Much Progress on Healthcare.gov, But "Back End" Fixes Will Determine Success
Of the many, many things I gave thanks for last week, there was Jeffrey Zients, the White House management guru brought in to sort out the mess that is the launch of ObamaCare, and for his geek squad working feverishly on the fixes. His long-awaited progress report was released on Sunday, and it's amazingly sanguine for a government document. Knowing big IT projects as we do, it's impressive how far the fix team has gotten in a matter of weeks, much of it in consumer-facing functionality on the "front end" of the website and the enrollment process. What remains to be seen is what can be done this month on the crucial "back end" functions that connect to insurance companies participating in the exchanges -- the functions for which ObamaCare will ultimately be judged when coverage kicks off on January 1, and the true test for Mr. Zients and his geeks.
"HealthCare.Gov on December 1 is night and day from where it was on October 1," Zients told reporters in his victory lap Sunday morning. "While we still have work to do, we've made significant progress with HealthCare.gov working for the vast majority of consumers." The administration released some geek speak to make its case. Response times, capacity, and system stability are markedly improved, and conventional wisdom is that the consumer-facing functionality -- the "B to C" part -- is in much better shape.
It's the "B to B" piece that's still a problem. The metrics Zients released Sunday focused almost exclusively on the front end of healthcare.gov -- there were precious few details on the back end, specifically on the all-important "834" transmissions to insurers that tell them who's signed up, and which have been problem-plagued since the launch. You'll recall that last month Henry Chao, who oversaw healthcare.gov's technical development, said 30-40% of the back end functions remained to be completed, including a system to send payments to insurers. Without timely and accurate 834s from the Federal data hub, coverage can't be effectuated, members can't get their insurance cards, insurers can't get paid, and claims can't start flowing through the system for the uninsured.
The omission was glaring, and the Administration jumped in to address it. White House spokesman Jay Carney said that 834 fixes were ongoing but that the problems were "vastly improved." "We believe that the majority of fixes to the 834 forms have been made, including significant ones over the weekend," Carney said. "We're going to continue to work with issuers to make sure that the remaining problems for issuers will be fixed."
"A number of the fixes that went into place this weekend in particular will significantly address some of the highest priority things that we know were a particular concern with those transaction forms," said Julie Bataille, spokeswoman for CMS.
But there's still clearly a very long way to go. Administration officials and a new "Payer Exchange Performance Team," made up of insurance industry leaders, in a meeting on Monday acknowledged that about one-third of completed applications since Oct. 1 contain errors generated by healthcare.gov. The errors included failure to notify insurers about new customers; duplicate enrollments or cancellation notices for the same person; incorrect information about family members; and miscalculated federal subsidies. It's still bad enough that yesterday CMS recommended that consumers who choose a health plan through HealthCare.gov contact the insurer afterward to make certain they are actually enrolled. "Consumers should absolutely call their selected plan and confirm that they have paid their first month's premium, and coverage will be available Jan. 1," Bataille said.
There is no margin for error this month. Deadlines for enrollment are coming up in less than 2 weeks for people to get insured by Jan. 1. If the 834s can't be fixed by then, and it appears likely they won't, the next big barrier to enrollment is the ACA's requirement that eligible exchange customers pay their first month premium before they receive coverage. Without clean 834s, susbidy verification and calculations given to the plans, no one knows what the first month's premium will be. That may be the next "audible" to be called on the field: the Administration will seek a way around the premium payment requirement, and then ask insurers to take a leap of faith, issue coverage, and hope that premiums and subsidies catch up later. And that's a real problem that strikes at cash flow for many of the smaller, regional players in the exchanges, and especially for start-ups, like the ACA's co-ops. Nobody set aside contingency funds for this kind of headache.
