move to our next step, Implement. We like to

implement the change on a smaller scale to better evaluate any additional modifications that may

result.

Once we have the results, we initiate our second to last stage, Check. During this step, we

analyze our data and determine if this would be the best option for the members. This is another

stage where we have removed the phrase, “We’ve always done it that way.” Even though we

have used the processes before, we are now looking at making this change for the entire

department. We are committed to focusing on changes for the benefit of our members, and once

the information has been checked, we move to our final step, Act.

During this step, we Implement our refined improvement opportunity on a larger scale through

either the entire department or organization. Should we find that the change does not work on a

broader scale, we begin our cycle all over again.

Once we created our closed loop improvement cycle, we started using it to determine success in

the department. The first area we reviewed was the voice of the customer, thanks to the

information provided by SQM. Of all the key performance indicators (KPIs) that are available from

SQM, the one that stands out above the others to Security Health Plan is First Call Resolution

(FCR). FCR has been a major focus for our department. Thanks to our member surveys we

understand that with an increase in FCR, you see a corresponding increase in all other areas.

With this thought and our “Promises kept, plain and simple” tagline, we are laser-focused on

decreasing the number of times a member has to call in for resolution. With our continuous

improvements in more than one area, we have seen dramatic increases in our FCR over the past

three years. We currently are knocking on the Best in Health Care door with 83% for 2017

compared to 78% for the last quarter of 2015.

Aside from FCR, there are five other metrics that we look at to determine the effectiveness of our

continuous improvement process: One Contact Resolution, Resolution, Call Center Csat, Esat,

and our Customer Retention Metrics. By viewing all five metrics along with FCR, we are able to

grasp a better understanding of areas that need to be improved and areas that are working well

in our department, as well as taking the information provided directly through member feedback.

Because of our success with FCR, we have seen great increases in all five additional categories:

• We are always aware of One Contact Resolution when implementing changes to increase

this metric. We do have resolutions occurring at more than just our call center; our online

member portal is the most recent channel in which we’ve seen an increase. We have seen

another strong increase in this category, going from 73% in 2015 to 77% in 2017.

• Resolution for Security Health Plan goes hand-in-hand with FCR. We understand that we

may not always be able to resolve the issue/question within one interaction, but we still

want it to be resolved in a timely manner. This is why we always go the extra mile with our

members to make their experience as seamless as possible. Our improvement in our FCR

has transitioned over to our Resolution where we have seen a 3% increase from 90% in

2015 to 93% in 2017.

• We also expect to excel in Call Center Csat as this tells us how a member feels about

Security Health Plan as a whole. We strive for the highest percentage possible, knowing

that high customer satisfaction can be a significant factor in membership growth. We are

gratified to see an astounding 6% increase over the past three years from 86% in 2015 to

92% in 2017.

• Esat (Employee Satisfaction) is another area Security Health Plan takes very seriously

because ultimately, we also want our agents to have a great experience. This is why our

agents are included in our ‘Continuous Improvement Process’. Their feedback helps us

pinpoint other areas that may need improvement, which in turn will help them provide even

better service to our members.

With all of the changes happening in the department, we are proud that we have seen positive

results in two of our important categories: CSR FCR Ability and QA Impact on Resolving Calls.

We have seen a 2% increase up to 50% this year for CSR FCR Ability and a staggering 4%

increase in our QA Impact on Resolving Calls, going to 43% in 2017.

Customer Retention Metrics is the last area that we look at to confirm that our continuous

improvement process is working efficiently. We want to make sure that the service we are

providing is continually meeting the needs of the member. With the changes implemented in our

department, we have seen a drop in two quarters, with our Quarter 2 being 1%, down from last

year’s 2%, and another drop in Quarter 3 from 3% in 2016 to 2% in 2017. Our year-to-date has

remained the same at 2% because great service was also provided in 2016.

Our continuous improvement process differentiates from our industry peers and competitors

because we are always looking to improve, even though we are at a very high level. In short, we

nitpick because we want to be the very best. This is where Security Health Plan stands out from

other companies even with increased self-service technology and a corresponding decrease in

personal contact, but our strongest channel of contact is by telephone. We feel our fearlessness

to change is our competitive advantage. We are always striving to adapt and change, both for the

benefit of our agents, and most importantly, for the benefit of our members.

Member feedback is at the center of our continuous improvement strategic plan. We partner this

information with our internal analysis of department production to identify opportunities for

improvement that will lead to increased member satisfaction and experience. For example, when

a member calls into Security Health Plan to go over the coverage for a service, we go over the

information and ask the member if we have resolved their questions or inquiries for today. This

48%

39%

2%

4%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

CSR FCR Ability

QA Impact on Resolving Calls

Employee Satisfaction Increases

2016

2017

change to our closing was made thanks to member feedback provided by SQM as well as our

internal analysis of our member interactions in making sure the member states during the call if it

is resolved. So, we don’t just rely on our scripts, but we know at the moment of truth if the agent

has resolved the members’ questions to their understanding.

I know this is a recurring theme, but Security Health Plan is fanatical about increasing member

satisfaction. Because of this focus, our development of an action plan occurs very quickly using

IDICA. First, the information is gathered to Identify the change that needs to occur. Then Security

Health Plan brings that information forward to the most suitable group to focus and Develop an

action plan. This could be a specific department at Security Health Plan or a specially assigned

team that is created to ensure that all areas are reviewed.

