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:

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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

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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