Maria got the devastating phone call that every spouse dreads.
Her husband, Nick, was being airlifted to the hospital after being seriously injured while bicycling. Details were limited, other than he was “in very bad shape.” Triage at the trauma center found Nick had suffered numerous fractures — and severe brain injuries. He was moved to ICU in a coma.
Then Maria got two more phone calls she never expected.
First, Maria heard from Brittany, a National Alliance case manager. Brittany offered to help Maria and Nick in any way she could. Brittany coordinated with the hospital team to assist with anything on their end as well. She monitored Nick’s case for pending preauthorization, and she stayed in close contact with the facility to make sure everything was taken care of quickly.
Then Maria got a call from Jennifer, a National Alliance dedicated service consultant who was taking charge on the customer service side. Jennifer offered to answer any questions about benefits and claims. Jennifer volunteered to make any phone calls and run interference for Maria. That meant Maria could focus solely on Nick and their family. Jennifer carefully monitored Nick’s account to make sure the claims were processing correctly. She continued her outreach with the family. Sometimes, there was no “business” to discuss; Jennifer just listened to Maria, offering a shoulder to lean on.
Today, Nick is home with his family after completing rehab. He continues to make strides in his recovery.
Jennifer and Brittany’s tag-team response to Nick’s case was not a lucky coincidence — though Nick was indeed fortunate to have a health plan with a concierge approach to customer service.
On its surface, this approach is astonishingly simple: co-locating customer service and care management to provide cohesive, coordinated and compassionate care. But the model is more than a marriage of convenience, as other health plans have not been able to match or master it. That’s because in addition to teaming these areas up, we took them to the next level. Customer service became customer advocacy with dedicated, specially trained representatives, and case management transformed into enhanced care management with dedicated clinical team members.
Technology plays the role of matchmaker in this joint effort. Both customer service and case management use a shared system that is updated in real time. For example, if a member calls with a benefits question, the dedicated service consultant can see if the clinical team has been trying to contact the member to remind him or her to follow up with a health coaching session or medical appointment. All employer benefits and vendors are integrated into the system. So, the clinical team can see what programs are available to the member — whether through BlueCross or not — and encourage the member to take advantage of them as appropriate.
Routing logic recognizes the member’s phone number, and connects him or her to the same dedicated service consultant who provided service to the member on the first … and subsequent … phone calls. That dedicated advocate remains the member’s single point of contact for the entire experience with our health plan. The system can also direct the member to a VRU specifically tailored to the member’s plan — once again including external vendors. Whether the member speaks to his or her dedicated service consultant who can do a warm transfer, or chooses the VRU route, he or she has only one phone call to place.
Our concierge approach clearly has advantages that members will appreciate and use. Our advocates are carefully recruited and trained to deliver the highest levels of service possible. We help members understand and get more value from their benefits. We connect them to the right programs for their specific care needs.
But there are distinct advantages for employer groups, too. Our dedicated advocates build strong relationships and connections with a group’s HR team to allow for a deep understanding of the employer’s benefits and culture. Our program also includes clinical and operational performance guarantees, as well as regular reporting on performance metrics. Our early interventions with members deliver measurable value and continuous improvement since members become more engaged in their health care.
Just ask Rhonda, a member with cancer. That devastating diagnosis, combined with the strong chemotherapy to treat it, left Rhonda bedridden. She clearly needed to follow-up care throughout her treatment but could not travel by car. Her benefits didn’t allow for non-emergency ambulance transport. Rhonda’s dedicated team noticed she was missing appointments for care she needed to get well. They quickly took action, connecting Rhonda to a community resource that could provide the transport she needed to get to her medical appointments. She was able to finish treatment and continue on her road to recovery.
When Rhonda or Maria and Nick think about their experience, the term “concierge approach” probably doesn’t enter their minds. What they do know is when they call their health plan, the person on the other end of the line will be someone — the same someone — who understands and cares for their health and wellbeing. And that’s taking customer service to the next level.