• No results found

Creating a Streamlined Service Center for California s Health Subsidy Programs

N/A
N/A
Protected

Academic year: 2021

Share "Creating a Streamlined Service Center for California s Health Subsidy Programs"

Copied!
9
0
0

Loading.... (view fulltext now)

Full text

(1)

 Creating  a  Streamlined  Service  Center  for    

California’s  Health  Subsidy  Programs  

Prepared  by  John  Connolly  

December  10,  2012    

The  California  Health  Benefit  Exchange,  in  coordination  with  the  Department  of  Health  Care  Services   (DHCS),  will  launch  a  new  service  center  in  2014  to  provide  individuals  and  families  with  a  unified   eligibility  determination  and  enrollment  portal.  This  service  center  will  allow  consumers  to  learn  about   their  coverage  options  and  simultaneously  apply  for  subsidized  Exchange  and  Medi-­‐Cal  coverage.  The   Affordable  Care  Act  created  the  impetus  for  this  effort  by  requiring  that  states  create  a  streamlined,   “no-­‐wrong-­‐door,”  eligibility  application  for  all  health  subsidy  programs,  including  Exchange  coverage,   Medicaid  (known  as  Medi-­‐Cal  in  California),  and  CHIP.  California  has  chosen  to  meet  this  requirement  by   establishing  a  service  center  with  the  capability  to  either  enroll  individuals  in  the  Exchange  or  directly   transfer  individuals,  when  appropriate,  to  county  service  centers  that  will  enroll  them  in  Medi-­‐Cal.  This   arrangement  preserves  the  counties’  role  of  enrolling  eligible  individuals  in  Medi-­‐Cal.  

 

The  ability  of  the  service  center  and  county  enrollment  call  centers  to  knowledgeably  answer  potential   applicants’  questions  and  to  handle  enrollment  in  a  timely  and  accurate  fashion  will  be  a  critical   component  of  creating  a  “first-­‐class”  consumer  experience.  In  fact,  the  ACA  stipulates  that  this   streamlined  application  process  must  not  require  applicants  to  provide  unnecessary  or  duplicative   information.  The  effectiveness  with  which  the  Exchange  service  center  and  the  counties’  enrollment   lines  are  able  to  coordinate  transfers  of  calls  and  applicants’  data  will  also  be  a  critical  element  of   creating  a  unified  enrollment  portal  envisioned  in  the  ACA.  Moreover,  these  capabilities  will  be  

particularly  important  with  the  large  expected  volume  of  new  enrollees  in  2014.  To  ensure  the  success   of  this  vital  element  of  California’s  subsidized  health  programs  under  health  reform,  this  brief  outlines   some  important  considerations  and  potential  performance  metrics  for  the  Exchange,  DHCS,  and  the   counties  to  include  in  their  ongoing  coordination,  improvement,  and  implementation  efforts  related  to   their  service  centers.    

 

ITUP  recommends  the  following  performance  measures  and  goals:    

• ITUP  supports  Covered  California’s  goal  of  answering  80%  of  incoming  calls  within  20-­‐30   seconds,  with  no  busy  signals.  

 

• Customers  should  not  wait  on  hold  for  assistance  for  more  than  five  minutes.  ITUP  recommends   a  performance  goal  of  two  minutes  or  less  for  hold  times  because  this  aspect  of  performance   will  likely  be  one  of  the  most  essential  to  successfully  processing  eligibility  and  enrollment   casework.    

 

• ITUP  additionally  recommends  that  service  centers  provide  a  service  center  call-­‐back  option,   similar  to  that  of  the  California  Department  of  Motor  Vehicles  (DMV)  customer  service  center.   With  this  feature,  an  automated  response  unit  would  prompt  customers  with  the  option  to  have   the  DMV  return  his  or  her  call  when  wait  times  exceed  five  minutes.  

 

• ITUP  recommends  a  goal  of  no  more  two  automated  response  prompts  per  call  for  directing   consumers  to  the  appropriate  destination.  Further,  units  should  always  serve  to  reduce  wait   times  and  direct  calls  to  the  customer  service  representative  that  is  most  skilled  in  handling  a   particular  application  or  question.  

