The Obamacare Call Center Experience: A Q&A With a Contractor

Call operators answer phones on the first day of Obamacare at an eHealthInsurance Services Inc. call center in Sacramento, California, U.S., on Tuesday, Oct. 1 2013. The Obamacare insurance exchanges struggled to handle a flood of consumer interest that closed the U.S. website for much of the day, and caused start up delays for most of the marketplaces run by the states. 
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Catherine Hollander
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Catherine Hollander
Oct. 9, 2013, 10:17 a.m.

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.

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