MediKredit, South Africa's first Health electronic Benefit Management (HeBM) company and a provider of online real-time (OLRT) management of healthcare transactions, has implemented HEAT, the service management application from FrontRange Solutions, to track thousands of daily queries from pharmacies, doctors and hospitals.
More than 99% of South Africa's pharmacies are contracted to MediKredit, whose pharmacy call centre agents are required to resolve queries for pharmacists while medical scheme members wait at the pharmacist's counter for medicines to be dispensed. (Separate call centre queues handle calls from doctors and hospitals.)
"If, for example, our online claim system identifies that a co-payment applies for a branded medication, there may be various generic alternatives that the medical scheme would pay for," says MediKredit operations director, Etienne Dreyer.
"Our call centre assists the pharmacist with the pricing rules and the amount the patient's medical scheme would cover for the generic medication.
"Whatever the query, it's crucial that our agents respond accurately and quickly because delays may result in the patient not getting the medication when he or she needs it.
"Also, because we assist pharmacists, doctors and hospitals in a real-time environment - while they are submitting claims - we can see what errors they are making and advise on how to correct them, speeding payments to the providers.
"What HEAT has done for us is streamline the workflow in the call centre and, thereby, enable our agents to answer over 1 000 calls a day, with over 95% answered within 20 seconds. That puts us well ahead of the average of two minutes for other healthcare call centres. All the pharmacist has to do is give our agents the practice number, and HEAT immediately populates the agents' screen with relevant information about the pharmacy and generates a ticket reference number for the pharmacist."
HEAT has also enabled MediKredit to track trends in calls, enabling it to report back to its providers (pharmacies, doctors and hospitals) and its funders (medical schemes and medical scheme administrators) on types and volumes of queries, pinpointing any anomalies.
"In addition, HEAT enables us to identify call centre agent training needs. This allows us to skill them up on a continuous basis and ensure the highest quality information is fed back to our clients," Dreyer says.
HEAT was chosen to replace MediKredit's previous system because of its ability to provide a separate ticket for each call, the options it gave MediKredit for customising the application over time, and its automated escalation functionality - which ensures a smooth handover of information from the call centre to the customer care division when call centre agents are unable to resolve calls within specified service level agreements.
Some initial customisation of HEAT was necessary to accommodate MediKredit's wide range of different categories and workflows. Other adjustments will be made in future because, as Dreyer says, "you identify additional enhancement and customisation options for a system as you work with it. Also, HEAT reports have told us a great deal about the nature of the calls we get, necessitating changes to our operational workflow and processes."
FrontRange Solutions (SA) product manager for Africa, Paul Bornhutter, says HEAT's advanced reporting capabilities do allow companies to adapt their operations and strategies in a progressively more precise way.
"Initially, you use the application to address pain points you know about, but your picture of reality is necessarily skewed because you don't have all the information. As HEAT begins to deliver more relevant customer information, you get an idea of what you're not addressing - either as a problem or an opportunity. Then, as you step up your processes to exploit the new information HEAT has given you, so you see even more opportunities you simply could not have spotted otherwise."
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