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Critics await ‘The Return of Open Enrollment’

Critics await 'The Return of Open Enrollment'

Last year’s rollout of online health insurance exchanges under the Affordable Care Act was – to put it mildly – disappointing. It turned out that providing insurance to millions of people, many of whom had not been covered before, was a lot more complex than expected. What’s more, neither the technology nor the processes were up to the job.

The situation wasn’t helped by all of the states that refused to establish their own online portals, putting additional pressure on the central federal site at HealthCare.gov. Still, when the dust had settled, more than 7 million people had enrolled to buy insurance.

When the exchanges failed to perform as expected during the first ACA open enrollment period, call centers provided a vital backup. Maximus, the Reston, Va., company that supports many government health and human services programs, provided call center services, fielding 4.8 million calls for five state exchanges and the District of Columbia as well as the federal site.

With the second open enrollment period set to open Nov. 15, what does the company expect this time around? “The system is much more mature now,” said Jim Miller, senior vice president for strategic solutions at Maximus. “There has been an awful lot going on in the last year.”

But that  doesn’t mean things will be easy. While Maximus and the exchange operators have the experience from OE1 to draw on, OE2 is expected to present a new set of challenges.

The federal and state sites that failed last year have undergone major overhauls, and they should be better able to perform. But the upcoming enrollment period will be shorter, from Nov. 15 through Feb. 15. New sets of questions and problems are expected as many of those already insured come back to renew their coverage. And after the low-hanging fruit was addressed last time, a new harder-to-reach population is being pursued this time around.

All of which means the call centers are gearing up for another busy season. But anticipating failure is what call centers are all about, Miller said. “Our responsibility is the alternative to success. We have to be ready for any contingency. We have to ask ourselves, what are the likely problems?”  

Maximus uses interactive voice response to direct calls and to access the proper resources, customer relationship management software to gather information on calls and callers and knowledge management systems to generate scripts addressing common problems.

The company anticipated significant problems last year in providing a complex product such as health insurance to first-time buyers. But it didn’t expect the almost complete failure of technology on many sites that kept customers from connecting or finishing their enrollment. Because of that, the number of agents in place to handle calls had to be scaled up from an initial 2,500 to 4,000. “We were able to flex to meet that demand,” Miller said.

But it wasn’t just a failure of technology that drove people from their browsers to their phones. Although online exchanges are the preferred method for enrolling and selecting policies for both the states and the federal exchanges, many users are not comfortable with self-service websites and want to talk to a real person.

One of the problems with the initial rollout of ACA enrollment, in addition to underestimating the complexity of the process that was being automated, was to overestimate what technology was capable of achieving. Technology alone does not serve all citizen needs, even when it works.

Still, with upgrades to the exchanges and an increased focus on the needs of citizens, “we think it will go better this year,” Miller said.

Posted by William Jackson on Oct 31, 2014 at 12:08 PM


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