(2)

• Enrollment  calls  may  be  justifiably  lengthy,  while  representatives  may  respond  to  caller  requests   for  information  quite  quickly.  Call  centers  should  utilize  post-­‐call  surveys  and  maintain  audio   recordings  to  identify  what  questions  (required  application  information,  benefits  of  different   plans,  provider  networks,  etc.)  or  issues  (multi-­‐program  households  or  changes  in  household   financial  circumstances,  for  example)  consumers  present  in  calls  of  varying  lengths.  This   information  would  allow  service  centers  to  identify  different  types  of  calls  and  assess  the   productivity  of  the  time  that  consumers  spend  on  the  phone,  given  the  varying  requests  that   they  present.  

 

• We  support  Covered  California’s  goal  of  having  a  call  abandonment  rate  of  less  than  3%.    

• Regarding  call  center  representatives  level  of  knowledge  and  helpfulness,  representatives   should  be  able  to  definitively  answer  questions  about  the  information  that  callers  must  provide   when  submitting  an  application.  Representatives  should  also  have  the  ability  to  answer  specific   questions  about  the  benefits  that  their  respective  plans  offer,  and  Exchange  representatives   should  be  able  to  explain  the  different  cost-­‐sharing  structures  and  overall  costs  of  its  plans.   Representatives  should  also  be  able  to  report  whether  or  not  specific  providers  are  in  plans’   networks,  and  whether  or  not  plans  cover  specific  prescription  drugs.  Additionally,  they  should   be  able  to  provide  customers  with  comparative  quality  ratings  for  offered  health  plans  (e.g.   wait-­‐times  for  appointments,  use  of  electronic  health  records,  and  other  established  best   practices  and  outcomes  measures  commonly  used  to  asses  quality).    

• Representatives  should  always  be  responsive  to  consumers’  concerns  and  questions  while   maintaining  respectful,  patient,  and  courteous  tone.  A  post-­‐call  survey  would  be  an  effective   way  to  allow  consumers  to  indicate  their  level  of  satisfaction  with  representatives’  performance.    

• ITUP  supports  Covered  California’s  goal  of  having  80%  of  calls  that  its  service  center  transfers  to   the  counties  answered  within  20  to  30  seconds.  

 

• Reducing  the  eligibility  determination  error  rate  to  as  near  zero  as  possible  should  be  the  service   centers’  unified  goal  and  the  metric  of  success  for  CalHEERS.    

 

• ITUP  urges  formal,  ongoing  quality  assessments  by  independent  quality  review  organizations  to   evaluate  the  service  centers’  ability  to  handle  the  enlarged  volume  of  casework.  Evaluators  from   these  organizations  could  pose  as  callers  and  present  a  range  of  questions  and  applications  to   service  center  representatives,  and  the  evaluators  would  provide  performance  reports  regarding   the  metrics  outlined  above.  

 

The  remainder  of  the  brief  describes  the  current  infrastructure  and  knowledge  about  service  center   performance  in  California,  and  the  following  discussion  presents  the  main  considerations  that  motivate   these  recommendations  for  service  centers  as  health  reform  implementation  continues.  

 

Building  on  Existing  Infrastructure    

The  Exchange  and  DHCS  will  be  coordinating  the  statewide  Exchange  service  center  with  the  county   welfare  offices’  service  centers.  Therefore,  building  a  coordinated  eligibility  gateway  that  is  as  seamless   as  possible  by  January  2014  will  require  a  great  deal  of  advance  planning  and  process  improvement  for  

(3)

all  entities  involved.  County  service  centers’  current  ability  to  enroll  new  Medi-­‐Cal  applicants  is  limited   by  existing  program  rules  that  require  more  detailed  paperwork  for  determining  eligibility,  a  process   that  must  often  be  handled  in  person  as  a  result.  Yet,  the  process  for  determining  eligibility  for  many   groups  eligible  for  the  program  will  be  more  manageable  for  county  service  centers  with  the  new,   simplified  rules  under  the  ACA  that  base  eligibility  on  Modified  Adjusted  Gross  Income  (MAGI).1  

 

Some  counties  also  currently  struggle  with  wait  times  and  call  abandonment,  which  are  issues  that  will   be  of  great  concern  with  the  increase  in  applicants  in  2014.  The  County  Welfare  Directors  Association  in   coordination  with  the  California  Health  Benefit  Exchange  released  a  survey  of  human  resource  

operations  that  examined  service  center  performance,  and  the  results  indicate  some  clear  areas  in   which  certain  counties  will  need  to  improve.  While  call  abandonment  rates  were  quite  low  in  some   counties,  the  more  populous  counties  with  larger  populations  applying  for  Medi-­‐Cal  and  other   assistance  programs  had  rates  that  were  as  high  as  nearly  18%.  Similar  trends  appeared  in  the  data   about  average  call  wait  times.2  To  prepare  for  an  influx  of  applicants  for  health  subsidy  programs  in  

2014,  counties  will  need  to  hire  and  train  additional  staff,  in  addition  to  increasing  operating  hours  and   overall  staff  capability  to  process  applications  and  handle  enrollment  over  the  phone.  

