The challenge

Accuracy is key in the healthcare industry, as lives may depend on the correct patient or medical information being available at the right time to all links in the healthcare chain. A leading health services company needed to improve the accuracy and quality of data queries in the back office to improve the speed and quality of patient-related information sharing.

Data about patients and the treatment they receive is collected and recorded throughout the provision of healthcare. From time to time this data needs to be verified by requesting clarification from health insurers. In order to maintain the accuracy of the data and patient confidentiality, the company needed to ensure that the queries were correctly formulated and securely sent to the right provider. Data inaccuracy is also open to potential legal, regulatory, and financial risks.

The Provider Query (PQ) process involves collating information — including patient charts and a cover letter requesting data clarification — into a "packet" which is then sent to a provider. This is audited to ensure accuracy, and the secure destination for the PQ (fax number) is obtained. A final audit is carried out, and the PQ is sent to the provider who verifies that the query has been received.

The client was not receiving the level of service required from its incumbent vendor and needed a partner capable of meeting the necessary targets for accuracy, quality, and performance.

The solution

TTEC was engaged to support the initial stages in the Provider Query process, producing the PQ packet, first audit, and the initial call to the provider. Following two months of successful operation with 99% accuracy levels, the client entrusted TTEC with all stages of the process, including delivering the PQ and verifying its safe receipt at the correct provider.

TTEC front-loaded staffing levels for the service to ensure capacity was in place as soon as possible on the engagement. TTEC’s hiring process ensured that only the best candidates were put forward for approval by the client. By including ‘gateways’ that identified which staff should be promoted into production following training, TTEC significantly improved the client’s previous outcomes for new hires. The team, located in Lipa, Philippines, has a long tenure with attrition rates significantly lower than industry averages.

In addition, TTEC’s quality and productivity monitoring systems provided visibility to the client of the day-to-day performance of the team. Indeed, some measures of efficiency were previously monitored daily, whereas TTEC provided hourly reporting.

The results

TTEC raised the bar for the client in terms of performance and collaborative ways of working have provided process improvements that have increased productivity. Accuracy and productivity targets were exceeded, with all KPIs at or above required levels, as reported by the TTEC scorecard, which was implemented from day one of the service.

Quality climbed following TTEC’s engagement, rising from 90% previously to between 98% and 99%, with productivity results 40% higher than the previous service provider. Accuracy has been a focus for TTEC from the start and has never dropped below 98% with some stages of the process maintaining 100% accuracy.

As a result, the client raised Quality and Performance requirements following the high levels achieved by TTEC.