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Part 2 – Serving workers’ comp patients and payers – what works and why

Yesterday’s post on the problems inherent in outsourcing/offshoring/automating customer service made the case that customer service functions must be handled internally.

Today, we’ll dig into a case study – the lesson being it’s not about your company’s metrics, cost structure, or “efficiency”, it’s ALL about your customer.

MedRisk is a physical medicine management company serving the workers’ comp industry. (MR has been an HSA consulting client for over 15 years) For years, it had the niche almost to itself, focusing its sales and service attention on corporate buyers. Along came Align Networks, a start-up that concentrated on the desk-level user, delivering stellar service to each and every adjuster and case manager.  Align was quite successful, eventually becoming the largest vendor in the PM management space.

A misstep by MedRisk helped Align.  Some years ago, MedRisk chose to outsource key functions, including some aspects of IT, billing, and outbound call center functions including patient scheduling. This did not go well, and the resulting dissatisfaction among desk-level users led some customers to switch from MedRisk to Align.

Confronted with the loss of business, MedRisk got back to basics.  The lesson was apparent; a dramatic change in customer service was critical. That involved a major shift in understanding about the central importance of the desk-level customer, the provider and the patient, and a recognition that those customers required, above all, personalized service.

Service isn’t about a couple codes on a bill, or the timing of a patient visit, or A/R days outstanding.   I spoke with MedRisk COO Michelle Buckman about this.

When we’re talking to a provider about our contract or a bill or treatment, it isn’t about crunching numbers on the issue, it’s about the overall relationship – we need to be the liaison, to understand it isn’t about that specific issue or problem, but the entire relationship. Anyone who calls in here, we need them to feel and know that the person on the end of the phone understands where they are coming from and is there to solve their problem…they weren’t getting that before.

We recruited US-based college grads who wanted careers in health care, looking to help people; we did NOT look for folks with call center experience.  That training isn’t necessarily helpful as it can be tied to ending calls quickly – that’s not what patients want to hear or how they want to be treated, and adjusters may need to have more time.

In fact, some metrics used by call centers are counter-productive; MedRisk found it’s much more important for staff to spend time on the phone to get a feel for what’s happening with the patient, the provider, the adjuster, to make sure questions are fully answered, issues identified and understood, then to get off that call and on to the next one. Buckman:

Our people are Patient Advocates. That is their title; their job is not just about setting an appointment, but guiding [patients] through the work comp process. Many [patients] don’t know anything about work comp or functional capacity evaluations, so we educate them…every number is a person who couldn’t pick up their child, or go to work; there is a person, a story, a need behind each one of these calls…

[The Patient Advocate] handles each patient end to end, monitors duration and type of care, in contact with the provider regarding progress. If there’s an issue, the Advocate engages one of MedRisk’s US-based PTs to evaluate the issue, [depending on the issue, resolution may include] perhaps peer to peer to discuss utilization and guidelines…if there is an issue, we get all stakeholders together to figure out how to get things back on track.

Getting there took a huge amount of effort and focus and disciplined execution to bring all customer-facing functions back inside the company. In turn, that required major investment in IT, because those customer service folks had to have the information and the tools necessary to quickly diagnose issues, answer questions, and resolve problems.

In-house IT was beyond necessary, it was mission-critical.  Again, Michelle Buckman:

customers want customized workflows, when IT was outsourced, the [outsourcing vendor’s] folks didn’t get our industry or what we wanted to deliver to customers…One size doesn’t fit all, different customers have different protocols – [I] can walk down the hall and talk to developers [so we can] build what that customer needs…doing it internally is phenomenal, developers understand this is not just coding but actually what they are trying to accomplish [with that coding]

MedRisk now numbers 125 Patient Advocates among its 700+ employees. That’s more than common metrics deem necessary, but “over-staffing” means customers aren’t waiting in a queue, stuck on hold, or rushed off the phone. The company pays those Advocates above call center wages, and invests in them. It hires locally, delegates a lot of responsibility to Advocates, looks to Advocates for system, IT, process, and service improvement ideas, and measures “tangible intangibles”, five core values that make up 35% of performance assessment. Treating staff well does produce some striking metrics;

  • the 4 key staff that began the transition from outsource to internalized customer service are still at MedRisk
  • 78% of patients are scheduled within 4 hours of initial notice
  • calls are answered in less than 10 seconds
  • the “regrettable turnover rate” for the Patient Advocate staff, which is simply losing the people MedRisk wanted to keep – is 9 percent (compared to industry averages far more than twice that)
  • average case duration – the length of time a patient is in PT – declined 15 percent after the Customer Advocacy Program went into effect.

More to the point, investor people, is the financial result.  MedRisk’s revenues and profitability have increased dramatically over the last few years, that growth driven in large part by very happy desk-level customers.

To be fair, this growth has been helped of late by their major competitor’s decision to outsource and offshore key customer-facing functions.

What does this mean for you?

For vendors, serving your customers like your cable company does isn’t a recipe for success.

For payers, do you want your front-line staff to deal with a cable company service model? 


3 thoughts on “Part 2 – Serving workers’ comp patients and payers – what works and why”

  1. …client or customer centric companies always, succeed. If only that was the universal approach we would have amazing levels of competition and progress in our industry.

  2. Perhaps Medrisk’s growth was also helped by their competitor(s) steering patients toward cheaper clinics, offering inducements, and acting in an anti-competitive fashion???

  3. One example:
    Just the other day when speaking with Broadspire, a Crawford company, I was directed to a rep who was not aware that Wisconsin was a state in the United States. Very difficult to navigate to a solution when your employees do not have the knowledge or skillset needed to satisfy the consumer.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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