Why containment misleads
Containment is easy to raise: make it hard to reach a person. A caller who gives up and hangs up counts as contained. So does a caller who gets a partial answer and calls back tomorrow. A line can post high containment while providers grow more frustrated every week.
What to measure instead
- Resolution: did the caller leave with a correct, complete answer?
- Escalation reasons: when a call went to a person, why? Each reason is either a scope decision or something to fix.
- Repeat calls: did the same provider call back about the same member or claim?
- Quality on every call: review all calls, not a sample, so the numbers describe the whole line.
EHVAhealth reports volume, containment, resolution, and escalation reasons weekly, and QA-scores every call.
Escalation is part of the design
In the Acuity Group deployment, 81% of in-scope calls were handled autonomously and 19% were escalated. Member services and prior authorizations were excluded by design. At CareFactor, questions for an outside PBM or prior authorization vendor are transferred to the right vendor for each group. Those escalations are the line working as intended: the caller reaches the right place, with the context of the conversation attached.
Pricing should not reward cutting callers short
Per-minute pricing creates pressure to end calls quickly. EHVAhealth prices per call, so a thorough answer never costs more than a short one, and nothing in the model rewards rushing a provider off the phone.