 

A  recent  Health  Access  study  of  DHCS,  Major  Risk  Medical  Insurance  Board  (MRMIB),  California  

Department  of  Insurance  (CDI),  and  Department  of  Managed  Health  Care  (DMHC)  customer  service  lines   revealed  some  additional  concerns  about  wait  times  and  their  capacity  to  answer  questions.  The  data   from  the  study  indicate  that  the  average  caller  to  the  DHCS  service  line  encounters  more  than  two   automated  response  prompts,  44%  of  calls  reach  no  customer  service  representative,  and  the  average   wait  time  to  speak  with  a  customer  service  representative  was  nearly  8  minutes.3  Each  of  the  other  

three  agencies  received  higher  scores  on  these  measures,  with  8%  -­‐  16%  of  calls  not  reaching  a  customer   service  representatives  and  wait  times  slightly  below  2.5  minutes.  These  results  should  prompt  some   quality  improvement  effort  in  preparation  for  the  Medi-­‐Cal  expansion  in  2014,  especially  given  the  much   larger  call  volumes  that  may  result  from  the  Medi-­‐Cal  eligibility  expansion  that  begins  on  January  1,   2014.  Although  counties  and  the  Exchange  service  centers  will  handle  the  majority  of  customer  service,   enrollment,  and  eligibility  questions,  the  DHCS  customer  service  line  will  also  likely  field  a  large  volume   of  inquiries,  particularly  with  the  considerable  changes  to  California’s  health  subsidy  programs  under   ACA  implementation.  

 

Toward  a  First-­‐Class  Consumer  Call  Experience    

Building  a  seamless  eligibility  portal  that  can  accommodate  the  large  number  of  new  applicants  and   process  applications  accurately  and  efficiently  in  2014  and  beyond  will  require  substantial  effort  and   resources  from  all  entities  involved.  The  effort  to  build  and  improve  service  center  capabilities  at  both   the  state  and  county  levels  should  be  informed  by  quality  and  performance  measures  for  customer   assistance,  eligibility  determination,  and  enrollment  functions.  The  Exchange  service  center,  DHCS,  and  

1  County  Welfare  Directors  Association.  2012.  California  County  Customer  Service  Operations:  Survey  of  Current   Human  Service  Operations.  Available  at:  

http://www.healthexchange.ca.gov/BoardMeetings/Documents/July_19_2012/County%20Customer%20Service% 20Centers%20Survey%20Report%20Final%20Draft.pdf    

2  Ibid.  

3  Health  Access  Foundation.  2012.  Putting  All  the  Ingredients  Together:  A  Recipe  for  Getting  Ready  for  Health   Reform,  Base  on  Results  from  a  Consumer  Assistance  Assessment  Survey  of  California  State  Health  Agencies.   Available  at:  http://www.health-­‐access.org/files/advocating/HAF.ConsumerAssistanceSurvey.pdf  

(4)

county  service  centers  will  need  to  take  consumers’  experiences  into  account  as  they  test  and  

implement  the  new  service  center  infrastructure  and  technology.  Several  aspects  of  a  call  to  the  service   centers  will  be  critical  to  their  ability  to  process  the  large  number  of  enrollment  applications  and  to   assist  individuals  simply  seeking  information  about  the  state’s  new  and  modified  health  programs.  The   remainder  of  this  brief  discusses  some  key  metrics  to  consider  and  performance  goals  that  might  serve   to  inform  service  centers’  operations  as  they  meet  these  considerable  challenges.  

