working productively with the marketplace call center

Tracy Zander, MPH, Navigator, Family and Children’s Service | 05.13.2016

Working Productively with the Marketplace Call Center: An Emphasis on Immigrant Populations

Objectives:

• To enhance productivity and experiences with the Marketplace call center

• To discuss and share other solutions and advice from other assisters

• To uncover solutions while working with the Marketplace call center with more challenging immigrant cases

• Increasingly challenging cases• Less buy-in from consumers• More time spent with consumers who aren’t eligible due

to coverage gap• More time needed for outreach to find uninsured

consumers

Why Enhance Productivity?

• To demonstrate to consumers that they can count on us• To ensure the enrollment process is positive• To help the consumer learn how they can navigate the

system• For the consumer to be empowered and proactive • To avoid filing an appeal• To make our jobs easier and more positive

Why enhance the experience?

…..Seriously!!

Take out your phone!

Top 10 states: Call Center Volume

INFORMATION NOT RELEASEABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publically disclosed and may be privileged and confidential, It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in the prosecution to the full extent of the law.

Background

• Tennessee uses the Health Insurance Marketplace as the only application portal to apply for Medicaid and CHIP

• There is no specific Medicaid or CHIP application

• State offices stopped offering Medicaid assistance December, 2013

• “You can also go to your local Medicaid office” Not an option.

• In 2012 Nashville had the fastest-growing immigrant population of any American city

• One out of every five Nashville students is Latino• Over 140 languages are spoken through city schools• New international arrivals are responsible for 60 percent of the

city’s population growth in the past decade

Background

• Nearly 90% of patients are foreign-born coming from more than 80 countries and speaking more than 70 languages

• 5,000 patient visits per year translating into 21,000 patient encounters

Top 10 Languages Requested at Call Center

• In total, the call center received 45,067 calls for languages other than English and Spanish during OEP Year 3

• The top 4 languages represent over 50% of all requests to the Language Line

n= 8,564

n= 7,326

Spanish n= 919,045English n= 13,302,655

What is the best way to address inconsistencies?

PREVENT THEM!

London, Kentucky

In our experience…

• (701) area code number does not go through

• Bottom line: if possible, upload to account online because it is updated in real time

• Ask for more time

Inconsistencies

SUBMITTED

VERIFIED

1. 2.3

After you submit the required verification, inform the consumer that the Health Insurance Marketplace will still send notices of the inconsistency until it is verified. These notices cause many consumers unnecessary panic.

Prevent inconsistencies

• When healthcare.gov asks for certificate of citizenship:• Go back to the beginning of the application and start again• Remove that application and start anew• Go back through application when you have the certificate

information• Optional, but an inconsistency will remain…

Alien number/USCIS

Certificate number

Selecting documents properly

This should not be checked for undocumented individuals

Common immigration documents

Sometimes the number is written here instead

Identity verification

Allowed

2submissions

Allowed

2submissions

Optional

The application ID is created early on during the application. Have it easily accessible if you need to call the Marketplace and offer to reference it first with the state you are calling from.

Then STOP. Do not press “Save and continue.”

Read and explain the agreement statements to the consumer before calling the Marketplace to avoid confusion and to keep consumer prepared and informed

If you see this screen, you’ve gone too far…

• Call volume increased by 7.6% from November 15th to December 31st and decreased by 7.2% in the last 30 days of Open Enrollment.

• Shift is likely due to increased number of consumers renewing coverage and can be expected to continue

• Customer Satisfaction increased – OE2 vs OE3 73% to 78%• Strong focus on soft skills in CCR training and quality

Consumer Call Patterns

Marketplace Call Center Volume

Call Arrival Pattern

• • For 60 of 92 days of Open

Enrollment, there is less than a 5 minute daily average speed of answer.

• On 28 or 92 days, speed of answer was under 30 seconds.

Customer Wait Times

Marketplace Call Center Volume

Spanish n= 919,045English n= 13,302,655

Call Center Topics

Plan Compare and Enrollment Closing Language:

Creating and Managing Your Healthcare.gov Account

Online Application Lead-In

Marketplace Plan Re-Enrollment/BAR

Ending Marketplace Coverage

Marketplace Call Center Information

How/Where do I send my docs

Lowering Costs on Monthly Premiums

Resolving Data Matching

Reporting a Life Change

Call Topics

OEP3 OEP2

Common Marketplace Referrals

Top 10 Referrals1. Medicaid 162,695

2. 1-800 Medicare 18,620

3. IRS 13,519

4. CHIP 11,259

5. Certified App Counselor 11,238

6. State Dept of Insurance 8,109

7. HRSA 6,541

8. Agent / Broker 5,885

9. Navigator 5,188

10. SHOP Call Center 3,365

Leaving the Medicaid GAP SEP

• Can only be accessed by contacting the marketplace call center

• Call center representatives can no longer automatically grant this SEP

Receive eligibilit

y for APTC

Call the call center to request SEP to enroll in

coverage

Representative will forward

application for review

10 business

day processin

g time

Receive mail

confirming SEP

granted

Enroll online or via the

call center!

Leaving the Medicaid GAP SEP

*Online option to file an appeal coming December, 2016!!!

* Wait about3-11 months

A note about appeals…

• Wrong eligibility determination? Why?• Try to avoid/prevent them• 90 days or ‘as administratively feasible as possible’• Expedited appeals• Separate entity: not associated with Marketplace call center nor

London, KY

Appeals continued

Even with sophisticated design, user experience

is what matters

• What have you found helpful that we haven’t yet mentioned?

Your experience

• What constructive feedback do you have for the Marketplace Call Center?

Your feedback

Moving away from…

…to this!

Please fill out survey for this presentation!

(Just Kidding!!!)

working productively with the marketplace call center

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