Case study: Healthcare

Driving down dissatisfaction for leading payer

Client background

The client is a leading payer in the US subject to evaluation against the Centers for Medicare and Medicaid Services’ (CMS) five-star quality rating system.

Business challenge

The client required assistance in meeting its Star Ratings targets. We established a service recovery process for a health plan client to ensure preventive countermeasures for potential Complaints to Medicare (CTM), member dissatisfaction, and unnecessary repeat calls. Our solution directly influenced our client’s Star Ratings.

The solution

Identify potential CTMs

We designed a recognition mechanism to identify potential CTMs, dissatisfaction, and repeat calls. We made service recovery calls to identify interactions that were recognized as potential CTMs and to reduce cases.

Leverage speech analytics

We leveraged speech analytics and built lexicon libraries and queries that recognize the CTM triggers. We layered these with the top call drivers to create a target sampling plan.

Improve the team

Agent monitoring and coaching ensured further success in reducing dissatisfaction.

Results

In line with advocating CMS Star Ratings, our customized service quality plan supported the identification of potential CTM and grievance, appeals, and determination (GAD) cases through targeted quality audits. Pre-to post-implementation, our wins for the client included:

0 CTM zeroed-out CTM identified after Service Recovery actions (observed after 30-60 days, post-implementation)

8%reduction in repeat calls and dissatisfied customers

Global locations

USA • India • Philippines • Jamaica • Colombia

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