BlueCross BlueShield of Tennessee Member Experience Journey

1. BlueCross BlueShield of Tennessee Member Experience Journey Presented by: Jane Havens, Director of Operations, BlueCross BlueShield of Tennessee

2. Overview of The Member Experience Journey BlueAccess Redesign Implemented Simplified Language Development Development Begins for Member Dashboard Launch Helpline Pilot Cross-Functional Workgroup Formed: Result, Member Experience Excellence (MEE) Ulysses Learning Pilot Insite Journey Begins January 2010 March 2010 August 2010 September 2010 October 2010 December 2010 February 2011 November 2011 Enterprise Implementation of Member Dashboard Formation of MEE Sub-Workgroups Funding approved for MEE initiatives Member Feedback Initiatives Begin

3. Member Experience Journey Details Simplified Navigation – Redesign of Self-Service Member Portal • Personalized claim, benefit, health and wellness information at the member level • Provider directory, treatment cost estimator, drug cost information so that members can make informed healthcare decisions.

4. Member Experience Journey Details Simplified Navigation – Monthly Claim Statements • Comprehensive detailed statement of claims payment for all members covered under policy. • Individual Explanation of Benefits (EOB) can be viewed and printed on self-service member portal (BlueAccess) • Monthly Claim Statements are mailed in four cycles based on the Subscriber ID number. Name Street Address City, State, Zip

5. Member Experience Journey Details Simplified Navigation – Simplified Language • An initiative to replace technical terminology, acronyms and jargon with common words that are easily understandable by BlueCross BlueShield of Tennessee members. • Simplified terminology is used across all written and verbal communication channels.

6. Member Experience Journey Details Contact Center Job Analysis • Reengineer the call center experience to provide a 360 degree level of support to both the member and the BCBST representative. • Pilot implementation of Helpline that is made up of Helpline leaders who interact with Consumer Advisors (CA) via Instant Messaging and Desktop Sharing. Microsoft Office Communicator technology allows for a seamless line of communication and support for the CA and ultimately the member • Helpline Database allows the Helpline leaders to document each question asked by subject/category including his/her response to the Consumer Advisor. The database is used for real time reporting and proactive interventions and training. • Partnership with Ulysses Learning to implement the eight step Customer Service Call Strategy in each operations area enterprise wide.

7. Member Experience Journey Details Ulysses Learning Goals • Provide a call strategy that improves First Call Resolution (FCR) and reduces escalated calls • Show empathy to members dealing with stressful issues • Become adult advisors to our members by understanding their needs and offering solutions that help them • Improve ability to defuse emotion and take control of conversations with members • Enhance questioning (and listening) abilities to get to the heart of the member issue • Provide the necessary behavioral skills to create more member-focused conversations and increased member satisfaction • Positively impact service measures and ensure long-term sustainability through more effective skills training and coaching • Provide a coaching process focused on sustainable behavioral change

8. Member Experience Journey Details Ulysses Learning Eight Step Call Strategy Eight Step Call Strategy Call Strategy Example 1 ‘I understand how these statements can sometimes be confusing Mrs. Jones.’ ‘I would be happy to pull up your claim and see what has happened.’ ‘For security purposes and to access your policy, may I ask you a few questions? Acknowledge the Customers Issue/Emotion Gain Control with an “I Can” statement Transition to probing 2 3 Probe with situation, issue and/or validation questions ‘What was the date of service and the provider’s name? … ‘That was 3/25/11 for Dr. Smith, is that correct?’ 4 ‘This claim has actually pended because we need to update your coordination of benefit information. I can update this information over the phone or if now is not a good time you may update this information online.’ ‘Which would you prefer?’ ‘I have updated your coordination of benefits information and sent this claim for adjustment. The adjustment will appear on your next Monthly Claims Statement. ‘Mrs. Jones, is there anything else that I can help you with today?’ 5 Provide a solution with options Gain Acceptance Recap and provide next steps Ask, “Is there anything else I can help you with today?” 6 7 8

9. Member Experience Journey Details Member Dashboard • Developed the capability to have a comprehensive profile of each member throughout his/her lifecycle with BCBST. • Consolidated multiple applications into a dashboard that will display related information in a single location.

