Published on Jan 21, 2022
Signify Health (SGFY), a vendor to Medicare Advantage plans that provides in-home risk assessment visits for plan members, operates competitive, high-pressure, sales-like call centers where agents are constantly pushed to beat productivity metrics such as conversion rates, appointments per hour, and bookings, according to a Capitol Forum investigation.
These high pressure, commission-based call campaigns appear to incent some call center agents to engage in deceptive and misleading practices to book visits. The relentless calls can frighten seniors and other vulnerable populations into believing they could lose their health insurance or miss out on extra services and benefits if they decline a visit, according to social media reviews of Signify and previous interviews with current and former employees and clinicians.
A call center representative who worked in a Humana (HUM) Your Home Advantage call center in South Florida that was recently acquired by Signify described an overnight culture change once Signify took over. The new culture, the agent said, embodied an aggressive sales-like mentality, single-mindedly focused on bookings metrics and meeting or exceeding a daily goal of 23 booked appointments. That description is consistent with findings from The Capitol Forum’s previous investigation of the company’s South Dakota call center.
“Humana did not talk about metrics, appointments per hour, productivity, or bookings and Humana did not use commissions-based pay structure like Signify does,” the Florida agent said. They explained that Signify pays agents a $2.50 commission for each booking but once they book over 400 bookings in a month the commission goes up to $5 for each booking retroactive to the first booking of the month. “Under Humana,” they said, “I didn’t get into trouble if people cancelled, and we could opt out people from calls without getting into trouble. Signify is like hard core sales.”
In the course of the investigation, The Capitol Forum also reviewed messages on Signify’s Slack channel as well as company call scripts and other documents that show Signify’s strategies to overcome health plan members’ resistance to booking a visit and its laser focus on booking metrics and data analysis.
Signify declined to comment for this article.
Competitive call center environment. Signify call center agents work remotely and are assigned to a team. Each team has a manager who hosts daily team meetings to review an analysis of the prior day’s performance metrics—conversion rates, bookings, appointments per hour (“APH”), and productivity—and to set goals for the current day.
The managers communicate with their team of agents throughout the day through Slack messages filled with up-to-the-minute performance metrics of individual agents and of the team. These messages, some of which were reviewed by The Capitol Forum, include charts and graphs that depict the performance metrics.
The messages laud agents and teams who hit goals, chide lackluster performance, and push competition between team members and teams. On a typical day, the agent said, the manager sends about four performance updates to their team.
Examples of recent messages, reviewed and lightly edited by The Capitol Forum to protect the anonymity of the source and their team members, read, “Awesome job Team! You were #1 yesterday! 40% Conversion, 5.20 APH and 90% Productivity!! Go Team!!!”
“We missed the appointment goal yesterday—but let’s kill it today!” one message read, which was followed by praise for the top six performers on the team, their names, and their previous day’s appointments per hour (APH) and total bookings.
Yet another message read “Today so far @1RedactedName is ahead with 5.81 APH, 24 Bookings!! @2RedactedName 5.45 APH, 24 Bookings!!…@8RedactedName 4.01 APH, 8 Bookings!!… We have 4 hours left!”
Company did make some changes to script after initial Capitol Forum reports but emphasis is still on booking in-home visits and placing repeated calls despite consumer objections. Signify recently implemented some changes to its call script after publication of The Capitol Forum articles that scrutinized the company’s call center operations and the impact the high-pressure appointment setting has on members, employees, and clinicians.
According to a message sent to agents summarizing the changes and reviewed by The Capitol Forum, agents are now to say the call originates from Signify Health instead of saying they are calling on behalf of the health plan. And, if a member asks if the visit is mandatory or required, “you will need to respond with a ‘no’ and add a rebuttal.”
Signify rebuttals are scripted responses tailored to overcome health plan members’ objections to booking a home risk assessment visit. Signify’s general call script instructs agents to “proceed to rebuttals” when a member objects, and, according to a recent Rebuttal FAQ, agents are expected to stick to the rebuttals as they are written and to rebut a member’s objections two times before terminating a call.
Unless a member specifically requests to be “opted out,” the call will be put back into the dialer queue and the member will be called again, according to the Florida agent. Signify instructs agents to ignore requests stated as “take me off the call list,” the agent explained.
“I was told that we don’t opt them out unless they say the words that they want to be ‘opted out,’” they said, “Some members say they want their name removed from the list but if I opt them out, I could get a coaching for that. We are not supposed to opt them out just because they said they want their name removed from the list.” Agents not in compliance with Signify’s procedures get a “coaching,” which is a review of the company’s expectations, described by the agent as a manager “telling you what you’re doing wrong and what you need fix.”
Because Signify puts uninterested members back into the dialer, each repeat call cycles through the required two rebuttals, according to the General Outbound In-Home Call Script Decliners Callback.
The agent said that to them it felt like they were like harassing seniors. “I can see notes on the account, calls logged every two days and the member is not interested, not interested, not interested. Members say, ‘You have been calling me all week back-to-back and I keep telling you no,’” the agent said.
Former and current agents and clinicians previously interviewed by The Capitol Forum said that members frequently complained about Signify harassing them to book visits and not taking no for an answer.