Maximus is a contractor providing customer-service operations for six of the state-based health insurance exchanges (New York, Vermont, Connecticut, Maryland, D.C., and Hawaii), and is helping operate two of the call centers for the federal exchange.
National Journal spoke with Bruce Caswell, the president and general manager of the health services segment at Maximus, about the first week of open enrollment under Obamacare. Edited excerpts from the conversation follow.
How many phone calls are you getting? Has it been about what you've expected?
I would say it's been about what we've expected. The call volumes were very high, obviously, initially, last week. The volume kind of declined as we reached the end of the week and over the weekend was lighter, and then they ramped up again on Monday.
What kind of questions are you getting?
I actually visited one of our call centers yesterday morning [in Baltimore]. I asked the very question you did, I said, "So what kinds of questions are we getting right now?" And it's questions related to account registration process, the identity proofing process, which has been a little glitchy in some of the exchanges, basic site navigation questions. So just helping people kind of get oriented to the site and navigate through them.
Are people calling you mostly to have you guide them through the website, or to sign up for insurance with you on the phone?
It's both, really. In instances where the portal might not be fully functional yet to enable individuals to apply completely online, we've been taking applications over the phone on paper.
Do you have a sense of how many of those there have been?
It's not a statistic that we've been separately tracking. We're just serving the consumers as they call in.
So, anecdotally, it's happening, but you're not sure on what scale.
That's probably right.
You said most of the questions are about navigating the site versus what's included in different plans.
It depends, quite frankly, on what site we're talking about.
A lot of the concepts we're speaking to and conveying are very new to individuals, such as, what's a copay? What's a deductible? It really underscored for us the importance of being able to communicate in plain language in a way that's culturally and linguistically appropriate for the target population.
How's that going? I'm not sure what your training process is like, but I imagine you would have some sort of responses written out for certain types of questions. Have you had to rethink any of that as you've gotten a hold of what people are asking?
As the questions continue to change, or they might take on a different complexion, or we get a sense of what's resonating with someone, or answering the question well versus not, we'll take the opportunity to debrief at the end of a shift or the end of the day. [We] ask the customer-service reps to work with their supervisors to identify areas where we might be able to refine or improve upon the scripts or the frequently asked questions that we're using, and then work those in on a priority basis often as quickly as overnight.
Do you have any examples of a question or response that has had to evolve already?
Probably the explaining some of the basic insurance concepts, as we said before, around deductibles and co-pays and what they mean and how they apply. It's a fairly complex thing and it's one that if you have a couple of ways to do it, a couple of tools, you'll be better served.
How long is the average call?
This is just anecdotal, right, so I'm not going to say it's a broad average across all the centers or anything. But I think the average call length was probably in the 6- to maybe 8- or 9-minute range initially, probably more due to the fact that people were working to get through the registration process [and] had questions about just navigating the website. If they had just basic general questions about the plans being offered and the premiums and the cost, you cover that in about that time.
I would not be surprised if the average handle times increase as we begin assisting consumers in the application completion process on a widespread basis.
Do you have an estimate for how long that would take?
We've done actually some time and motion studies around that.
A simple case of an individual with no dependents--maybe not even applying for help paying the costs--that might be an application that's, I don't know, 15 minutes in length.
Someone with a larger family or complex household composition, or seeking assistance and help paying for the cost, or needing to provide additional information--in some instances you have to provide information related to employer coverage--or for individuals that are using an authorized representative to assist them in completing the application, you could see handle times in excess of 30 minutes in those cases.
There's been a lot of coverage of the glitches and people's frustrations trying to sign up. And Obamacare's in the middle of all the fiscal fights in Congress right now. Is anyone calling in and being angry about these things?
No. I was surprised yesterday, also, when I asked, "What are some of the more interesting questions you've been getting?" And one of the responses I got was, well, people are surprised we're open because they thought that the government shutdown affected the states, as well.
So it sounds like things have been going pretty smoothly for you. Has anything not been going smoothly? Any places where you've had to change course?
It's not been without bumps in the road, but we've been really pleased that the service centers have been able to provide useful information to consumers who have been trying to navigate the process.
I think that this goes back to a bigger point. It's a complex process for many individuals. It's not like buying an airline ticket. Individuals, as I recall from a study that [Frost & Sullivan] research did in 2011, in the existing private insurance market, in excess of 60 percent of the transactions that are completed, are completed in conjunction with a call center representative.
We've expected for some time that consumers were going to want assistance through the process and that's exactly what we're seeing.
The state exchanges seem to be running more smoothly than the federal one right now. Has that come through in the call centers?
I probably couldn't really draw too much of a distinction between the federal and the state experience, honestly.
It's not any harder to be a call-center employee for your federal helpers than it is to be one in Maryland?
No, I wouldn't see why, really. No.