 

Time  to  first  connection    

The  amount  of  time  a  consumer  waits  on  the  phone  is  the  first  dimension  of  quality  that  a  consumer   experiences  when  calling  to  apply  for  a  program,  or  to  ask  a  question  and  gather  information.  The   Exchange  staff  have  set  a  goal  of  answering  80%  of  incoming  calls  within  20-­‐30  seconds,  with  no  busy   signals.4  The  recent  Health  Access  Foundation  study  showed  that  DHCS  calls  were  answered  within  8.6  

seconds,  on  average.  Reaching  this  goal  seems  both  central  to  keeping  consumers  on  the  line,  and  very   attainable  with  call  center  technology.  Yet,  this  measure  would  have  little  effect  on  the  overall  time  that   consumers  would  have  to  commit  to  a  service  center  call  if  an  automated  answering  service  places  them   on  hold  for  an  inconveniently,  or  unreasonably,  great  amount  of  time.  As  a  result,  other  quality  metrics   may  be  both  more  challenging  and  greater  priorities  for  service  center  planning.    

 

Wait  time  for  a  live  customer  service  representative    

One  of  the  most  important  elements  of  customer  satisfaction,  and  very  likely  a  determinant  of  call   abandonment  rates,  is  how  long  a  consumer  has  to  wait  to  speak  with  a  live  customer  service  

representative.  Individuals  have  many  demands  on  their  time,  and  the  efficiency  with  which  the  service   center  can  handle  calls  will  be  critical.  Counties  report  widely  varying  wait  times  to  speak  with  customer   service  representatives  at  their  service  centers.5  With  the  increase  in  applicants  in  2014,  the  Exchange,  

DHCS,  and  counties  may  face  a  considerable  challenge  in  maintaining  wait-­‐times  brief  enough  to  keep   consumers  on  phone  lines,  and  to  achieve  a  high  level  of  user  satisfaction.  While  the  increased  volume   may  be  a  challenge  for  service  centers,  asking  customers  to  wait  on  hold  for  more  than  five  minutes  for   assistance  seems  likely  to  have  a  considerable  negative  impact  on  both  the  call  abandonment  rate  and   the  customer  satisfaction  level.  Furthermore,  we  recommend  that  the  service  centers  set  a  performance   goal  of  two  minutes  or  less  for  hold  times  because  this  aspect  of  call  center  performance  will  likely  be   one  of  the  most  essential  to  its  ability  to  successfully  process  eligibility  and  enrollment  casework.      

Adding  a  service  center  call-­‐back  option,  similar  to  that  of  the  California  Department  of  Motor  Vehicles   (DMV)  customer  service  center,  offers  another  option  to  prevent  customers  from  spending  unnecessary   time  on  hold.  With  this  feature,  an  automated  response  unit  prompts  customers  with  the  option  to  have   the  DMV  return  his  or  her  call  when  wait  times  exceed  five  minutes.6  Since  a  state  department  already  

4  California  Health  Benefit  Exchange.  2012.  Service  Center  Status  Update.  Available  at:  

http://www.healthexchange.ca.gov/BoardMeetings/Documents/September%2018,%202012/X_CHBE_ServiceCent erBoardPresentation_9-­‐18-­‐12.pdf  

5  County  Welfare  Directors  Association.  2012.  California  County  Customer  Service  Operations:  Survey  of  Current   Human  Service  Operations.  Available  at:  

http://www.healthexchange.ca.gov/BoardMeetings/Documents/July_19_2012/County%20Customer%20Service% 20Centers%20Survey%20Report%20Final%20Draft.pdf  

6  California  Deparment  of  Motor  Vehicles.  Available  at:  

(5)

uses  this  technology,  Exchange  and  DHCS  officials  should  discuss  this  option  with  their  counterparts  at   the  DMV.    

 

Number  of  automated  response  units,  calls  when  no  live  customer  service  representative  reached    

The  number  of  automated  response  units  encountered  and  a  caller’s  ability  to  reach  a  live  customer   service  representative  are  key  elements  of  the  consumer  experience  for  service  centers  to  track.   Automated  response  units  are  important  tools  that  can  boost  call  center  efficiency  by  directing  calls   appropriately,  prioritizing  consumers’  needs,  and  more  quickly  answering  less  complex  consumer   questions.  However,  they  can  also  be  sources  of  caller  frustration  when  individuals  are  directed   inappropriately,  placed  in  multiple  lengthy  customer  service  queues,  or  ultimately  never  reach  a  live   customer  service  representative  as  a  result.    

