By Judd Bagley

The American healthcare industry enjoyed an infamously privileged status for a long time.

For decades, it didn't much matter how consumers felt about their member experience. Competition was minimal because employers made most health care plan decision. Complaints rarely made it beyond one's immediate social circle – which was itself generally comprised of people equally unhappy with their own member experiences.

In 2010, two enormous but unrelated factors combined to bring change.

First, the Affordable Care Act (ACA) created a health insurance marketplace, which allowed members to shop for healthcare insurers in much the same way that they shopped for other imposing-but-accountable service providers, like banks. In addition, the ACA also mandated that measures of member satisfaction be gathered and used as a basis for Medicare and Medicaid reimbursement.

Second, the rapid emergence of social technologies allowed members to express their sentiments far beyond their acquaintances. In some cases, members' good and bad experiences became universally accessible in a digital culture where online peer reviews carry as much weight as personal recommendations and are often trusted more than one's own physician.

Payers responded by focusing on improving member experience, which often meant contracting with specialized business process outsourcers (BPOs) able to provide high quality member support economically. This move is a large part of what's driving healthcare BPO's robust 6.3% compound annual growth rate, according to an industry report.

In 2020, a third factor emerged which upended the status quo yet again: Covid-19.

Among other things, Covid-19 swiftly eliminated any efficiency benefits realized by centralized member services, which had long been foundational to the BPO playbook as it ensured efficiency, quality control, and data security compliance. Yet over the course of a week in mid-March, centralized contact centers shut down globally, with only those BPOs able to quickly and effectively send member support agents home to work left standing.

Several months have passed since those trying times, and while still early, it's clear that Covid-19 has had a surprisingly positive impact on outsourced member support.

For example, in 2019, the average licensed agent supporting Medicare subscribers had about 18 months' experience at BPOs like Everise. In 2020, the average licensed agent has almost six years' experience to draw from. In the complex world of Medicare sales and support, it's difficult to overstate how great an impact an additional 4.5 years under one's belt can have on agent effectiveness and member satisfaction.

The difference is one of geography. Until recently, recruitment was limited to areas in and around those cities with brick and mortar call centers. Today, BPOs can recruit from the majority of US states, which permits greater selectivity. And because agents value the option to work remotely, that benefit can be factored into new-hires' rates.

The benefits of breaking free of geography extend beyond finding more experienced licensed agents.

In 2019, which now feels like the old days, new agent training took place in large, tightly packed rooms filled with people living within a drivable radius of their facility. These classes were led by individuals of great competence but possibly more expert in some areas than others.

The pandemic ended that approach and forced the BPO industry to re-imagine agent training.

Today, remote collaboration technologies permit surprisingly high levels of fluid interactivity between students and trainers, and as well as among fellow students. Pop quizzes and other focusing activities keep trainees on their toes and progressing, with the added benefit of alerting trainers to potential problems early on. Subject matter experts residing anywhere in an organization can own and teach what they know best.

All this produces better prepared agents that achieve greater efficiency, sooner.

The move to home-based work also helped the industry solve the long-standing seasonality problem affecting both in-house and outsourced healthcare member support programs.

Enrollment periods produce temporary demands on support that are many times higher than that experienced the rest of the year. Historically, large groups of agents were trained and put to work for just those few months, then either released, which is terribly inefficient, or allowed to sit idle – which is terribly uneconomical. BPOs with diverse client lists can now cross-train and cyclically reassign healthcare agents to, say, financial services leading up to tax season, and from there to tourism accounts, with their large numbers of summer travelers, and from there back to open enrollment.

The outcome is greater access to the higher quality work that full-time, tenured agents produce in ever greater abundance over time.

One of the thornier issues confronting home-based customer support has been data security, and the lack of an on-site supervisor to enforce rules safeguarding personal health information (PHI). Here, too, technology steps in. Remote worker security applications are reaching the market which use video to monitor agent activity and hide PHI or other sensitive data if it detects a phone camera aimed at the screen or the presence of an unauthorized individual within sight of the monitor. Some of these solutions use facial recognition technology to assess emotional wellbeing and assign each agent a score on a sort of contentment index, alerting supervisors if the score drops in concerning ways.

In our experience, agent happiness is directly correlated with lower attrition and higher efficiency, and these measures are directly correlated with more satisfied members.

Centralization is a configuration as fragile as it is efficient, being subject to the kinds of meteorological, epidemiological or cultural disruptions that are increasing in frequency and tend to influence some geographies more severely than others.

We've also found that a widely dispersed agent footprint with increasing emphasis on more rural populations yields resilience and adaptive capacity in uncertain times.

Finally, the pandemic has caused the ranks of both newly unemployed and self-employed to swell, producing a notable – but most likely temporary – demand for high touch open enrollment support. To contain costs, this surge in demand has prompted new interest in the development of scalable AI-powered tools able to accurately handle basic requests and back office functions for a fraction of the time and expense of a live agent.

New investments in artificial intelligence will pay off nicely now and in years to come, both in reduced costs and higher satisfaction on the parts of younger members who value the option of serving themselves over dealing with real people.

2010 and 2020 will go down as years marked by events sending seismic waves through the healthcare industry and the member experience landscape. In each case, BPOs' survival demanded a meaningful and well-executed response. In the early days of the pandemic, it might have seemed entirely unlikely that anything positive would be produced by the chaos it induced. And yet, thanks to technology and freedom from former constraints, member support agents are now more experienced, efficient, happier, reliable, intelligent and occasionally artificially intelligent than ever before. The impact on member sentiment is significant and serves to build enduring loyalty in spite of extreme circumstances.

About the author: Judd Bagley is vice president of marketing at Everise.