AH034 - Customer Care in Healthcare: Setting a Higher Bar, with Will Tafoya

Transcript

Lightly edited for clarity.

[00:27] Justin Venneri: Hello and thank you for joining us for this episode of the Astonishing Healthcare podcast. This is Justin Venneri, your host and director of communications at Capital Rx, and today I'm excited to have Will Tafoya with us. Will is our senior vice president of operations. And Will, correct me if I'm wrong, but you've been with Capital Rx since 2019, or was it 2020?

[00:46] Will Tafoya: Yeah, no, I started in 2019. And thanks, Justin. I'm thrilled to be here today.

[00:51] Justin Venneri: Likewise. Really, really looking forward to this. I guess if we can start off having been here for just over five years now and having basically built our call center team out from the ground up, can you give us a little bit about your background and your path to Capital Rx?

[01:04] Will Tafoya: Sure. Absolutely. So, my history started out as a long-distance telephone operator back in the '70s. So, this is back in the day where there were old cord boards, but that's where I was able to build the foundation that I have today when it comes to service and also how to be able to lead within larger contact centers. So over time, that experience transferred with me as I moved into the healthcare industry. I've been in the PBM industry now for -- it's going on 38 years. Started out with National Rx services and then worked at other PBMs over the years as I continue to grow within the healthcare space.

[01:47] Justin Venneri: And so that previous experience coming in here to Capital Rx, I think in general, it would be great to hear your overall perspective on customer care and contact center leadership.

[01:58] Will Tafoya: Yeah, absolutely. So, customer care in any business is key to being able to provide the level of support and services that your end users have a need for. And in our environment, although we are considered a B2B, right, we contract directly with clients and payers to be able to process their claims and provide the benefit, if you will, or administer the benefit for their membership.

At the end of the day, the individuals who have a need for our support and our services are the end users. The members, the patients, the providers, and the pharmacies as well. So, from a customer care perspective, one of the things that I've learned over the years is that customer care has to be knowledgeable of everything pretty much that occurs within an organization in order to be able to effectively serve. So that's why we develop our training, to be able to answer a host of different types of questions and provide a different type of support that is needed to be able to ensure that people can get their medication when they need it, that they are able to lead healthy lives that everybody wants to do throughout time in our environment.  

Justin, I think the thing, the key here is, particularly at Capital Rx, is that we are able -- meaning customer care -- we're able to be able to provide that level of support which definitely shows in our satisfaction ratings. Our customers constantly give us kudos – we call them kudos, or compliments, if you will -- of how we handle their situations. And we hear from our pharmacies and our provider community that we are, meaning Capital Rx, we are one of the PBMs that provides that level of support and service that they need to be able to provide the services that they require.

[03:55] Justin Venneri: It's interesting, because when you think about it from that perspective and the way you've described it, the team on the line has to be able to communicate effectively with all of those different stakeholders to be able to take care of the member at a point in time based on whatever the scenario is they're dealing with. So how do you go about hiring and building out your team, given that that's the job that they're doing every day?

[04:18] Will Tafoya: Yeah, that's a great question. So, when it comes to hiring and staffing, one of the things that I learned, you know, through my prior experiences, is that if you go out and your talent pool that you're tapping into in the environment is individuals who do not have pharmacy experience the level of knowledge is not as great as if you're able to bring certified pharmacy technicians in. And so, I was really blessed when I came to Capital Rx to have a leadership team that allowed me the opportunity to go out and source for and hire these PTCB certified pharmacy technicians from the pharmacies. And the reason why we did that, Justin, is for a number of reasons, right? These individuals come with not only healthcare background and payer experience, but they also come to us with pharmacy experience, which is really the key to being able to manage in a pharmacy benefit management, or PBA type of environment. So, as we stand today in Capital Rx, about 70% to 75% of our agents are PTCB certified pharmacy technicians, and the remainder are individuals who came from other types of healthcare environments. So, when it comes to the experience level and the labor pools that we tap into, it is those two primary pools to be able to bring individuals and that we know can provide the level of support and service that we expect.

[05:57] Justin Venneri: I guess it goes beyond being able to pronounce the drugs correctly, right? And communicate effectively with the provider and the pharmacy if need be. So, it does make sense that the frontline folks would have that certification or that level of experience in retail pharmacy or otherwise, right?

[06:16] Will Tafoya: Yeah. Well, one of the things that you definitely hit on there, Justin, was being able to not, you know, to pronounce the name of the medications appropriately. But in addition to that, to understand what disease state that medication is being prescribed for. Now, to be clear, we are not clinicians. Even as pharmacy technicians, we are not considered clinicians. But at the end of the day, to have that clear line of sight to this medication is typically being prescribed for hypertension, it just gives us the ability to speak more intelligently, diligently, to the therapies.