 

The  Health  Access  study  found  that  calls  to  DHCS,  MRMIB,  CDI,  and  DMHC  averaged  between  1.2  and   2.6  automated  response  units.  Two  automated  response  prompts  seems  to  be  a  reasonable  number  for   directing  calls  to  the  appropriate  destination.  However,  more  than  three  transfers  to  different  

automated  response  units  seems  excessive,  and  units  should  always  serve  to  reduce  wait  times  and   direct  calls  to  the  customer  service  representative  that  is  most  skilled  in  handling  a  particular  application   or  question.    

 

One  indispensible  characteristic  of  automated  call  units  for  consumers  should  be  the  option  to  transfer   from  automated  response  units  to  a  live  customer  service  representative  at  any  time.  The  share  of  calls   that  never  reached  a  customer  service  representative  varied  from  8%  for  CDI  to  44%  for  DHCS.  Counties   and  the  Exchange  should  strive  to  prevent  this  outcome  entirely  if  a  consumer  wishes  to  reach  a  live   representative.  Since  many  programs  will  be  new  and  issues  related  to  insurance  and  health  subsidy   programs  can  be  quite  technical  and  complex,  every  consumer  should  be  able  to  speak  with  and  receive   assistance  from  a  customer  service  representative  if  s/he  desires.  Moreover,  call  centers  should  

continually  assess  the  level  of  helpfulness  and  effectiveness  of  automated  response  units  for  consumers.    

Overall  call  length      

The  total  amount  of  time  that  consumers  spend  on  the  phone  will  also  be  an  important  piece  of  the   service  center  performance.  This  factor  depends  on  many  of  the  other  metrics  discussed  in  this  brief,   including  wait  times  to  speak  to  a  customer  service  representative,  number  of  transfers  among   automated  response  units,  as  well  as  the  level  of  knowledge,  efficiency,  and  accuracy  of  customer   service  representatives.  Therefore,  overall  call  length  may  be  a  secondary  performance  measure   because  it  is  the  product  of  several  others,  but  it  is  a  useful  broad  metric  of  consumer  experience  when   assessed  in  the  context  of  different  customers’  needs.  For  example,  one  consumer  may  call  with  a   relatively  simple  question  that  an  automated  response  unit  can  answer  with  2  minutes  of  total  call  time;   a  consumer  may  call  with  a  few  complex  coverage  questions  that  could  require  around  15  minutes;  and   an  enrollment  call  could  span  30  minutes  or  more.  In  fact,  a  customer  may  call  to  enroll  a  family  

member  in  Medi-­‐Cal  coverage  and  herself  in  Exchange  coverage—a  process  that  would  potentially   involve  representatives  from  two  different  service  centers.  While  calls  may  be  justifiably  lengthy,  call   centers  should  utilize  post-­‐call  surveys  and  maintain  audio  recordings  to  identify  what  questions   (required  application  information,  benefits  of  different  plans,  provider  networks,  etc.)  or  issues  (multi-­‐ program  households  or  changes  in  household  financial  circumstances,  for  example)  consumers  present   in  calls  of  varying  lengths.  This  information  would  allow  service  centers  to  identify  these  different  types  

(6)

of  calls  and  to  assess  the  productivity  of  the  time  that  consumers  spend  on  the  phone,  given  the  varying   requests  that  they  present.  

 

Call  abandonment  rates    

Call  abandonment  provides  a  key  measure  of  the  customer  experience  because  it  is  usually  the  result  of   a  consumer  waiting  on  hold,  being  transferred,  or  struggling  with  an  automated  response  unit  to  an   extent  that  s/he  feels  is  unsatisfactory  and  hangs  up.  The  Exchange  has  set  a  goal  of  having  an   abandonment  rate  of  less  than  or  equal  to  3%.7  This  metric  will  also  very  likely  depend  on  the  metrics  

discussed  above,  including  the  wait  time  for  a  customer  service  representative,  number  of  automated   response  units,  and  overall  call  length.  Therefore,  it  will  be  important  to  focus  on  the  above  

performance  measures  to  meet  the  performance  goal  the  Exchange  has  set  with  regard  to  call   abandonment.  

 

Knowledge  and  helpfulness  of  customer  service  representatives    

The  level  of  mastery  and  helpfulness  of  customer  service  representatives  will  be  one  of  the  most  crucial   elements  of  performance  for  the  Exchange  and  DHCS  to  monitor.  While  these  aspects  of  customer   service  are  more  qualitative  than  some  others,  they  can  greatly  influence  the  consumer’s  overall   evaluation  of  a  call.  As  a  result,  the  Exchange,  DHCS,  and  counties  should  both  measure  these  elements   of  their  service  center  representatives’  performance  and  uphold  standards  of  quality.    

