Episode 86 of the Astonishing Healthcare podcast focuses on several pharmacy and health plan member service-related topics with Lisa Ellerhorst (Sr. Director, Customer Care Operations) and Sonia Pettis (Manager, Customer Care Operations)! Lisa and Sonia have been with Judi Health (Capital Rx) since 2020 and have helped Will Tafoya develop our unique contact center model from the ground up. Building on Episode 34 - Customer Care in Healthcare: Setting a Higher Bar, and the questions plan sponsors can ask during the RFP process (Episode 84), we discuss:

• Several of the most frequent reasons plan members call and how those questions are handled, including switching a prescription from retail to mail and vice versa, prior authorizations for GLP-1s, and more.
• How to navigate transitions and focus on quality care (over speed).
• What it takes to maintain a high level of customer satisfaction (99%) while handling a 50% spike in call volume year-over-year.
• The communication strategy used to educate members and help them navigate new offerings effectively.
• The role of AI and how agentic AI can support member care and free up our skilled, PTCB-certified reps to handle more complex issues.
• Future-proofing the service model and preparing for the 2026 welcome season.

Related Content

• Pharmacy Benefits 101: Building an Award-Winning Call Center from Scratch
• Watch: Are Your Prior Authorizations Actually Working?
• AH017 - Pharmacy Benefits 101: Prior Authorization
• How employers can take back control of unnecessary pharmacy spending
• Capital Rx’s Customer Care Team Wins 5 Stevie® Awards for Customer Service

For more information about Capital Rx and this episode, please visit Judi Health - Insights.