Humana Perfect Service Journey

Jenni Suda

Director, Service Operations

November 11 & 18, 2010

Organizational Chart

2

The Power of Perfect Service

� Delivering unexpected value and quality

� Providing guidance on complex needs

� Going beyond satisfaction

� Creating engagement with those we serve

Building a proactive culture

What Perfect Service means to us

3

� Building a proactive culture

� Making what’s most important to those we

serve, most important to us

An aspirational journey that evolves as the needs of our organization, partners

and members change

Defining our Journey

Know me as a partner

Anticipate needs

Personalized

Proactive

4

Executing the basics

Accurate

Reliable

Courteous

Easy to use

Transaction driven

No client segmentation

Efficiency vs. experience drivenWho are we? Why care?

Perfect Service in action: Proactive Guidance Unit

Enrollment confirmationAlert subscribers that we have processed their paper

enrollment request: 90% indicate call was valuable

Dental waiting periodsReach out to new members to remind them of their waiting periods:

Non participating provider guidanceContact members planning to see a non-participating provider to educate

them on options: 80% take action and switch to a participating provider

5

Over 1 million proactive contacts with consumers

Pharmacy prior authorizationsNotify members their prior authorization is approved within 48 hours

of approval: eliminated 73% of prior authorization calls

Reach out to new members to remind them of their waiting periods:

reduced 67% of waiting period calls and 97% of waiting period appeals

Employer registration go greenEncourage employers to register on the web and opt in to electronic recurring

payment: increased the volume of employers who opted in by over 1500

Service Support

�Proactive

� Out/Inbound

Correspondence

� 1st time Caller Indicator

� Demographics Update

Indicator

� Recent Transactions

6

�Guidance Alerts

� Personal Nurse

� Go Green

�Personalized

� Personal Notes Section

� Happy Birthday/Newborn

indicators

� Clinical Referral

Programs

Dedicated Service Unit

� Experienced Customer Care Representatives,

average of 12 years with customer service

� Trained on intuitive customer service approach

� “Pods" utilized within dedicated structure to support

groups within BHCG

� 100% of all calls recorded“Thank you for your excellent customer service over the

“I have never had such good service. I was very impressed with the time she took to give clear explanations of her network benefits.”

Secured E mail feedback

7

� 100% of all calls recorded

� BHCG Executive Director monitors monthly service

metrics and performs call auditing

� 90% member satisfaction with Customer Care

Representative

customer service over the

phone this morning. It is refreshing to have a pleasant experience regarding a customer service issue. Keep up the great work at Humana!”

Phone call into supervisor

BHCG Dedicated Unit DifferentiatorsNavigating the Health Care System

� Adoptee program

� Emulate and educate members on web tools

� Non PAR Guidance

� Support all foreign languages, including Spanish Interactive Voice Response System (IVR)

8

� Trained on key indicators to refer members to Health Resources such a Personal Nurse

� Personalized and proactive service

� Pre-Pay Claim audits / Peer to Peer Reviews

� Voice of the Customer (VOC)

� *Please rate how satisfied you are with your overall experience with Humana

� *Please rate how satisfied you are with the way our Representative handled your call today

� *Please rate how courteous your Representative was today

� *Please rate how knowledgeable your Representative was today

2 Million / Month 30,000/ Month

Customer

Calls

Customers are

offered the survey

Customers are then

assisted by

Customer Care

Representatives

Customer

completes

survey and

results are

compiled

When the call ends,

A survey is sent to

The Customer

**VOC Member Survey Questions

Voice of the Customer (VOC) Survey Process

9

*Based on a 1 – 5 scale

**Data not always available at the group level – depends on call volume which drives completed survey volume

Representative was today

� On a scale of 0 to 10, with 0 being very unlikely and 10 being very likely, how likely are you to recommend Humana to a friend or family member?

� Do you feel that the issue you called about has been resolved?

If a caller answers, “No,” or “Too Soon to Tell,” to question 6, the caller will have the option to leave a Wav File message to provide additional feedback

Survey Results

available near

real time

to CCS via

Agent VOC

scorecard

Service

Improvement

Teams act on

analytic based

priorities

Service Improvements

Process, Tools

Data &

Observations

Associate

Feedback

Data Analysts

review

resolution data

to identify

trends and

priorities

Overall Satisfaction with Humana

10

Satisfaction with Humana Representative

11

Courtesy of Humana Representative

12

Knowledge of Humana Representative

13

Has Issue Been Resolved

14

15