[06:50] Justin Venneri: Makes sense, and probably have some empathy or understanding of what the member might be going through.

[06:56] Will Tafoya: Absolutely. Yeah, absolutely.

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[06:59] Justin Venneri: And then just curious about what it's like out there now, just hiring wise, the pool you mentioned, given the current economic environment, what are you seeing in terms of available supply of labor, so to speak?

[07:11] Will Tafoya: Great question. One of the things that we have seen as we continue to hire here at Capital Rx is there's not a lack of a labor pool out there or of technicians who are willing to come on board with us. One of the things that we recognize is that in order to be able to be successful, you have, in any company, you have to have a great culture. And, you know, that culture has to be a supportive environment. You know, you've got to be able to educate appropriately and to be able to provide the level of guidance to the individuals. If your culture is such that word of mouth gets out there to other pharmacy technicians in the space, they want to come on board. So, when it comes time for us to go out and start recruiting, we don't have problems with labor pool. We don't have issues of being able to secure the right people that want to come to work at Capital Rx. And so, from that perspective, we're in a very good position. In fact, we're currently in the process of recruiting for our welcome season 2025. And with that, we've been able to already secure the number of people that we need for our first class. That's going to start in late September.

[08:26] Justin Venneri: That's awesome to hear. Okay. And then one question that comes up often, just in general, revolves around virtual versus physical call centers. Do you mind just sharing your thoughts on that?

[08:36] Will Tafoya: Yeah, absolutely. So virtual environments versus brick-and-mortar contact centers, there is a definite difference, right, when it comes to how you lead individuals within a virtual environment versus a brick-and-mortar environment. And one of the things that I've learned, you know, since we are a 100% virtual contact center environment, is that as long as your processes and your expectations of individuals are clear and concise and that we understand that things can happen on occasion and we help people work through those situations, then we're good to go in a virtual environment. As a matter of fact, when you have a brick-and-mortar environment or contact center, there is more risk from a disaster recovery perspective than there is in a virtual environment. You know, something happens, and we, you know, in a specific region of the country that the Internet should go out. We've got backup because we've got people throughout the United States that can provide that level of support without any interruption. So I personally have learned, I will say, being the old dog in the environment, you know, I was always brought up in the brick-and-mortar type of contact center, but having had the opportunity to develop and lead the virtual contact center environment, it is absolutely my preference in today's environment.

[10:04] Justin Venneri: So how does your team work with the clinical team? Is there some overlap? And what are your thoughts on your team in general, working with other departments? How do you escalate issues so that your team can resolve them or make clients aware or the appropriate other teams can be involved and make the clients aware or just resolve the issues for the members?

[10:26] Will Tafoya: So customer care is typically the primary point where anything that's going on within the environment, we learn about it first. And so from that perspective, if we detect that there's an issue, let's just say with claims adjudication, and we're getting calls from pharmacies having trouble processing claims, then, you know, we're able to escalate that very quickly internally to the appropriate work group so that they can start looking into to it and work to get it solved. For, you know, as far as how we partner with other departments, like clinical, the work that we do in customer care versus the work that clinical does has to be completely aligned. So, anything that we're doing from a prior authorization perspective, if we're conducting an intake for prior authorization, our agents have to perform that intake the way that clinical asks us to in order for them to be able to take the baton and finish the process once we submit the intake.  

So, the processes that we develop across all of the departments within the organization have to be aligned to what is required within those work environments to be successful. And we've been able to be very detailed within customer care. We have ongoing partnering meetings with our partners in clinical and finance to make sure that we're doing what we need to be doing and how we're doing it is aligned with what they expect and need. So, from that perspective, I think that we as an organization do very well in comparison to some of the other environments that I've led in historically. One of the things that has not happened at Capital Rx at this point, and there's always a risk for this as we move forward, but I think with everybody that we have in place and all of the level of collaboration that we have, we will not go into those siloed environments that is very prevalent in other organizations that I've been in historically. I think that as long as those lines of communication are open, we're in a very good spot.

[12:30] Justin Venneri: It's actually a good segue to a question I have. I'm just curious about client specific training, such as cultural training for a given client. Can you explain how you go about specific training such as that?