10. Member Experience Journey Details Member Centric Decision Management (MCDM) Empowering our business through an end-to-end outreach engine and governance process • Automate • Synchronize • Prioritize • Monitor • Integrate • Augment • Optimize • Improve • Jim, Age 60 • Coronary Artery Disease • Post Heart Attack • Discharge Care Plan in Place • Compliant with All Meds • BMI < 25 • Empty Nester • Engage with a Letter or Email • Janice, Age 54 • Diabetes • Frequent Usage of the ER • Non-Compliant with Meds • BMI > 35 • No Established PCP Relationship • Married with Family • Engage with a Disease Mgmt Nurse Cost Ability to Impact • Joe, Age 20 • Smoker • BMI < 20 • Young Single • Engage with a Life Style • Coach or • Recommend an on-line • Health Module • Jill, Age 36 • BMI < 20 • Potential High Risk Pregnancy • Young Married • Engage with a Case Manager • Send high risk pregnancy • management tips

11. Member Experience Journey Details Member Feedback • Feedback Aggregation • Feedback can occur across a variety of contact points and mediums (i.e. Survey, Grievance, Complaint, Letter, E-mail, etc.) • Goal of Member Feedback initiative is to – identify, aggregate and format data into one central repository for analysis and reporting • First Call Resolution – IVR Survey • Automate and enhance the collection of member feedback related to FCR and member satisfaction with Consumer Advisors.  • Members will be surveyed about their experiences with BCBST Customer Service within 48 hours of their interaction using an Interactive Voice Response (IVR) solution.  • This initiative will help us to manage and monitor FCR results.

12. The ccSigma Journey • Followed the training with weekly mentoring sessions that take the techniques & tools learned in training and applies them to an improvement project to achieve the following: • Ensure the techniques are practiced before atrophy sets in • Re-enforce the methodology to ensure “real” root causes are identified and improvement action is precise • Change the culture to integrate into day-to-day activities • Began the journey with a 1-week comprehensive assessment of processes, metrics, & performance with the objective to: • Learn the unique characteristics of the department • Compare / benchmark processes & performance to other plans, other insurance carriers, and other industries • Prioritize & quantify improvement initiatives • Used ccSigma Yellow & Green Belt training as the means to transfer the skills to use data & process to deliver significant performance improvements: • Material is designed specifically for human operations environments (contact center, claims, etc) so participants can immediately apply to their job • Facilitated by an operational expert/executive with extensive experience

13. ccAssessment Overview • Assessment Objectives • Approach • Assess the following contact center dimensions to identify improvement opportunities • Key Performance Indicators (KPIs) • Customer transaction processes (call, fax, email) • Operational support processes (Workforce Management, Performance Management, Quality Monitoring, Knowledge Management, Recruiting, Training) • Customer routing and servicing strategy (multiple groups completing similar tasks, rework related to customer transfers/hand-offs) • Technology processes (IVR, ACD, Call Routing, Agent Desktop Applications, Call Recording, Workforce Management, Reporting) • Compare against industry best practices (Insite has completed over 510 assessments across various industries) • Learn the unique characteristics about BCBST so that the ccSigma training can be further customized • 4.5 intense days across 3 locations • Onsite in Chattanooga • Remote for Memphis & Nashville • Collected and analyzed both performance data and operational processes utilizing Insite’sccSigma tools/techniques and benchmarks • 3 tracks facilitated 34 sessions across MBA • U500 • Major Accounts • Corporate Accounts • TVA • FEP • TRH • Individual Products • Group 44 • Single Point of Contact

14. Testimonials Ulysses Learning – Service Mentor “I truly enjoyed this training class and do feel that because of this training my job will be more relaxed and beneficial to our customers. I have learned how to allow the member to let me know what they want before I start asking them a lot of questions, this does calm the member down and let them know they are being heard. … I feel this more customer friendly way of taking calls would be beneficial throughout all of BCBST departments of customer service!!” – Consumer Advisor “Luke was so informative, he helped me resolve so much. I was so impressed with how he handled the call. I just wanted someone to know he was on top of his game!” – Satisfied BCBST Member “Jennifer was more than helpful, she did more than she had to do. I called in frustrated and ended not so frustrated!” – Satisfied BCBST Member “I just had the best customer service experience ever, not just with insurance companies, but with any call center ever. Jymea called the providers for me and got the issue resolved. I just wanted to let you know she took care of me and I appreciate it!” – Satisfied BCBST Member Insite Managed Solutions – ccSigma “The Insite Sigma program has opened a new door for me. I have enjoyed learning the DMAIC process as well as having the tools to show the numbers that back up the new processes that we need to implement. Insite has given BCBST the tools to analyze any obstacles that may come our way.” – Angela Turner, BCBST Product Coordinator • “Insite and the ccSigma program has changed the way I think about everyday life here at BCBST. It has taught me that the processes we have in place may not be the best processes or due to product and technology changes may not work anymore. I’ve learned that it is always best to re-look at things instead of just assuming that the information I am looking at is the best for everyone. I can also say that now that I have trained the MBA on my workgroup’s pilots that the hard facts go a long way instead of the “gut feeling” approach. …” – Misty Givens, BCBST Product Coordinator