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Blue Cross Blue Shield of Massachusetts FCR Measurement Best Practice

SQM Group Helped Blue Cross Blue Shield of Massachusetts Achieve:

Consecutive Years Certified  World Class First Call Resolution Performers
First Call Resolution Measurement Best Practice Award Winner

FCR Measurement Best Practice

Again, our view is that FCR is more than just a metric; FCR is a proven company-wide operating philosophy for our people, processes, and technology operating practices for cost-effectively delivering a great member experience. In the last five years, our call center has consistently been in the first quartile or at the world-class level for FCR and member satisfaction performance compared to SQM’s FCR/CX benchmarking over 500 leading North American call centers. We have achieved world-class FCR performance in our call center because we have incorporated the “FCR operating philosophy” into our core people, processes, and technology operating practices to ensure that we are focused on delivering FCR. Our FCR operating philosophy helps us deliver on our corporate promise always to put our members first.

For the last five years (2016 to 2020), our Retail Sales and Retention call center has been certified by SQM as a world-class FCR performing call center. The criteria to be certified as a world-class FCR performing call center is your FCR rate must be 80% or greater. Of the 500 call centers SQM measures, only 5% of their clients perform at the world-class FCR/CX standard of 80%.

First Call Resolution Measurement

Company Description

Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We are committed to working with others in a spirit of shared responsibility to make quality health care affordable. Consistent with our corporate promise to always put our members first, we are rated among the nation’s best health plans for member satisfaction and quality.

Blue Cross Blue Shield Massachusetts

Opportunity Statement

At Blue Cross Blue Shield of Massachusetts, our frontline Member Service employees put a premium on excellent service. We take pride in delivering our corporate promise to put our members first. Part of this promise is to ensure First Call Resolution (FCR) wherever possible. How do we do this? By integrating FCR into every aspect of our business, every day, across the whole company, involving everyone from the CEO down. Put differently; we treat FCR as more than just a metric; FCR is an operating philosophy at all levels within the organization.

FCR Governance Structure

To help encourage company-wide awareness, we created an FCR governance structure to ensure the member (e.g., customer) experience is always top of mind for all company areas. Infusing the voice of the member (VoM) into everyone’s work by playing back calls regularly during meetings at all levels demonstrates the impact of FCR on those who aren’t normally involved in member experience. It also shows company employees why FCR is essential. Feedback from other areas has been tremendous because they didn’t realize how their jobs impact members downstream.

One leader says, “The calls we listened to made me appreciate the challenges our members and agents experience in trying to navigate the healthcare system and how important it is to have the right tools and resources available to both.”

The FCR governance structure looks like this:

FCR Governance

External – Measurement of First Call Resolution

We use SQM for the external (e.g., VoM) measurement of FCR and have done so since 2008. For the external post-call survey measurement method calculation, a survey is conducted within one business day of a member’s call. FCR rate is based on two survey questions. A call is considered FCR if a customer answers ‘yes’ to the question, “Was your call resolved?”, and in ‘one call’ to the question, “How many calls did you make to resolve your call? Here’s a look at our current member experience surveying suite and how those surveys are used:

  • Phone Surveying Method – to benchmark FCR across all BCBS Plans. The sample size quota is 2,000 per year and is conducted daily. The BCBS Association requires this FCR data.
  • Phone Surveying Method – to track FCR across all business units within our organization. The sample size quota is 1,000 per month and is conducted daily. The FCR data is used for trending and process improvement opportunities.
  • IVR (Outbound) Surveying Method – to track agent call resolution and member satisfaction (Msat). The sample size quota is 4 surveys per agent per month, and surveying is conducted daily. The data is used for holding agents accountable for call resolution and Msat performance, coaching, and recognition purposes, along with mid-year and annual performance reviews.
  • Action Alerts – are based on survey results. An action alert occurs when a member rates their call center experience as dissatisfied and the call as unresolved. Action Alerts surveys are always a top priority. We ask our leaders to handle these surveys as soon as possible, provide feedback and coaching to the agent, and follow up with the member if necessary.
  • Agent Recognition – based on survey results, we recognize all agents certified by SQM as World Class FCR/MX Performers each year. Every month, we recognize agents who have achieved 100% call resolution and use members’ direct ‘Agent Verbatim Feedback’ to highlight great member experiences to keep the agents motivated.

Internal – Measurement of First Call Resolution

We use our internal data within our customer relationship management (CRM) tool to measure the closure rate of documented calls by our frontline agents for added perspective. While this measure does not consider the member perception of the interaction, it does allow us to gauge performance, identify trends, and provide account-specific feedback. We can also compare and contrast our FCR results from SQM’s external measurement of FCR to see where there are areas of alignment and if there are any performance gaps.

Speech Analytics is another way to monitor repeat calls and call category types to ensure we validate fluctuations and address call drivers’ trends.
In addition, we consistently report on call types and volumes through our CRM and Workforce Management systems to ensure we have enough staffing for seasonality changes in volume. This reporting also allows us to identify account-specific trends and issues that arise.

  • From our SQM surveys, we learned there was an opportunity to enhance our internal processes and decrease the turnaround time of subscribers submit claims.
  • We used our internal call data from Speech Analytics, our CRM, and our claims area turnaround time to get the full scope of the issue and validate call patterns for subscribers to submit claims.
  • A business case was developed through a collaborative effort across departments to expedite processing in our claims department for subscribers to submit claims.
  • Previously, some of these subscribers submit claims that required members to submit attachments. Through the new streamlined process, an attestation model was developed, decreasing the need to review lengthy claim attachments and make the submission process easier for members.
  • As a result of the improvements made, we experienced a reduction in repeat calls while providing a better member experience.

SQM Group Call Center Best Practice Awards

SQM Awards Received

Best Practices: FCR Measurement: 2020
Call Center World Class FCR Certification: 2016, 2017, 2018, 2019, 2020