[12:42] Will Tafoya: Absolutely. One of the requirements that I have and expectations that I have of my team, you know, as an organization, we're going through the implementation process of a new client. It doesn't matter if we have other clients that do, that have similar types of businesses or what have you. There are going to be cultural differences within those respective organizations. And so, one of the things that I have built into my team is a process whereby we sit down and have an open, thoughtful conversation with our client that's being onboarded so that we can gain perspective and understand what their culture is. How do you expect us to engage with you? How do you expect us to engage with combined membership, and what is it that you want us to focus on when we're providing that level of service? And we have found that to be an incredible catalyst for the agents to have a clear understanding of who this client is, what they're about, how to service them, and how to be able to provide input and feedback so that we can go back to the clients on some occasions, because some clients come to us and they say, tell us if there's something that's going on that we need to be aware of from a cultural perspective, and we have that ability and that line of communication open to go back to that client and engage them in conversation about some things that we may be hearing through the process of providing the level of support that they have an expectation of, but we're able to help guide them as well.  

At the end of the day, it has to be a collaborative process, and it needs to be able to provide a level of differentiation when it comes to the level of support that we provide. And that is what we do on a daily basis here.

[14:29] Justin Venneri: And I have a couple of tech related questions for you. I'm not going to let you off the hook without asking about AI, but before I get to AI, how does our technology platform, JUDI, with all of the communication that's required and with all of the different stakeholders, can you just share an example or two or your take on the role technology and Judy plays in allowing us to provide the level of support you expect us to provide to our clients?

[14:55] Will Tafoya: JUDI is the catalyst for everything that we do in customer care. It provides our representatives with information about the patients. It provides them information about the family structure that we're servicing. It provides us with information around the medications that they're taking or the claims that are processing any authorizations that may be in place in addition to the benefit information. All of that information collectively is contained and managed within JUDI. And JUDI gives our representatives that one stop shop, right, to be able to do anything and everything that they need to do to be able to provide the level of support that's required for that caller at that point in time.  

So, I will tell you that in my prior lives, we had to navigate multiple systems to be able to answer one question. In my past life, my job just prior to this, it was four systems to answer one question, one simple question. We had to look at four different systems to make sure that the answer we were providing was accurate. So, you know, if you really think about member experience and efficiency, JUDI gives us the ability to provide an outstanding level of service when it comes to member experience and gives us the ability to be much more efficient when it comes to servicing a caller at any given point in time. So from JUDI’s perspective, I love it, and I will tell you that, you know, one of the things that I tell people is I've worked on a number of different platforms in my day, and if I can use JUDI with little to no training, and I mean very little training on being able to use it, anybody can do it, and it's a great thing.

[16:46] Justin Venneri: I hear you on that. Yeah, I recall being in the call center back in college and at a bank and having to log into a bunch of different systems to try and answer a question. And I'm like, this is not fun. It takes more time.

[16:58] Will Tafoya: Absolutely it does. I'll also take it a step further and answer your question. You did ask me this earlier on. I'm sorry I missed it. But you did ask about technology specific to AI, potentially chatbots and things of that nature.

[17:14] Justin Venneri: Yeah. Just like what you've evaluated or what you've looked at, what you’re excited about, where it could help in a contact center would be great to hear.

[17:21] Will Tafoya: Well, had you asked me that question two years ago, my response would not be what it is today. And one of the things that I've told some of my colleagues out in the contact center space, as well as my own team internally, is I've drank the Kool-Aid. I see the benefit with the technology that's out there today to be able to provide the level of support that we need to provide.  

One of the things that we are doing right now as we speak is my team and I went through an exhaustive vetting process, if you will, to evaluate providers in the marketplace that had the ability to help us build and leverage AI to the degree that we can in our environment. And with that process, we did select a vendor to help us build that out internally. We're currently in the process of defining those requirements, and we'll start working internally to make all of the appropriate connections. But AI, historically, you looked at service from the perspective of what can you automate? This was years ago. What types of calls can you automate? And that was called call deflection.

[18:44] Justin Venneri: Okay.

[18:45] Will Tafoya: So, while there are calls that you could automate, relatively easy using standard technology that's out there today or historically, today, the technology is very different, and it creates a different type of experience for the caller. One of the things that we're looking to do is -- and of course, Justin, just to be clear, the use of that technology is dependent on the receptivity of the individual that it's being presented to. So, we've got to be very mindful of that as we're going through the process of building this.  

But, you know, there will be types of contact that our system will offer -- self-service options -- to the caller. It could be retail pharmacy network lookup. It could be understanding that a claim is rejecting at a pharmacy and the pharmacy is calling in for some assistance and it's a simple entry of a submission clarification code or something to that effect. So, those are things that we might be able to automate, provided that the caller or the individual is receptive to that which will free the agents that we have up to be able to focus on those more complex types of issues and concerns that our callers have a need for.  

