Achieving breakthrough member NPS® and CSAT for a global healthcare payer

Overview

A global health insurer wanted to improve member engagement while transitioning to more stringent Centers for Medicare and Medicaid Services (CMS) requirements. By introducing interactive training, new types of data mining, and defect analysis, Sagility improved customer satisfaction (CSAT) and increased the number of members recommending this payer to friends and family.

Business challenge

The client was transitioning to stricter CMS requirements, with accounts monitored more closely with additional audits. Sagility was the preferred, trusted vendor to lead a member satisfaction improvement effort, supporting remediation work with voice support for the client’s Medicare base. The client needed help in troubleshooting key operational and member satisfaction weaknesses.

The solution

Sagility responded from its El Paso, Texas, site by employing a proprietary training methodology for agents. This new, interactive training approach—focused on the senior citizen market and their needs—incorporates sensitivity, empathy, coaching, patience, and accountability. The real-world modules enable agents to experience firsthand the specific conditions of the client’s Medicare members, creating environments for the agents where they are sensory or physically challenged. These activities give agents an understanding of Medicare members and their health profiles—from arthritis to the effects of hearing, vision, or other sensory loss.

Sagility added value to the new customer experience (CX) measurement approach with defect analysis and action planning. The team deployed resources to deep-dive into call details using raw survey response data and applying mutually agreed rules, classifying defect reasons into Sagility errors, and identifying client-controllable issues related to process, technology, or customer limitations. Data mining helped to develop action plans to reduce Sagility-controllable defects and further improve the member experience. Applying advanced text- and speech-mining capabilities to survey responses elicits additional insights and member experience areas.

Results

Through training and data analytics, Sagility improved the client’s Net Promoter Scores® (NPS®) from 8.2 to 8.6 in one year. A broader three-year analysis, however, shows that Sagility actually increased the original 6.47 NPS® score (a passing score is 5.8) by 33% to an all-time high of 8.6.

The CSAT score for the program spiked to 3.8 out of a possible 4. CSAT success is directly attributable to members’ positive feedback in areas of agent courtesy, knowledge, and reduced customer effort.

From an operational perspective, the same Sagility training approach that drove NPS® and CSAT success resulted in a call quality score of 97% (up from 95.33%), helping the client comply with new CMS requirements and significantly reducing CMS complaints—in fact, by up to 51%.

Global locations

USA • India • Philippines • Jamaica • Colombia

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