 

With  regard  to  the  level  and  types  of  knowledge  that  call  center  representatives  should  have,  they  ought   to  be  able  to  definitively  answer  questions  about  the  information  that  callers  must  provide  when  

submitting  an  application.  Moreover,  Medi-­‐Cal  and  Exchange  service  center  representatives  should  have   the  ability  to  answer  specific  questions  about  the  benefits  that  their  respective  plans  offer,  and  

Exchange  representatives  should  be  able  to  explain  the  different  cost-­‐sharing  structures  and  overall   costs  of  its  various  plans.  Representatives  should  also  be  able  to  tell  consumers  whether  or  not  specific   providers  are  in  plans’  networks,  and  whether  or  not  plans  cover  specific  prescription  drugs.  

Additionally,  they  should  be  able  to  provide  customers  with  comparative  quality  ratings  for  offered   health  plans  (e.g.  wait-­‐times  for  appointments,  use  of  electronic  health  records,  and  other  established   best  practices  and  outcomes  measures  commonly  used  to  assess  quality).    

 

To  ensure  a  first-­‐class  consumer  experience,  training  about  the  new  programs,  specific  eligibility  and   enrollment  protocols,  and  the  specific  plans  offered  should  be  a  very  highly  prioritized  activity  for   service  centers.  If  ongoing  quality  assessments  reveal  that  certain  representatives  are  unable  to   accurately  answer  the  questions  above,  they  should  be  required  to  review  preparation  materials  or   attend  additional  training  sessions  before  receiving  a  certification  that  demonstrates  mastery  of  these   topics.  

 

Nevertheless,  it  is  plausible  that  certain  individuals’  circumstances  may  be  complicated,  and  questions   about  the  particular  costs  and  benefits  of  plans  may  be  complex.  If  a  representative  is  unable  to  provide   a  caller  with  a  prompt  answer  in  some  unusually  complicated  cases,  supervisors  should  be  on  hand  and   able  to  assist  representatives.    

7  California  Health  Benefit  Exchange.  2012.  Service  Center  Status  Update.  Available  at:  

http://www.healthexchange.ca.gov/BoardMeetings/Documents/September%2018,%202012/X_CHBE_ServiceCent erBoardPresentation_9-­‐18-­‐12.pdf  

(7)

 

The  manner  in  which  customer  service  representatives  handle  and  respond  to  consumers  is  another   critical  piece  of  callers’  experience.  Representatives  should  always  be  responsive  to  consumers’   concerns  and  questions  while  maintaining  respectful,  patient,  and  courteous  tone.  A  post-­‐call  survey   would  be  one  way  to  allow  consumers  to  register  their  level  of  satisfaction  with  these  elements  of  call   representatives’  performance.  Such  a  survey  should  ask  consumers  whether  or  not  they  felt  that  they   were  treated  respectfully  and  with  patience.  This  dimension  of  customer  service  should  also  be  included   in  any  formal  service  center  quality  assessment  program,  in  which  evaluators  can  rate  the  level  of   respectfulness  and  patience  that  representatives  exhibit.  

 

As  implementation  begins,  formal,  ongoing  quality  assessments  will  be  essential  to  understanding  how   well  the  Exchange  and  the  counties’  service  centers  are  able  to  handle  the  enlarged  volume  of  casework.   Assessments  should  include  quality  evaluations  conducted  by  independent  quality  review  organizations.   Evaluators  from  these  organizations  could  pose  as  callers  and  present  a  range  of  questions  and  

applications  to  service  center  representatives,  and  the  evaluators  would  provide  performance  reports  to   the  Exchange,  DHCS,  and  the  counties.  These  evaluations  should  measure  all  of  the  elements  of  quality,   both  quantitative  and  qualitative,  discussed  in  this  brief.  In  sum,  the  Exchange  and  DHCS  should  be   vigilant  about  maintaining  a  first-­‐class  customer  experience  with  call  centers,  and  these  entities  should   use  the  terms  of  their  contracts  with  counties  and  vendors  to  achieve  this  objective.  

