When it comes to member support and customer care, healthcare is different. These interactions are rarely just transactional—a person’s well-being and life can be at stake. Healthcare organizations must transform the experience and effectiveness of healthcare support into true healthcare advocacy that centers around the member or patient and is laser-focused on helping them throughout their health journey.

Beneficial health experiences are especially important for anyone with a serious health issue, and member care must be provided conscious of its effect on physical well-being, as well as mental and social wellbeing. Health issues can have tentacles that impact every aspect of somebody's life. What really brought this home to me was a recent member call where our advocate provided care and interacted in a way that embodies everything that healthcare advocacy is about.

ADVOCACY EXAMPLES IN HEALTHCARE: A MEMBER INTERACTION

A member called and immediately shared her recent diagnosis of diabetes. After wishing that she had gone to the doctor sooner about her swollen feet, she asked our advocate whether Lancet strips were covered by her insurance plan. This simple inquiry could have been handled quickly, but three things demonstrated how our advocacy model is making a difference one interaction at a time.

First, the advocate immediately acknowledged this member’s diagnosis, offering, "I can only imagine how troubling it must be for you to hear this diagnosis; let me help you through this journey." A commitment was made to the member showing empathy and compassion. The advocate then confirmed her coverage for the Lancet strips in a very straightforward manner and continuously asked questions to ensure the patient’s understanding of her plan’s coverage.

Where the advocate truly excelled was in saying, "I heard you mention problems with your feet. Did you know that your plan covers two foot exams a year? Do you want me to schedule an appointment? Perhaps they can help provide some relief for you." That advocate was looking around the corner for adjacent issues and ways to help her in her journey with this newly diagnosed chronic disease. We call our employees advocates for a reason, and this was really an exemplary demonstration of doing that on behalf of a member.

FOCUSING ON INTERPERSONAL CONNECTION

The healthcare advocacy model shifts every contact from just a phone call to a real connection that is grounded in competency, confidence, and compassion. If these elements are in place for every interaction, then you're making a difference in a member or patient’s life. Our advocates have a strong degree of passion for making a difference in someone’s life and strongly demonstrate an awareness of suffering and a motivation to help. We screen for these attributes and are looking for people able to articulate their feelings, acknowledge hardship, and verbally express empathy.

HEALTHCARE ADVOCACY TRAINING

The healthcare advocacy training provided by ResultsCX, embodied in an older adult named Pearl with significant healthcare needs, focuses on giving every client member a face and linking their needs and concerns to similar issues among our advocates’ older family members and acquaintances. Many of our facilities helping members that serves this population have further engaged advocates by adopting local residential facilities to make a real difference in their communities.

At its heart, advocacy training helps to reinforce and cultivate compassion in every agent, building on the particular profile that we look for when we choose a candidate to represent us in the healthcare vertical. These are people whose characteristics predispose them to understanding our model and to adopting it easily, provided we give them the tools. In turn, we find that this agent staff performs differently than they would on a transactional phone call or run-of-the-mill chat interaction.

EVERY STAKEHOLDER BENEFITS FROM MEMBER ADVOCACY

The advocacy model is powerful for everyone involved—members, health plans, and our staff. One guiding principle for this model is for our advocates to encourage Medicare recipients to use all of the benefits that they're paying for, whether a gym discount, a free annual glaucoma test for diabetics, etc. Members who take advantage of all of these benefits help produce a 1.5% to 3% increase in our client healthcare plans’ bottom line, because these wellness-focused benefits help members stay healthy.

Very importantly, our advocates are motivated by being able to proactively help members and be accountable for a member's health journey. This often translates into improved staff retention as well as higher levels of engagement for agents providing this kind of care.

COMMUNICATION HAS A VITAL IMPACT ON HEALTHCARE OUTCOMES

At a basic level, the ResultsCX advocacy model is centered on the vital role that communication plays in healthcare. The Centers for Medicare and Medicaid Services (CMS) recognizes the impact of great support on patient outcomes. This is very apparent in the changing CMS approach to their Star ratings, which are linked to billions of dollars in incentive payments as well as to the reputation of a Medicare Advantage plan. Many enrollees choose their plans based on their Star rating. As part of regular CMS changes to how measurements are determined, by 2023 57% of the Star ratings score will be determined by customer experience metrics. We are already in a great place for our advocates to regularly demonstrate that they are patient- and member-focused and prepared to provide a high-level of service that can also influence clients’ Star ratings.

Ultimately, the ResultsCX healthcare advocacy model takes member support to a higher level, so that recipients feel like they have been helped along on their healthcare journeys while also having meaningful interactions and great experiences. This requires advocates who believe their job is a calling and not just another call. There’s no denying that member support in healthcare will continue to involve paperwork, regulations, and processes, but the advocacy element in our model is what can go a long way toward changing the face of healthcare and outcomes. This is an enormous responsibility, and one that we are proud to be able to accept.

Learn more about the ResultsCX advantages for healthcare support here.

About the Author

Becky Watkins, Senior Vice President, Client Services, ResultsCX

Becky leads client solutions at ResultsCX and serves as the senior point of contact for all clients. She brings over 30 years of experience in the BPO industry, including 10 years dedicated to healthcare solutioning and outsourcing.

Becky joined ResultsCX in 2017 following leadership roles at Alorica and APAC Customer Services. She has earned a reputation for fostering organizations’ ability to deliver personal and empathetic human connections between their high performing agent teams and clients’ customers and members. Becky is especially adept at ensuring that any technology leveraged to enhance service, effectiveness, and efficiency also enhances the achievement of excellent customer experiences.