Agent Oversight Opportunities
The leaves will soon be changing, a sign of renewal. It sounds cliche, but I don’t know where this year has gone. There has not been much opportunity to stop and smell the roses while they were still in bloom! CMS has been busy and so have we.
I had the pleasure of addressing a group of compensation experts representing quite a few Blues plans in the very hospitable city of Jacksonville, Florida last week. I would link to the conference or the materials, but most likely it is hidden from us in the uber-exclusive BlueWeb extranet of the BCBSA. Many thanks to Glen Ross and company for having us!
Agent Oversight was my topic of choice, since AEP is coming as quickly as those leaves will be changing. Plan Sponsors are deep into marketing strategies, material preparation and (hopefully) systems updates and re-training to gear up for what hopes to be a successful AEP. I addressed two areas of agent oversight and provided some guidance and best practices for some common misses.
The first opportunity addressed pertained to Outbound Enrollment Verification, or OEV. You wouldn’t believe what a hotbed this is for unnecessary beneficiary cancellations. Many call center representatives are not always asking the additional questions to determine if their script information doesn’t jive with what a sales agent told a beneficiary. For example, the CMS model script makes no mention of Low Income Subsidy nor how it would affect a potential member’s out-of-pocket costs. I provided quite a few recommendations and best practices to the group, including the recommendation to customize the model script and submit for 45-day review, and to have sales staff provide OEV information after the enrollment form is completed. The beneficiary should know what the next step is in the process, and there’s nothing like a heads-up about the next phone call from the health plan to reenforce the commitment to member-centric service.
The next area of opportunity pertains to some common misses in the sales allegation investigation process. A comprehensive investigation is not only reactive to allegations, but it also incorporates proactive steps to reduce future occurrences of the same issue. Lack of documentation is at the heart of some common failures. We’ve seen at times there is no one central repository for investigation notes. Interviews are not conducted in a timely manner, which begs the question, where do sales allegations fall on a priority list? We know there’s a ton of work to be done to maintain agent information to ensure they are appointed appropriately; we handle it in Sales Sentinel. However, the relationship with the agent is an ongoing process. Plan Sponsors should communicate to agents that allegations are going to be a part of doing business. The sky will not fall upon receipt of one. What matters most is the outcome of that investigation, and taking steps to ensure future occurrences are avoided.
Regional Offices are keeping a close eye on outlier plans by reviewing calls to 1-800-MEDICARE, aka Complaint Tracking Module (CTM) calls. Not only are they looking for outliers in overall CTM volume, but they are reviewing percentages of marketing misrepresentation cases within. If they are appearing there, most likely they are appearing in Customer Service inquiries and not being identified and handled as grievances. My presentation on these two opportunities for oversight, as well as best practices, can be found here on the Point. Not a member yet? Sign up here or contact us for group rates.
Resources
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