Web Service Improves New Mexico's Largest Health Plan

June 1, 2005

One plan puts Web power to work and reduces call center volume

In late 1999, we at Presbyterian Health Plan made a commitment to boost our business use of the Internet. Our executive team began outlining a Web strategy to strengthen operations, improve service to customers, and increase our overall efficiency. We began assessing two main issues.

On the tactical side, we needed to reduce the volume of incoming phone calls handled by our staff. This manual process was both time-consuming and expensive, with many employees answering simple questions via the phone that our customers and providers could more efficiently answer themselves if they had Internet access to our data systems. We also considered a more strategic issue-how could the Internet help assure the long-term health and viability of the company? Ultimately, we believed that the Internet would dramatically change the way we ran our business, and in doing so, help us to stay competitive in the future.

After conducting research on Web platforms to support our health plan, we chose the HealthWeb® Suite from The TriZetto Group. Using this system, we could create intuitive Web-based services for providers, members and employers. HealthWeb addressed our Web requirements and could interface with our existing administrative system. 

We chose to have the company host our Web platform to reduce our upfront capital investment, ensure predictable pricing and guarantee service levels with around-the-clock technical support.  With the hosted option, our implementation was also faster than if we had installed the system ourselves and run it in-house.

For the implementation, we first targeted provider-inquiry capabilities, which were the easiest to bring online. We then tackled more complex online functionality for employers, including enrollment updates and adding or changing dependent coverage for members. Importantly, we also added online transactions for members, who now have the ability to change primary care providers, update addresses and request ID cards via Presbyterian’s Web site. In 2003, we also enhanced functionality for providers, including requests for medical and pharmacy authorizations. 

The number of online inquiries via HealthWeb has grown rapidly.  Before the system implementation, 74.2% of physician inquiries that could have been handled via the Web were made via person-to-person phone calls to Presbyterian.  By June 2002, that figure had decreased to 36.7%, and today it has fallen to 6.7%.

In all, Presbyterian reduced its total call volume from providers by two-thirds, or about 20,000 calls per month.  The reduction in phone calls has saved Presbyterian roughly 750 hours each month in staff time, with further savings expected. Through consistent use of Presbyterian’s Web site and the HealthWeb technology, one of our large provider groups has eliminated 75% of its telephone calls to us.

Because of the reduction in inbound calls, we can now redeploy call-center resources, using them more efficiently.  Employees who previously handled only inbound calls now spend time placing proactive calls to new members, addressing more complicated questions and ensuring, for example, that members have selected a primary care physician. This is customer care at its best.

With 4,000 registered users to date, HealthWeb is central to our successful e-business strategy. Its ease of use was a major factor in the wide-spread adoption of online services by our customers and other constituents. Our 68 % reduction in calls can be directly related to the information now available to providers online through this Web technology.

HealthWeb has allowed our organization to improve customer service and at the same time significantly reduce the volume of phone calls from providers, employers and members. The decreased call volume has contributed to a positive return on our technology investment. It has also enabled resources to be shifted from reactive to proactive customer service. With the help of TriZetto technology and the company’s knowledgeable staff, we were able to become operational on our Web system quickly. Plus, because of their support, we could focus our efforts on promoting the adoption of Pres Online, the brand for Presbyterian’s new Web-based services.

As healthcare continues to evolve and change, we believe we have the right technology in place to continue to compete in a notoriously challenging industry.

Dr. Scrase is a practicing Internist and Geriatrician and president of Presbyterian Health Plan, the largest health plan in New Mexico.