So Mr. Zients and his geeks can't let any grass grow under their feet, and we all ought to spill some Starbuck's or Red Bull for what lies ahead for them. But to also give some perspective, a hat tip to Dr. J. Mario Molina, CEO of Molina Healthcare: "A few people are going to have data that's not correct; but compared to the tens of millions of people who don't have coverage right now, that's a minor problem." He's thrilled with the progress made, and points out "We process a couple million patients through our system the last week of the month as it is."
Whether you're a glass half-empty or full type of person, I think we can all agree we are looking at one wild and hairy enrollment reconciliation process in Q1 and 2 of 2014, so grab your shovels. There's a pony in here somewhere.
Resources
Join us December 11 from 2:00 — 3:30 pm ET for a lively session with Gorman Health Group strategy and data analysis experts who will discuss actual case studies that show how plans can mine data for precious insight that can help improve performance. Register >>
Gorman Health Group's Valencia, was designed to create workflows organizations need for critical operational functions, and give you insight into where your membership and premium-related data is out of sync. See how Valencia can revolutionize your capitation management >>
Consultant Assessment in the Headlines
Consultants were in the news this week; that doesn't happen often. In this scenario which I will not deeply dive into, a private consulting team was brought on to independently assess the status of a certain federal health insurance enrollment system. Their assessment, after reviewing hundreds of documents and conducting scores of interviews, includes a number of risks with some detailed root cause drivers.
A risk assessment conducted well in advance of any initiative helps leadership and stakeholders understand what potential failures or gaps exist within a system or process. Most readers who have compliance responsibilities are aware of the requirement to conduct a formal baseline assessment, and then to periodically re-evaluate the accuracy of that baseline assessment. The reality is that with all the day-to-day responsibilities that compliance needs to handle, the baseline assessment or the re-evaluation often takes a back-burner.
It is recommended that an organization seek an external resource to conduct these evaluations. With our experience working with plan sponsors nationwide, our Senior Consultants and Clinical teams can take care of that assessment for you, leaving you with a report of gaps, risks, and recommendations on how to correct. Don't have the time? We can help you correct the deficiencies. Ask yourself when the last time a comprehensive risk assessment was performed; determine if you have time to conduct it on your own, and then contact us to discuss how we can help.
Resources
The annual risk assessment is an essential part of the ongoing risk management process that assigns priorities for mitigation plans. Learn more about how Gorman Health Group can help you identify and remediate inefficiencies >>
Join us December 11 from 2:00 — 3:30 pm ET for a lively session with Gorman Health Group strategy and data analysis experts who will discuss actual case studies that show how plans can mine data for precious insight that can help improve performance. Click here to register >>
Pay me now or pay me later: Things to keep in mind when you set your 2014 budget
Back in the '80's Fram Oil Filters had an advertising campaign that featured an actor dressed as a mechanic, admonishing viewers to get their oil changed and get a new oil filter, to prevent costly engine damage. "Pay me now or pay me later," he said.
When it comes to some key Medicare Advantage functions, the "pay me later" scenario can be perilous indeed.
Take data reconciliation, for instance. MA plans, especially those with drug coverage, need to reconcile at least a dozen different types of data with CMS: Enrollment data; Transaction reply reports; Retro processing contractor; Beneficiary churn ; Capitation payments; Premium data; Out-of-area residence; Subsidy payments; Medicare as secondary payer; Prescription claim (PDE) data resolution; Part D coordination of benefits (COB); Enrollment data validation; Compliance & reporting; Medicaid state roster and best available evidence of Medicaid enrollment.
The sheer volume of data and transactions dictates use of automated processes and controls to manage the reconciliation workflow. Spreadsheets won't cut it, and quasi-manual processes rapidly fall behind the need for daily data import and analysis. Failure to reconcile results in incorrect claim and capitation payments, premium collection issues, enrollment and benefit errors, reduced quality scores, and the potential for excess repayment under drug plan risk corridor reconciliations. Even for small plans, there can be millions of dollars at stake.
