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. 
Bloomberg via Getty Images
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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