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With Unprecedented Challenges, Health Insurance Companies Have New Options to Transform and Save

By Juhi Fadia September 14, 2020

Vasupradha Srinivasan, Senior Analyst at Forrester, and one of the top thought leaders in the contact center technology industry, wrote last week, that contact centers responded to the global health crisis with “an amazing tenacity and resourcefulness in solving for people, technology and business continuity.” In her blog and a related video, she explains that while the learning curve was steep in many cases, including making the shift to cloud-based agents and managers given work@home requirement, operators are now in a position to institutionalize the best practices.

Contact center leaders, she wrote, “reacted with a lot of agility in supporting client requirements despite lockdowns and shelter-in-place protocols. A lot of what has been done so far has been reactionary, however, and akin to short-term impact management,” and found that their current operational blueprints were ineffective. “As a result, they need to comprehensively streamline their operational thinking and solution design.”

She suggests leaders ask, “How do you tailor recruitment, onboarding, training, and ongoing talent management for a hybrid workforce?  How do you strengthen performance management?” She also addresses one of the most serious challenges given the lack of a controlled, premise-based workforce. “Strategies to ensure consistent levels of compliance and security across hybrid workplaces need differentiated thinking,” she said.

You can find her full report here.

We caught up with Ted Haugland, Senior Director at Eventus, a Denver-based contact center and CX strategy, consulting, managed services, and software company that supports Fortune 500 companies. Haugland leads the CX/CRM delivery practice, and when we asked him for his take on what Contact Center companies can do strategically, tactically, immediately and longer-term, he shared his company’s response to COVID-19, and then shared a success story associated with a several-year engagement with one of the largest Blue Cross Blue Shield companies (part of the BCBS network) which has driven more than $15-20 million annually in cost savings while improving CX and positioning the company to drive even more transformation in 2021.

“We’re in the business of helping people help other people,” Haugland said. “When our leadership team witnessed the explosion of cases and absorbed the guidance regarding social distancing and mandates for people to work from home, we kicked into high gear last March, and within days were engaging with clients to help them think through their options, we created systematic, practical, and easy to implement programs for our Managed Services Clients to rapidly adapt to this crisis.”

This included launching contingent workforce with an Agent at Home solution, setting up over 400 FTEs in less than 48 hours. Haugland said Eventus identified six common pain points and addressed each challenge head on.

“Our clients needed to adapt to drastically changing labor requirements, agent location restrictions, deflection and automation given massive surges in inbound calls, and security and compliance issues,” Haugland said. “They had to transform quickly, but with constricted budgets, so a lot of what we helped with was working with their existing vendors or introducing new vendors to avoid budget overruns.”

A large part of Eventus’ business comes from designing and implementing digital transformation initiatives, including the ongoing project for BCBS.

“We started by developing their “Customer Service 2.0 Vision and Strategy” a few years ago, then expanded the collaboration to include Financial Modeling and Business Case Development, Vendor Management Selection and Playbook, Command Center Design, Buildout, and Playbook, Contact Type Insights Analysis, Skills Based Routing Redesign and Flow Analysis, Omni Channel Architecture and Orchestration and Process Optimization,” Haugland explained.

Nearly one in three Americans rely on BCBS companies for access to safe, quality, and affordable healthcare. With over 107 million members in all 50 states, Washington, D.C., and Puerto Rico, 96 percent of hospitals and 95 percent of providers contract with BCBS companies, which is far more than any other insurer.

Haugland said the $15-20 million + in annual savings came from call quality improvements leading to higher First Call Resolution ($6-7 million), Handle Time Reduction ($3-4 million), Intelligent Call and Message Routing ($2-3 million), and Headcount and Associated Overhead Reduction ($5-6 million).

“Every health insurance company in the US and globally are struggling to keep up with demand and changes,” Haugland said. “The good news is there are, in the aggregate, billions of dollars that can be saved with more efficient operations, leveraging automation, software platforms, cloud applications, knowledge management, training, omnichannel orchestration and more. We have the technology and experience today to enable health insurers to come out on top in 2021, after navigating through 2020’s unanticipated complexities. Necessity is the mother of invention, but it is one thing to respond in the moment, and another to take a step back and identify new ways to improve CX across the board, for sustainable gains.”

According to the Insurance Information Institute, total private health insurance direct premiums written were $919.6 billion in 2018, including: $715.6 billion from the health insurance sector. In 2018 there were 5,965 insurance companies in the U.S., and 931 health insurance companies. Insurance carriers across all categories contributed nearly $630 billion, or 2.9 percent, to the nation’s gross domestic product (GDP) in 2019, according to the U.S. Bureau of Economic Analysis.

The ten largest health insurance companies in the U.S. in 2018, based on market share as reported by Beckers Hospital Review were:

1. UnitedHealth Group

Direct written premiums: $156.9 billion

Market share: 14.2 percent

2. Kaiser Foundation

Direct written premiums: $93.2 billion

Market share: 8.5 percent

3. Anthem

Direct written premiums: $67.2 billion

Market share: 6.1 percent

4. Humana

Direct written premiums: $56 billion

Market share: 5.1 percent

5. CVS Health

Direct written premiums: $55.4 billion

Market share: 5.0 percent

6. Health Care Service Corp.

Direct written premiums: $36.9 billion

Market share: 3.4 percent

7. Centene Corp.

Direct written premiums: $36.3 billion

Market share: 3.3 percent

8. Cigna

Direct written premiums: $29.3 billion

Market share: 2.7 percent

9. WellCare Health Plans (Centene)

Direct written premiums: $20.5 billion

Market Share: 1.9 percent

10. Molina Healthcare

Direct written premiums: $18.5 billion

Market share: 1.7 percent

Juhi Fadia is an engineer, analyst, researcher and writer covering advanced and emerging technologies.

Edited by Maurice Nagle
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