One recent example is the implementation of a new CRM Salesforce for the organization but

mainly for our Customer Service department. Salesforce is the system that our agents are now

using to navigate our member information. The in-depth process to Implement this system took

an enormous amount of time and resources during our busiest quarter. We identified an issue

with the length of time it was taking our agents to find information in our core system. This was

not because our agents did not know where the information was located, but because there were

so many programs that were open to access it. Once this was identified, a core team was created

from the operational areas in Security Health Plan to find the best system to meet our needs. This

development process was how we landed on the Salesforce program, as all applications and

programs would now be in one console view. Once the decision was made on this system, the

team implemented it to a select number of individuals to allow for multiple levels of testing. During

this time we looked for any bugs that would hamper its effectiveness. While working on

implementation, we were able to start the fourth process, checking the information to verify if this

was a success and determining when we were ready to Act.

Security Health Plan likes to use at least two areas of focus to determine if an improvement

initiative was successful: SQM results (specifically KPIs), and agent/production metrics. We also

look into agent metrics as this is an area that can always be improved. We first go through the

information provided by SQM to determine if we have improved the member experience by

looking at the volume of positive surveys, as well as possible increases in FCR. FCR is the

category that we look at improving the most, so this is our focus to determine if the improvement

initiative was successful. Once the information is collected from SQM, we move to the

agent/production metrics. We have found that there is a correlation between the increase in FCR

and the agent/production metrics. As we see an increase in FCR, we see an increase in member

satisfaction across our survey results.

Another example of how Security Health Plan checks to see if an improvement initiative was

successful, was through our implementation of the new call closing discussed earlier. We now

directly ask members if we have resolved their questions/inquiries during the call. This really was

a fairly small change, and we allowed the agents some leeway in developing their own verbiage

on the closing for three months so that we could determine which form of the closing gave us the

best results. This change was implemented for the months of April, May, and June. It was during

these months that we saw a drastic increase in the FCR over the previous three months. The first

quarter had an average of 78% for FCR, but the second quarter saw an increase of 5%! We had

increased our quarter FCR to 83%, just 2 ticks away from Best in Health Care, and we did not

stop there.

With this Check to determine success, we made the decision to fully implement the call closing

to be used by all agents, but with a slight change in the wording. During our check, we found that

there can be confusion on how to present the question. We came across instances where agents

would present the question with the assumption that they had already resolved the issue and

would phrase their question as, “Is there anything additional that I can resolve for today?” After

checking on the SQM results and the member information, we found that because we are already

assuming that we have answered their initial question, we took away the opportunity for the

member to tell the agent that they, in fact, did so. Because of this check, we made the

determination that we need to present this question to the member in a form where we are

discussing the current interaction to allow the member the chance to answer the question.

Our final step is one of the most important to Security Health Plan. We want to make sure that

when full implementation occurs everything is working as designed for an optimum result. We

take great pride in ourselves regarding this final step, Act. It is because of all of the other steps

that we are able to excel. When we have all of the information gathered from the implementation,

and it has been checked to verify if it was a success, this is when we start our final step. We make

any necessary improvements so that our initiative will work in the very best possible way on behalf

of our member’s experience. We then roll-out the improvement initiative to the entire department

or health plan if necessary. While implementing, we work with the departments to make sure that

the changes are working for them to ensure a productive and positive roll-out and produce the

desired outcome for our members. Since the members are our key focus for our processes, we

want to make sure that everything is handled internally before initiating contact with our members.

We are currently in the Act phase for our Salesforce system. We had started the new system

department-wide on November 2, 2017. We are now finalizing the Act phase by verifying the

efficiency of the new system for our agents and the service that is being provided to our members.

On the first day with the new system, we saw a decrease in our Average Handle Time (AHT) by

over 2 minutes. Normally this is not a metric that we look at closely, but when we see a drop in

AHT because the call wrap-up time decreases, we see an increased amount of calls handled by

more than 10%. We continually monitor this information to verify that we recognize the increase

in efficiency.

Security Health Plan’s main focus is our members; anything and everything that we can do to

increase member satisfaction is always on the front of our minds. And, it is a credit to the

perseverance of many key individuals who we have been able to incorporate a business-wide

mindset of FCR. This mindset shows in the following statement from our Chief Executive Officer,

Julie Brussow:

Thanks to our continuous improvement process we have been able to implement multiple

initiatives at the same time to increase our member's experiences and stay true to our motto,

“Promises kept, plain and simple.”

“Security Health Plan’s SQM survey results are an excellent resource for helping us

take steps to improve our service to members. Thanks to the feedback we receive on

surveys, FCR has become a metric our entire organization is focused on. That focus on

FCR has led us to make changes that improve our members’ experience. Our members

don’t have to call us multiple times about the same issue. It is more efficient for us to

do the job right the first time, and it ensures members have the information they need

the first time they interact with us. This will translate to our members being less anxious

and frustrated with the health care system because their path to answers comes with

fewer hassles. Our goal is to improve our members’ overall health care experience

through greater efficiency and better service.”