 

Referral  wait  times  when  transferred  to  counties      

Counties  will  retain  responsibility  for  enrolling  individuals  who  are  eligible  for  Medi-­‐Cal  under  ACA   implementation,  while  the  Exchange  will  have  a  separate  service  center  to  handle  applications  for  its   coverage  offerings.  If  the  Exchange  service  center  receives  calls  from  individuals  who  are  likely  eligible   for  Medi-­‐Cal,  it  will  directly  transfer  those  calls,  along  with  any  relevant  data  collected,  to  county  service   centers.  County  service  centers  will  additionally  have  the  ability  to  enroll  individuals  who  are  eligible  for   Exchange  coverage.  While  this  “two-­‐touch”  system  of  call  routing  raises  some  logistical  challenges,  the   Exchange  has  set  a  goal  of  having  80%  of  calls  that  its  service  center  transfers  to  the  counties  answered   within  20  to  30  seconds.  To  reach  this  goal,  it  will  be  pivotal  for  the  Exchange,  counties,  and  DHCS  to   ensure  that  all  systems,  employees,  and  protocols  are  connected  and  coordinated  as  possible  to   maximize  accuracy  and  efficiency.  

 

Rate  of  accuracy  of  determinations    

The  accuracy  of  the  service  centers’  eligibility  determinations  will  be  another  crucial  dimension  of  the   consumer  experience  that  will  affect  many  of  the  elements  of  quality  discussed  above.  The  California   Healthcare  Eligibility  Enrollment  and  Retention  System  (CalHEERS)  will  have  the  capability  to  determine   whether  someone  is  eligible  for  the  Exchange  or  Medi-­‐Cal  if  individuals  are  applying  for  coverage  under   modified  adjusted  gross  income  (MAGI)  criteria.  Reducing  the  eligibility  determination  error  rate  to  as   near  zero  as  possible  should  be  the  service  centers’  unified  goal  and  the  metric  of  success  for  CalHEERS.   This  objective  is  critical  because  errors  could  send  applicants  through  multiple  eligibility  paths  and   service  center  queues—an  outcome  that  will  likely  have  a  substantial  adverse  effect  on  enrollment  and   call  abandonment  rates,  as  well  as  customer  satisfaction.    

 

The  issue  of  accuracy  is  particularly  important  for  the  Exchange  service  center  because  it  will  transfer   applicants  to  a  county  service  center  once  a  representative  determines  that  an  applicant  is  likely  eligible   for  Medi-­‐Cal.  If  this  initial  assessment  is  incorrect,  this  transfer  may  unnecessarily  result  in  the  customer  

(8)

waiting  on  hold  in  a  second  queue  until  a  county  customer  service  representative  can  process  the   enrollment.  Since  the  county  service  centers  will  have  the  ability  to  handle  Exchange  enrollment,   consumers  unnecessarily  transferred  would  still  be  successfully  enrolled,  but  with  a  greater  time   commitment  and  a  less  positive  experience.    

 

Therefore,  to  increase  the  accuracy  of  this  initial  determination  the  Exchange  service  center  should   collect  enough  data  to  make  a  full  assessment  of  eligibility.  This  approach  would  use  the  new  CalHEERS   information  technology  available  through  the  ACA  to  maximize  the  accuracy  and  efficiency  of  eligibility   determinations.  Further,  representatives  can  transfer  the  information  collected  in  this  assessment  to  the   counties  to  initiate  the  Medi-­‐Cal  enrollment  process.  

 

Tracking  Performance    

To  evaluate  many  of  the  performance  metrics  outlined  above,  it  will  be  crucial  for  the  state  and  county   service  centers  to  have  the  capability  to  track  the  path  of  each  call  and  each  application.  The  Exchange   technology  staff  have  indicated  that  they  plan  to  assign  unique  identifiers  to  calls  to  track  call  paths  and   outcomes.8  These  unique  identifiers  should  enable  the  service  centers  to  know  how  long  a  consumer  

waits  on  hold  before  speaking  with  a  customer  service  representative,  how  many  automated  response   units  the  caller  encounters,  whether  or  not  a  consumer  is  able  to  speak  with  a  live  representative,   overall  call  length,  and  whether  or  not  the  consumer  abandoned  the  call.  We  strongly  support  the  use  of   unique  identifiers  and  feel  that  this  feature  will  be  a  vital  component  of  quality  assessment.  

