Arkansas Health Insurance Marketplace
Call Center Discussion
September 26, 2014
www.pcghealth.com
Table of Contents
• Overview
• Potential Services
• Call Center Models
• Other States’ Examples & Costs
• The RFP
Arkansas Health Insurance Marketplace 2
Overview
Arkansas Health Insurance Marketplace 3
Overview
When thinking about a Call Center, it is important to ask the following:
Arkansas Health Insurance Marketplace 4
Question Arkansas’ Answer
Who does the Call Center serve? ?
When will people call in? ?
Should the center have walk-in capabilities? ?
What training is important for staff? ?
Does the Call Center need to be located in-state? ?
What is the budget? ?
Will the Call Center assist Medicaid enrollees? ?
Will online chat be a feature run by the Call Center? ?
Will the Call Center assist with Marketing & Outreach? ?
Overview
Is it AHIM’s goal to procure a Call Center, or a Consumer Support Center?
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Call Center
- Telephony, Mail, Chat
- Pure Q&A
- Overflow Staff Provided by Vendor
- Increased Efficiency
- Minimized Cost
Consumer Support Center
- Telephony, Mail, Chat, and In-person Assistance
- Outreach and Assistance, Events
- Increased Staff Training and Resources
- Increased Community Presence for HBE
Potential Services
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Potential Consumer Support Center Services
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Functionalities
General Information Health Plan Issuer Questions / Carrier Support
Referrals (Individual Market and SHOP) Case Updates and Verification
Application & Renewal Assistance (Individual Market
and SHOP)Self-Service Web Portal
Application & Renewals Processing (Individual
Market and SHOP)SHOP Support
Verification Processing (Individual Market and SHOP) Agent / Broker Support
Enrollment Assistance (Individual Market and SHOP) Appeals and Grievances Intake and Processing
Email and Mail Processing (Individual Market and
SHOP)General Inquiries and Intake Services
Exemptions Intake Application File Transfers and Processing
Assister Support (In Person Assisters,Certified
Application Counselors)Self Service Web Portal Support
Issuance of Notices (Individual Market and SHOP) Intake of Notices (Individual Market and SHOP)
Account Changes and Updates (Individual Market
and SHOP)SHOP Appeals and Processing
Enrollment Reconciliation Enrollment Reconciliation (Carriers)
Call Center Models
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Potential Models
Multiple models of Call Centers exist
• Contact center
• Inbound call center
• Outbound call center
• Blended call center
• Telephone answering service
AHIM can adopt one, several, or a combination of all of the above models
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Potential Models
AHIM Consumer Support Center
• Operated and maintained by AHIM
• Directly responsible for procuring Staff and Technology
• Directly responsible for Management and Oversight
• AHIM would control all staff augmentation
Vendor Consumer Support Center
• Operated and maintained by Vendor
• Responsible for procuring Staff and Technology, supervised by AHIM
• Responsible for Management and Oversight, supervised by AHIM
• Vendor would control staff augmentation
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AHIM can procure services within the state, from an existing SBM, or an
outside vendor
State Call Centers
StateType of
MarketplaceCost
Length of Contract
VendorServices
RenderedLocation
CA SBM $25M 2 years 3 CSC sitesTelephone,
ChatCA
CO SBM $25M 1.5 years State-runTelephone,Mail, Chat
CO
CT SBM $15M 3 years MaximusTelephone, Mail, Chat
CT
RI SBM $24M 1.5 years ConnexionsTelephone, Mail, Chat
RI
WA SBM $11.6M 2 years FaneuilTelephone, Mail, Chat
WA
11
Covered California
• Operates 3 different support centers across the state
• Contra Costa
• Fresno
• Rancho Cordova
• Monday-Friday from 8-6, and Saturday from 8-5
• 1-(800) 300-1506
• Support 13 TTY/ Foreign Language specific telephone numbers
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Connect for Health Colorado
• Monday-Friday from 8-6, and Saturday from 8-5
• 1-855-PLANS-4-YOU
• Online Chat feature
• Currently 541 plans with 18 carriers
• Headquartered in Denver, state-run call center in Colorado Springs
• Current plans and budget are to buy a permanent facility in Colorado Springs, as well as upgrade technology
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Washington Health Benefits Exchange
• Monday-Friday from 8-6, and Saturday from 8-2
• 1-855-923-4633
• Headquartered in Olympia
• Over 50 health plans for Individuals
• Center located in Spokane hired 60 FTE, overflow out of state
• Of 2015 spending budget, over 25% of funds will go to customer service (more than double the amount spend on marketing/ advertising)
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The RFP
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The RFP
• Typical RFP release response and evaluation time is less than 2 months
• Cost Proposal can be offered multiple ways:
• All inclusive
• Per enrollee per month
• Per minute per month (in general, or by specific interaction)
• With or without startup costs included
• Services that can be included:
• Staffing
• Training
• Quality Assurance
• Document Management and Fulfillment
• Interactive Voice Recognition (IVR)
• Automated Call Distribution (ACD)
A RFP can be tailored to Arkansas’ needs
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Public Consulting Group, Inc.
148 State Street, Tenth Floor, Boston, Massachusetts 02109
(617) 426-2026, www.publicconsultinggroup.com
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