Medicare HMO rep solves healthcare mysteries
Leading Preferred Care Partners' Outbound Team, Cristy Alfonso makes sure all 26,000 members get monthly phone calls to meet their healthcare needs.
BY JENNY STALETOVICH - jennystaletovich@bellsouth.net
This article appeared in The Miami Herald on March 17th, 2008
While it may not sound like an enviable job, there are eight stout-hearted souls at Preferred Care Partners whose job it is to listen to -- even encourage -- talk about pain and suffering.
The Medicare HMO created the Outbound Team, as it's cheerfully called, shortly after it was founded about five years ago to distinguish it from the pack.
Its success was almost immediate, said team supervisor Cristy Alfonso.
"We'll call over the holidays, and you have no idea how lonely a time that can be," she said. "So when we give them that phone call, sometimes that's the only phone call they'll get."
The way it works is simple: When someone joins the HMO, they are assigned to a team member. That team member will call to welcome them, Alfonso explained, and then begin keeping track and making monthly calls. They'll call with birthday greetings, offer good cheer at Christmas or Hanukkah, make appointments, follow up on surgery or decipher the latest mailer from Medicare for the company's mostly elderly clientele.
Initiated on a trial basis with just a 1,000 members, the program now includes all 26,000 members, Alfonso said. The calls, she said, are not billed to Medicare but considered a courtesy of the plan.
The staff is assigned a set list of members with the hope they'll develop a relationship with each client, she explained.
"We have members who want us to call the doctor's office to get test results because they want us with them when they get the news," said Alfonso, who has had members ask her to drive them to doctors' appointments. "Anytime they get a bill they don't know how to handle, they call us. They call us about FPL. Any utility. Sometimes they even send us their personal stuff."
The company only assigns staff to the team after the employees have worked at least six months in its call center, which gives supervisors a chance to evaluate them, Alfonso said. Team members must have a great deal of empathy, as well as patience.
"The job itself requires being on the phone all day long," she said. "During a call, they talk to us about all their needs, their personal lives. It really is a relationship."
Calls can last from 10 minutes to 30 minutes, she said, depending on the topic. Staff must be very familiar with how Preferred Care handles claims and what its benefits are, as well as the way Medicare and healthcare delivery works, she said.
"We tell them to think outside the box. If a member is having a tough time with the pharmacy, we call the pharmacy so the member has to do the least amount of work possible," she said.
"You have to be very sensitive, be very patient and be caring, which at the end of the day is what makes the difference, that you do care for the person you're talking to."
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