CMS wants to roll out new customer service features on the federal exchange for the fourth open enrollment period, Healthcare.gov CEO Kevin Counihan said Wednesday (Feb. 24).
In a conversation at the National Association of Health Underwriters conference, Counihan previewed a customer relations management, or CRM, interface that would give call center workers a record of past conversations with a particular customer and let them check the status of any previous inquiries -- a service “ticket” system and central database of sorts.
The technology would allow customer service representatives and contractors to pull up someone's file, avoiding the need to rehash discussions a customer already had with other workers.
“That's not what you want to do, that's not what we want you to do,” Counihan said. “Is that rocket science? No. Is it something we should have had years ago? Probably.”
The project comes as Healthcare.gov is drawing in more traffic in its third year than ever before, so the marketplace wants to evolve to meet the increased workload and customers' expectations for service. Nearly 14.6 million people contacted the federal call center during the third open enrollment period from Nov. 1, 2015 through Feb. 1, HHS said Feb. 4.
Jenny Sullivan, director of the Best Practices Institute at Enroll America, said the effort to get a central support database up and running has been underway for years as part of CMS' long-term strategy. Her organization, along with several other consumer-oriented stakeholder groups like Families USA, the Center on Budget and Policy Priorities and the National Health Law Program, have met with CMS multiple times since last summer.
They have urged the agency toward a system where call center representatives, appeals workers, staff handling citizenship and immigration data and other contractors can all see the same trove of information when helping someone throughout the enrollment process. To be effective, Sullivan said, the database needs to include each person's application details, notices they have received, proof of legal residence and related citizenship information and more.
Advocates are “hoping there will be greater interoperability between all pieces of the puzzle that affect a consumer's application,” said Mara Youdelman, managing attorney at the National Health Law Program. “Right now we've got Healthcare.gov, call center contractors, we've got application eligibility contractors, we've got appeals contractors. Ideally, if a consumer calls any of those, that information should be available to the others.”
Those who are trained to work with certain types of documents would keep the same responsibilities. For example, call center workers would ideally be able to tell consumers that the marketplace had received a particular piece of information and let them know if anything else is still needed, but would not be in a position to determine whether the paperwork submitted is sufficient. Staffers in each line of work would respect the boundaries of other areas, Youdelman said, such as the legal protections of those who work on appeals.
Counihan indicated to Inside Health Policy that the project is in its early stages but on track. If the system is to launch by the next open enrollment period -- and if that is set to begin Nov. 1 as proposed -- CMS has just over eight months to get it off the ground.
“We're beginning the business requirements for it, so the whole technical piece, as you know, with any kind of technology has to be established,” Counihan told IHP. “We've got an implementation plan to take us into open enrollment four so we're making good progress. We think it's going to be very helpful. We've got one of our best folks managing the project.”
A CMS spokesperson said they don't have any additional information when asked whether a contract has been awarded or how much the project might cost.
Advocates are curious where the agency is on the project now, but welcomed the news that it could arrive this fall.
“In terms of the technology, we're very encouraged they're developing the systems to allow better tracking of a consumer's application … from the first touch to Healthcare.gov through the plan selection process” and beyond, Youdelman said. “The call center doesn't have enough access to information of applications right now … they're almost boxed in by the technology.”
This effort represents something that's doable, Sullivan added, a project that is realistic for where the exchanges are now. She said it will likely take multiple phases to entirely roll out the system.
The advocates stress that it is of paramount importance that consumers' privacy is protected in building and running the interface. The call center already handles personally identifiable information, so this interface shouldn't be much different, Sullivan said.
Enroll America wants CMS to create a similar portal for navigators, assisters and brokers. To date, that hasn't been on the “Yes, this is something that's possible” list for the Center for Consumer Information and Insurance Oversight, Sullivan said.
Youdelman also hopes the consumer service initiatives move the exchange closer to a true “one door” approach to health care.
“The hurdles we have now are the barriers that consumers face trying to sort through who to call, when to call and who can solve my problem,” she said. “If all actors in this play have access to the same information, it shouldn't matter.” -- Rachel S. Karas (rkaras@iwpnews.com)