 

In  addition,  evaluators  ought  to  have  the  capability  to  track  calls  across  service  centers  to  assess  all  of   these  performance  metrics  for  an  applicant  who  is  transferred  from  one  call  center  to  another.  It  will  be   essential  for  the  service  centers  to  know  how  seamless  the  transfers  between  the  state  and  county   service  centers  truly  are.  These  data  will  be  essential  to  officials’  understanding  of  the  effects  of  the   structure  of  and  relationship  between  state  and  county  service  centers  on  workloads,  the  quality  of   customer  service,  and  improvements  that  might  be  necessary.    

 

Data  Sharing    

The  ACA  stipulates  that  the  streamlined  Medi-­‐Cal  and  Exchange  application  processes  must  not  require   applicants  to  provide  unnecessary  or  duplicative  information.  Therefore,  the  transfers  of  data  between   CalHEERS  and  the  counties’  Statewide  Automated  Welfare  System  (SAWS)  databases  and  between  the   state  and  county  service  centers  will  be  critical  to  meeting  this  requirement.  This  capability  will  be  very   important  when  individuals  apply  for  assistance  through  one  portal  and  are  transferred  to  another.   Further,  information  stored  in  these  databases  could  potentially  increase  efficiency  and  accuracy  when   individuals’  circumstances  change,  causing  transitions  between  the  programs.  If  systems  can  readily   transfer  and  share  data  from  various  health  subsidy  and  other  assistance  programs,  a  more  efficient  and   accurate  eligibility  and  enrollment  system  would  reduce  the  burden  on  beneficiaries,  as  well  as  

potentially  increase  retention  rates  and  create  more  consumer-­‐friendly  programs  as  a  result.    

   

8  California  Health  Benefit  Exchange.  Available  at:  

http://www.healthexchange.ca.gov/BoardMeetings/Documents/September%2018,%202012/X_CHBE_ServiceCent erBoardPresentation_9-­‐18-­‐12.pdf  

(9)

Summary    

The  ACA  explicitly  requires  states  to  create  a  streamlined,  seamless,  “no-­‐wrong-­‐door”  eligibility  portal   for  all  health  subsidy  programs.  This  requirement  recognizes  the  importance  of  a  consumer-­‐friendly   eligibility  and  enrollment  process  that  reduces  the  burden  on  the  applicant  as  much  as  possible.  This  aim   will  serve  to  maximize  enrollment  and  retention  rates  in  health  subsidy  programs,  reduce  duplicative   administrative  work  and  expense,  and  ultimately  increase  beneficiaries’  access  to  and  continuity  of  care.      

Ensuring  that  this  eligibility  and  enrollment  portal  becomes  a  reality  in  California  requires  quality   assessment  and  improvement  measures  that  are  informed  by  continuous  data  collection.  This  brief   outlines  a  set  of  measures  that  will  be  important  for  the  state  and  counties  to  track  to  gain  an   understanding  of  the  consumer  experience  and  how  effectively  these  new  systems  are  meeting  the   objectives  of  the  ACA.  As  the  state  and  counties  implement  new  ACA  programs  and  systems  in  2014,   these  quality  metrics  will  enable  officials  to  understand  how  well  the  systems  are  performing  and  what   steps  might  be  necessary  for  continuous  quality  improvement—a  process  that  should  continue  through   the  months  and  years  following  the  initial  implementation  of  the  new  enrollment  portal  in  January  2014.  

References

Related documents

This master's thesis comprises a technical, economic and risk analysis, which are based on the evaluation and comparison of the performance of a multilateral

Shifting the political, regulatory, and environmental risk to the government while retaining the financial, construction, and operation risk by the private sector is

Two calls for a ‘critical medical humanities’ comprise: Sarah Atkinson, Bethan Evans, Angela Woods and Robin Kearns, ‘ “The Medical” and “Health” in a Critical Medical

• press the TEMPERATURE INCREASE button again for the next Stored Error Code • when the Stored Error Code of 0000 is displayed, there are no further Stored Error Codes • to

Hence, this study offers an analysis and empirical evidence on the role of outsourcing and internationalization of R&D activities of foreign MNCs in upgrading the

Petersburg, FL, USA Times Tour (Eastern US), Jannus Landing, St... Pete

•• Link efficiency to the FEAR data center Link efficiency to the FEAR data center?. •• Increase data center efficiency Increase data

My project is to raise awareness among providers, and identify resources and next steps providers can take to help patients who screen positive for food insecurity,