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Customer Contact Centers Are Critical for Second Open Enrollment

by Dustin Cortright

With the second wave of open enrollment for the Affordable Care Act (ACA) set to begin on November 15th, we can anticipate a high volume of newly eligible and returning consumers applying for health insurance, many of whom will be eligible for Medicaid coverage. While health insurance exchanges (“marketplaces”) and Medicaid Directors have been working to solve some issues from the first open enrollment, the second open enrollment poses new challenges. 

This Open Enrollment Will Be Different

When the first open enrollment period began on October 1st, 2013, many pundits assumed that consumers would gladly go to marketplace websites and apply, select and enroll for health insurance without much need for assistance. Unfortunately, technology glitches, an overwhelming response and consumers experiencing difficulties with understanding an unfamiliar process caused an unprecedented high volume of calls, emails and web chats into the customer contact centers. These customer contact centers became a linchpin in getting consumers through the eligibility and enrollment process. Both federal and state marketplaces, as well as some Medicaid programs, immediately ramped up staffing to accommodate the increasing volumes.

For the second time around it would be easy to assume that, with many of the technology issues resolved and some valuable lessons learned, this open enrollment would be more predictable and easier to manage, but new factors will make it even more difficult to set expectations. The second enrollment period is heavily focused on bringing in harder to reach populations, which most likely will require more assistance than those from the previous enrollment period. Many of these consumers speak a primary language other than English, have little to no familiarity with health insurance, and their family members often have mixed eligibility for the different health insurance programs.

During the first open enrollment period, some consumers lost eligibility for failing to pay premiums or provide required verification of key information; others were caught in the technology and processing quagmire and never managed to enroll. If you couple both of the above state’s issues with a shorter enrollment period and an inconsistent and confusing renewal process, you can no longer depend on last years’ experience. In addition, a new dynamic is being introduced during and after this open enrollment: reconciling advanced premium tax credits with 2015 tax filings. Two key areas can help with getting the most out of the contact center staffing: enhanced training and contingency planning for technology glitches.

Train, Train, Train

Focusing on in-depth training of customer service representatives (CSR) is key to assisting these new consumers as well as existing Medicaid beneficiaries who need to be re-screened for Modified Adjusted Gross Income eligibility. Many of these cases will be very complicated, and it will be important for every CSR answering the call to have the information and ability to help. If consumers become frustrated from not getting answers, they’re likely to give up, resulting in them and their families continuing to be uninsured. Additionally, the external messaging to consumers could be incorrect, overwhelming or just confusing. It is critical to train all CSRs to know accurate information, correct misconceptions and to relay it in a manner that is both understandable and friendly.

The comprehensive training of the CSRs should be continuous and should proceed into and past Day 1 of open enrollment. The training should also require new CSRs to “shadow” veteran CSRs, have them paired with mentors, and go through detailed practice sessions to learn how to handle a variety of situations and improve their call etiquette prior to answering live calls. Customer contact centers should also leverage knowledge sharing to quickly distribute new or changing information for all CSRs. During the last open enrollment, it was critical to have internal frequently asked questions and knowledge base documents readily available and updated for CSRs due to the rapidly changing information and evolving consumer needs. Because new questions arise frequently and consumers’ information needs can vary widely, it is also wise to hold daily meetings before and after CSRs shifts to share new information and tools for helping consumers.

Establish Contingency Plans for Every Scenario, Including Technology Glitches

As we saw in the first open enrollment period, technology can be more of a hindrance than help, especially when it’s not functioning properly. While everyone is hopeful that the critical system defects and issues have been resolved, a huge lesson from the first open enrollment is to plan for failure. Technology brings the promise of efficiency and cost-savings, but when it fails, the consumer should not be the one to suffer. Therefore, it’s critical to prepare for outages and technology glitches by ensuring that contingency and mitigation plans are in place so that consumers can continue to access coverage, even if it requires a CSR to fill out a paper application over the phone. With the heightened attention on last year’s problems, consumers will have little patience for lengthy hold times and multiple follow-up calls.

Time Is On Your Side

Many unknowns about the forthcoming open enrollment period remain, but there is one constant: it will require friendly, informed people to help consumers get health insurance coverage. While there is still much to do for the next open enrollment period, state and federal marketplaces and Medicaid programs still have time to gear up customer contact centers to handle the challenges that can come. With an enhanced focus on training and contingencies for customer contact centers, they will help ensure that they get the most of out of their program resources and, most of all, ensure that those who truly need health insurance can access it.

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