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This chapter is from the book

Case in Point: HMO Customer Service

The management team of a large HMO has set its financial goal as dramatically increasing profitability over the next five years. However, because the local population will grow by only 3 percent to 4 percent annually, profitability will come from current HMO members, with only a modest increase in new ones. The managers know that a significant segment of their membership will be "aging into" Medicare eligibility over the next five years. Typically the HMO experiences high turnover at that point because it isn't perceived as a strong Medicare administrator.

To reach its financial goals, the HMO knows that keeping its existing members as they become Medicare eligible is crucial. From a process perspective, management needs to overhaul its customer service (CS) operation, which becomes a strategic process in this new business plan. Currently, customer service representatives (CSRs) have an incentive to close calls quickly—the more they close, the more capacity the department can handle. However, this creates a problem with respect to potential Medicare members, so the CSRs have developed the habit of passing all Medicare-related calls to another department. Because of the incentives, this makes the customer service department look good on paper because the calls are closed by the CSRs as soon as the handoff is made. The CSRs may even feel that their customers are satisfied because they are being transferred quickly to the right person.

From a customer perspective, this creates frustration because it increases the number of times the customer is transferred before his issue is resolved. From an organizational perspective, the calls are transferred to someone who is actually not responsible for servicing existing Medicare members but whose job is to research competitors' Medicare offerings and develop competitive plans. Answering these calls prevents her from hitting her objectives.

To address these challenges, management has set new objectives and metrics as shown in Table 1.2. Management expects to see customer satisfaction increase as members approach Medicare eligibility. This is a leading indicator that should allow it to predict any increase in members who convert to Medicare (a lagging indicator).

Table 1.2 New Customer Service Objectives and Metrics


Transfers Key Performance

Closed Calls with Minimum

Indicator Transferred Calls by Issue

  • Retention of members as they "age into" Medicare eligibility

  • Percent of members who convert to Medicare

  • Customer satisfaction by age group

tion increase as members approach Medicare eligibility. This is a leading indicator that should allow it to predict any increase in members who convert to Medicare (a lagging indicator).

How can content services contribute to these business objectives? First, a true content services specialist is going to see immediately that the incentive structure for CSRs is unnecessarily burdening the Medicare plan specialist. The knowledge necessary to address Medicare issues is bottlenecking with the specialist largely because of the incentives that deter CSRs from gaining the knowledge to answer Medicare questions directly. The solution involves changing this plan (which is not the CS team's job) to get content to the CSRs and to train them to use it (which is the CS team's job) so they don't have to transfer the Medicare calls.

To affect the first objective—closing calls with a minimum number of transfers—the best place to begin looking is not the CSRs but the plan specialist:

  • Are there common questions and answers that can be easily captured and made available to CSRs?

  • Have these been documented?

  • How do you roll out new plan information to the organization?

  • What are you not achieving because of the support calls you have to answer?

Then you can begin looking at the content available to the CSRs:

  • What information pertaining to Medicare is available?

  • What training have CSRs received on Medicare?

  • Can a CSR quickly identify a caller who is a Medicare member?

  • Can a CSR quickly identify a caller who will soon be eligible for Medicare?

  • Can a CSR easily send promotional information to a caller who will soon be eligible for Medicare?

  • Can a CSR quickly articulate the advantages of their company's Medicare programs?

By helping the CSRs and the plan specialist address these issues, the content services team helps achieve the objective of minimizing transfers and therefore of increasing customer satisfaction in the target age group. To achieve the objective of retaining members, the team can take additional steps with the marketing and sales departments as well as the Medicare plan specialist. It can help develop the content necessary to reach out to members proactively, and it can help the specialist—who has to develop competitive plans—identify the necessary competitive intelligence.

Customer service performance can be determined through a direct customer survey (see Table 1.3) that measures level of satisfaction within the key age group. As shown, content services can help companies realize strategic, measurable business objectives. At issue is not managing content for its own sake. Figuring out how it is produced and delivered serves the real interests of the business. If the content services team is effective, the results will be seen in improvement of the KPIs.

Table 1.3 Customer Service Survey

Survey Items


I have a good understanding of the benefits of the Medicare plan.






I believe the Medicare plan is superior to the other plans available on the market.






Customer service has helped me understand the benefits of staying with this HMO for my Medicare plan.






1 = strongly disagree; 2 = disagree; 3 = no strong opinion; 4 = agree; 5 = strongly agree

Content services can and should be a key operational component of business strategy. All businesses are, to greater and lesser degrees, content producers. Some organizations, such as universities, libraries, news organizations, and research institutions, are all about the production, storage, and circulation of content. Others, such as manufacturers and service companies, are also about content but as a means of achieving other ends. In all organizations, content is vitally important to the achievement of objectives.

The focus of this chapter was to articulate the content services–strategic business objective link. To this end, we argued the following:

  • Content is a vital part of all organizations largely because it creates important relationships with employees, partners, customers, investors, and so forth.

  • Managing content must be within the context of business objectives.

  • The benefits of managing content as a part of strategy can and should be measurable, as long as the business objectives are measurable.

In the next chapter, we will look at poor content management practices. Such practices are rife within organizations and lead to a condition we call infosmog—the inability to take effective actions and make informed decisions because content is not effectively managed. All of this is in preparation for Part Two, in which we discuss practical approaches to identifying and managing your company's most important content.

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