Great Customer Service a Good Goal for Health Plans

A startup health plan draws its customer service approach from the Ritz-Carlton and L.L Bean. The call center answers by the third ring, and reps have authority and information to fix problems.

"Get closer than ever to your customers. So close that you tell them what they need well before they realize it themselves."—Steve Jobs

Consumers have emerged as the key players in a range of healthcare reform initiatives. Newly empowered individuals are widely viewed as a driving force for change, with federal regulators banking on informed patients to push for value in their dealings with healthcare providers and payers.

Successful health plans have seen the rise of the consumer on the horizon.

After J.D. Power and Associates released its consumer satisfaction ratings for health plans last month, I called a half dozen of the top performers in regions across the country to learn about their approaches. Overwhelmingly, they focus on good member experiences. These businesses "get it."

"The recognition Tufts Health Plan received from J.D. Power reflects our efforts to enhance the member experience, collaborate with providers, and support each other," James Roosevelt Jr., Tufts Health Plan's CEO, told me in an email. "This type of direct focus on taking care of the member is what makes the difference—it's the way we do business. This recognition is a terrific accomplishment."

Now a startup health plan is drawing from other industries and organizations known for outstanding customer service. James La Rosa, MD, is chief customer experience officer for North Shore-LIJ CareConnect Insurance Co., the insurance division of Great Neck, New York-based North Shore-LIJ Health System. He told me recently that customer service was at the heart of the health system's business plan when the decision was made about four years ago to create an in-house health plan.

"We would be able to offer customer service that knocked their socks off," La Rosa says of the vision for NSLIJ CareConnect. The health plan's call center was modeled on customer service programs at the Ritz-Carlton Hotel Company and outdoors retail giant L.L. Bean Inc. "We've had customers drop off chocolates and cakes at our site."

By answering all customer calls within the third ring, NSLIJ CareConnect has a caller drop rate under 2%, he says. For most health plan customers, "the major issue they have is with the phone tree. How is the member going to feel during a call? That's the Ritz model."

NSLIJ CareConnect has followed L.L. Bean's lead in providing robust customer service at the call center level. "They have authority to rectify issues," La Rosa said of L.L. Bean call center employees.

At the NSLIJ CareConnect call center, employees have dual computer screens in front of them: one with a patient's health plan information, the other with medical history information. And the call center has easy access to a medical officer to help answer patients' questions quickly.

The focus on customer service is paying off not only for the health plan but also for the entire health system, La Rosa says. NSLIJ CareConnect has low complaint rates and patients do not call back "four or five times for the same issue." Health plan employees can quickly connect patients to emergency medical services and other healthcare providers in the NSLIJ Health System. "We're integrating all the services we offer through the health system through the health plan," he says.

La Rosa, who practiced as a physician for 20 years, has seen the value of good customer service in medicine and business.

"We treated our patients like gold. Your appointment would be on time," he says of his practice. "It was very difficult to do. We answered every patient's call. If we made a mistake, we made a mistake. It was a very open model.…You look at successful companies; they're the ones with good customer service. You look at Amazon, and their customer service is amazing."

In the evolving healthcare marketplace, it behooves health plans to cater to their customers. Otherwise, their competitors will be doing the catering.