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CALIFORNIA HEALTH BENEFIT EXCHANGEJune 19 Board Meeting

Service Center Panel Discussion

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Managed Risk Medical Insurance Board (MRMIB)

• The Board consists of volunteer members appointed by the Governor and the Legislature:

– 3 members appointed by the Governor

– 2 member appointed by the Legislature

– 4 ex-officio members

• The Board administers 5 programs which provide health coverage to various uninsured populations through a purchasing pool model:

– Major Risk Medical Insurance Program (MRMIP)

– Access for Infants and Mothers (AIM) Program

– Healthy Families Program (HFP)

– Pre-Existing Condition Insurance Plan (PCIP)

– County Children’s Health Initiative Program (C-CHIP)

• The Board is a model for transparency and public participation through its monthly public board meetings

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• Creative and Innovative Development and Design of New Programs and Systems

– PCIP

– HFP

– AIM

– MRMIP

• Use of Third Party Administrator (Public Private Partnerships)

– Quick Implementation of Program and Systems

– First Class Customer Service Performance and Accuracy Requirements

– Effective and Cost Efficient Administration of Program

– Multiple levels of Quality Assurance and Auditing

• MRMIB Core Values– Provide and promote access to affordable coverage

– Comprehensive, high quality, cost effective healthcare services

– To improve the health of Californians

• MRMIB Vendor Selection based on Best Overall Value to the State based on Quality, Technical Approach and Cost-Effectiveness

Managed Risk Medical Insurance Board (MRMIB)

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MAXIMUS Call Centers

• Leader in Medicaid, CHIP and PCIP Service Centers • 82 million customer calls since 1995• 53% of all Medicaid and CHIP beneficiaries in the US• 28 government based health and human service call centers • 18 state health projects and the District of Columbia

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California Service CentersHealthy Families Program (HFP)

Member services support to answer all questions related to enrollment and retention in HFP. Call types include plan selection, premium payments, eligibility requirements, open enrollment, etc. Customer Service Representatives speak 16 languages.- 865,000 children

Access for Infants and Mothers (AIM)

Member services support to answer all questions related to enrollment and participation in AIM - 7,600 expectant mothers

Pre-Existing Condition Insurance Plan (PCIP)

Member services support to answer all questions related to enrollment and participation in PCIP and MRMIPWarm transfers to MRMIP and PCIP Third Party Administrator (TPA) How Heard surveys for marketing and outreach efforts. - 11,000 enrollees

Health Care Options (HCO)

Medi-Cal enrollment broker customer service for the Medi-Cal Managed Care Program in 16 counties. Applicants and beneficiaries are provided accurate, unbiased and current information regarding the health care options supporting informed health care choices.

Single Point of Entry

Application support with the completion of an application for the Healthy Families Program (HFP) and Medi-Cal program information.

Help Desk Health-e-App technical questions and support to public users and application assistors.

Outreach Customer service allocated to program inquiries and requests for materials from application assistors, stakeholders, health industry inquiries, families and individuals exploring health care options.

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California Call Center Highlights

• Extended hours for live support Monday-Friday 8am-8pm & Saturday 8am-5pm (HFP, AIM and PCIP)

• Interactive Voice Response self-service 24 hrs/day– Public Service Announcements– Self-service transactions such as plan selection during open enrollment – Call routing based on program or nature of assistance needed– Automatic caller identification– Data Analytics

• Monthly inbound call volume of 593,000 calls and 206,000 outbound

• Public Services Announcements for events (Open Enrollment) or helpful information such as the Earned Income Tax Credit

• Post Call Customer Service Surveys (HFP and AIM): 97% of callers rated the result of their experience Highly Satisfied or Satisfied.

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Service Center Philosophy Highlights

• First Call Resolution– Quality Interaction – Caller satisfaction

• Knowledge Management Solution• Quality/Data Management System

– Quantifiable results– Metrics tell the story

• Integrated Voice Response (IVR)• Independent Validation

– ISO 9001:2008 certification– SSAE 16 annual audit– Agreed Upon Procedure Audits

• Scalability– Rapid response to consumer need– Responsible resource investment– Business Process Modeling

NV_SSHIX-131

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Performance Standards and Measurement

• Performance Standards should drive performance and accountability – down to the individual level

• Incentivizing Performance can use various approaches– Pay for Performance – Liquidated Damages for non-performance

HFP, AIM and PCIP Performance Standards

Level of Performance Liquidated Damage

Seconds to live voice 85% in 25 seconds 1% of the applicable monthly vendor invoice

Telephone line abandonment rate 3% 1% of the applicable monthly vendor invoice

Telephone line busy rate 3% 1% of the applicable monthly vendor invoice

Voice mails returned within two (2) business days

100% 1% of the applicable monthly vendor invoice

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Workforce & Business Process Management

• Staffing allocations determined using tools, data analytics and modeling to performance expectations

• Model to “see around the corner” for peaks or call pattern changes• Workforce Management Solution supports continuous staffing

allocation adjustment– Multiple Language– Staff Schedules– Call type– Arrival Patterns– Consumer Needs

• Expeditious reaction– Shift change– Skill set change– Training and Information updates– Workforce increase or decrease

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Personnel and Services Profile

• Customer Service Representatives (CSR) – Live CSR support in16 languages. CSRs represent the communities we serve – Cross trained to support multiple toll-free lines– Blended staffing model– Attrition rate is less than 5%. Call Center industry standard for attrition is approximately 40%

• Training Program– Comprehensive formal class room training followed by a call coaching program– On-going training in the form of refresher trainings or providing direction on new program changes– Comprehensive knowledge management solution to include readily available training materials,

call scripts, work instructions and desk aids

• Designated Health Plan and CWD liaisons to relieve burden on consumer to coordinate across multiple programs and agencies

– Liaisons work closely with CWDs to maintain current information in MEDS– Initiate contact with CWDs to facilitate the smooth and efficient flow of enrollment within the

appropriate program– Dedicated toll free 800 number for the CWDs

• PCIP Customer Service Representatives – Provide information regarding requirements & application process for both the MRMIP and PCIP

programs, including assisting existing members with warm transfers to MRMIP or the PCIP

benefits administrative vendors