Business plan voip

There's not a person walking planet who enjoys getting stuck in a phone queue. For physician practices pressed to verify eligibility, respond to pended claims and resolve billing discrepancies, the experience is especially frustrating--and extremely time-consuming.

Fortunately, today's health plans are all about self-service--for employers who buy them, brokers who sell them, members covered by them and providers who participate in their networks. Any health plan or payer worth its salt designs portals so constituents can handle most changes and questions via online self-service. Then, sometimes the challenge becomes motivating constituents to use those online self-service capabilities.

What if you do logon and do use self-service, but still can't find exactly what you need? BlueCross BlueShield of South Carolina (BCBSSC) has addressed that by augmenting its Web-based capabilities with a recently introduced Voice over Internet Protocol (VoIP) feature called STATchat. The technology lets physician practices connect instantly to a live provider services representative when they are unable to find the information or resolution they need through online self-service.

For provider offices, one of the best parts is that STATchat users move to the head of the queue; they get the next available provider relations representative. Also, because the system prepopulates the provider services rep's desktop with information about the physician office and the covered member for whom they are calling, response from BlueCross is delivered that much faster to the end-user.

Unlike a traditional phone call, where conversation first gets converted into electronic signals and subsequently moves through a network of switches along a circuit, VoIP telephony allows sound to be converted into data packets. These data packets travel through private networks or the Internet, much the way e-mail travels, and then get reconverted back into sound on the receiving end of the call.

Simple as a Headset

While VoIP is complex, using STATchat isn't. It requires little more than a computer headset, according to Practice Manager Samantha Watkins of Colonial Family Practice in Sumter, S.C. The organization employs 53 people, including three board-certified physicians, two physician assistants and a nurse practitioner. A total of 11 support personnel use STATchat for dedicated help with claims, payments, eligibility issues and patients' plan-specific coverages. "If all the insurance companies would model after the BlueCross BlueShield's Web-based tools, physician practices could be much more efficient," says Watkins.

She says a conventional phone call to a live, payer-based provider rep can sometimes keep a staff member on the phone for 30 minutes. Watkins and her team logon to the My Insurance Manager-Provider secured section of BCBSSC's Web site (www.southcarolinablues.com) and use its self service functionality to find their own answers. Now, when more help is required, the employee can click on STATchat and talk live, over the Internet, with a BCBSSC provider services rep. Watkins says the connection is made "usually within 20 or 30 seconds" and is never more than a one-minute wait.

"We can get a question knocked out in two minutes," says Watkins, comparing it to the traditional 20-minute phone call using a conventional 800 line. Colonial's staff might use STATchat between 20 and 30 times a day. "We save hours of staff time each day," says Watkins.

Take the Fast Track

In North Charleston, S.C., the Palmetto Primary Care practice represents a larger practice than Colonial, but a smaller percentage of employees there use STATchat. About 40 doctors and another 200 employees constitute the practice where Tammy Truel is accounts receivable manager, and it is Truel's team that utilizes the Internet voice technology.

"It's the fast track to provider relations," says Truel. Her team uses STATchat only for billing and collections issues, but she reports the same level of efficiency as Watkins. "Time management is the top advantage for us." Efficiency, she says, is critical for a fiscally sound physician practice, and she says STATchat adds to her office's efficiency initiatives.

Brandy Collins is the practice's BlueCross BlueShield coordinator, and she uses STATchat every day. "It saves Brandy at least one hour a day," says Truel. The Palmetto team also reports fast turnaround and resolution on their STATchat questions. "It's the difference between making one call every 10 minutes versus two calls per hour," says Truel.

Adding Value for Valued Users

From a business perspective, BlueCross BlueShield enhanced its Web-based provider tools to add value in the direction it wants to drive business--that of information technology. Assistant Vice President of Health Care Services David Boucher says the organization has about 10,000 providers in network with about 45,000 related registered users, all of whom can use its Web self-service capability with related voice technology.

Among those who logon for self-help, "about 97 percent of the time, users are able to get the information they need without requiring more personal intervention." In the past, those who did require help could send a secure e-mail to BCBSSC and receive human intervention that way.

"As a business, we focus on lower administrative costs to attract customers," says Boucher, "but we also focus on enhanced services to retain providers. Lower unit costs make us more attractive to employers as potential customers, while improved services and efficiency make us more attractive to providers." STATchat, he says, serves both sides of the equation.

The unit cost is substantially lower than a live rep answering an 800 line and can even beat an automated voice-response system--because about 40 percent of the time, system users opt of automated voice-response systems, choosing to speak with a live rep, compared to only 3 percent of the time among those using online self-service, according to Boucher.

STATchat is BCBSSC's private label for Click-to-Talk technology available from CrystalVoice Communications, Santa Barbara, Calif. Boucher says the implementation period was about 18 months, including vendor selection and beta testing. The service debuted in August, so BCBSSC will monitor its progress and success during the coming months. After analyzing its effectiveness with provider offices, BlueCross will consider expanding the technology to include members, brokers and employers through their customized portals.

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