So, we are dipping our toes into the technological capabilities that are out there and we're going to evaluate it as we continue to build it and measure the level of success and the level of receptivity. And then as we do that, the objective is to not have a negative impact on our customer satisfaction. And so with that being the case, there has to be a number of checkpoints that we have in place as we continue to move forward to make sure that we are doing the right thing and creating the efficiencies that we can while still providing the level of service and support that our clients and our members expect.

[20:40] Justin Venneri: Got it. And Will, thank you so much for taking the time to share your thoughts with us today. I know you're busy and I just have two more questions for you. And that was actually a really nice transition off the cuff. I wanted to ask you about measuring success and, you know, customer satisfaction is really important. Our member NPS is really important to us. I'd love to hear your thoughts on those. And how do you like to measure success? And what are a couple of statistics you could share with us today?

[21:08] Will Tafoya: I think I'm going to turn the table on you, Justin, and I'm going to ask you as a consumer or as a customer, when you have to pick up the phone and call into any business that has a contact center, what's your expectation when it comes to how quickly the agent answers the phone, how they engage with you and so on and so forth?

[21:28] Justin Venneri: Putting me on the spot. Nobody's done this yet. My expectation is that its quote unquote reasonable. And by reasonable I think it's -- nobody likes to yell at an automated system, right? You don't want to have to struggle to get someone on the phone. So, if you feel like you're not getting through, it'd be nice to have somebody pick up and, you know, maybe 20 seconds, plus or minus a little bit, seems reasonable to me. I don't know. You tell me.

[21:54] Will Tafoya: Yeah, absolutely. So that is a general expectation that's out there, right? The thing that I've learned over the years is that customers or members, patients, they have two very basic expectations: serve me and serve me with some form of immediacy.  

So, from that perspective, ASA is an important metric. And it's an important metric for a couple of reasons. Number one, there are industry standards out there that contact centers use. Some businesses have the ability to have an average speed of answer that's as high as a minute before a customer service rep answers a phone. In our environment, from a client expectation perspective and a member expectations perspective, the level of tolerance is about 30 seconds. So, we need to be answering our calls, on average, within about 30 seconds. And we do that. Our objective is to do that 80% of the time or higher. Now, if we're answering our calls within 4 seconds, 100% of the time, that means that we have other opportunities that we need to take a look at. Right? We're probably a little overstaffed. Maybe we need to do some things a little bit differently. But at the end of the day, average speed of answer is an efficiency metric that members have an expectation of the level of service that they receive is average handle time.

[23:21] Justin Venneri: Okay.

[23:21] Will Tafoya: So, in our environment, one of the things that we do not do is I do not put an average handle time expectation on an agent. What I tell an agent is service the caller, service them efficiently and effectively. But if it takes you an hour to resolve their concerns and to be able to have a happy camper when they hang up, then it takes you an hour to do that, and it's all about the averages. So, my agents are keenly aware that while handle time is an important metric from an efficiency perspective for us, we've been able to continually drive that number down without telling agents that you only have 200 seconds to spend with the customer. Our expectation is take care of the customer, take care of them fully, so they don't have to call back about the same issue again. So, my team has been quite masterful at that over the years.

[24:15] Justin Venneri: That's awesome. And so, I'm going to do a little twist here. Instead of the most astonishing thing you've heard or seen, I would love to know what the best piece of advice is that you've received over the years that influences how you lead your team.

[24:28] Will Tafoya: Gosh, that's great. I had a leader many, many years ago that I worship the quicksand she walked on. I really did. She was the best leader that I have ever had. And it was because she taught me how to do the things that I needed to learn. And from that perspective, she used to always tell me, you will have the respect of your team if you are inspiring them to be constant learners and you teach them how to do the things that you expect them to do. You don't just lay an expectation out and then walk away. Right. And so that, to me, has been one of the key pieces of advice, if you will, and alerting that I had from my past, that was the most influential in my years. Of leading people. So, I say thank you Pat because she was awesome. She was an individual that I looked up to and I will share this. There were a number of years even after she retired that I would pick up the phone and call her and say I'm stuck and she was always there for me and so that's something that I will never forget as long as I live.

[25:49] Justin Venneri: Thats amazing and I can see how that would be influential. Will, thank you so much for taking the time to chat with me today so our listeners can hear about our contact center and your philosophy on managing it and the work were doing. So, I look forward to having you back on and I hope you have a great rest of your day.

[26:05] Will Tafoya: Thank you. Pleasure was all mine.

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