Compliance is another area where failure to invest in automated systems now can cause a bad "pay me later" outcome. The cost of a bad CMS compliance audit isn't just the staff time to correct problems. Most compliance problems are directly linked to member satisfaction issues, and a "bad" audit is symptom of deeper problems that lead to high member services call volume and disenrollment rates. Not only does CMS expect plans to be audit ready all the time, members expect things to go right all the time. We have found that the best approach is to use information technology tools to continually monitor compliance at the department level, to maintain complete and organized documentation, and to identify areas where compliance is lagging — where management intervention is warranted. Compliance programs need to be documented, regimented and sustainable. Compliance doesn't wait to happen. It takes an organized and on-going campaign, supported by automated tools to remind, track, document, and spotlight problems.
A third opportunity for trouble is in how sales agents are trained, vetted, and monitored. CMS requires annual training, which is best done using computer-based learning systems. Embedded testing provides documentation of comprehension. On-going supervision requires diligent tracking of complaints and allegations to confirm, respond, and assess improvement. As with other complex tasks, an automated solution reduces opportunities for errors and omissions.
At a time when every dollar counts, it's a good idea to consider budgeting for an investment in software solutions that solve these problems. Gorman Health Group has built software that supports our own consultants as they work with health plans on these issues, and these tools are available for health plans to use in their own operations. The GHG software is unique in that all of these applications are Web-based, fully hosted solutions that present no strain to IT resources. And GHG's subject matter expertise drives each product's unique functionality.
I invite you to contact my colleague RaeAnn Grossman, to start a conversation about your goals, the risks you face, and your available resources and budget for the 2014 year.
RaeAnn Grossman
Chief Sales and Marketing Officer
Rgrossman@ghgadvisors.com
Resources
Decision-makers from Health Plans and Provider Organizations are invited to join GHG for a free webinar on November 19th: "The future of the Government sponsored health care." Register for this free event now >>
The Online Monitoring ToolTM (OMTTM) is a complete compliance toolkit designed to help organizations track the compliance of their operations. Visit our website to learn more about how the OMT can help your organization >>
The way in which you onboard, train and conduct ongoing oversight on your sales agents is critical. GHG created Sales Sentinel™ specifically to meet the needs of health care organizations operating in regulated government markets. Learn more here >>
Every health care organization is looking for improved outcomes, better compliance and enhanced process efficiency when it comes to managing membership and premium payments. GHG's Valencia was designed specifically to meet those needs.
Reading the Stars in Medicare in 2014-2015
Whatever you may think of healthcare.gov, CMS is killing it on the Medicare Star Ratings Quality Demonstration.
As we move into the final year of CMS's historic and controversial $8.5 Billion Quality Demonstration, we see clear evidence that quality incentives are working, plans are making major investments to improve their ratings, and quality is improving across the industry. One thing we can be sure of in uncertain times: proven performance-based payment systems like MA Star Ratings will spread to Medicaid, the exchanges, and commercial accounts in the next 3-4 years under banners of transparency and accountability. $8.5 Billion in a $3 Trillion industry seems infinitesimal, but Stars are moving the industry in ways outsize to their impact.
Many industry experts giggled at the Affordable Care Act ‘s (ACA) provision allowing MA plans to earn up to 5% additional reimbursement from the government for quality metrics based on the CMS star system, and 10% in double bonus (mostly rural) counties. The Star ratings system was, at the time, a laughable ranking barely 2% of beneficiaries paid any attention to. Not anymore. In 3 years, CMS has evolved Stars to an increasingly sophisticated carrot and stick for quality improvement, with massive financial implications for payers.
To date, each half-star rating equated to roughly $50 per member per month in bonus payments. For 2014, we estimate the enrollment weighted-average increase to plan paymentst from Star bonuses is approximately 4.75% and 3.3% in 2015. Anything below 4 Stars in 2015 means no bonus and a major financial headwind for plans. With MA plans seeing roughly 5% margins, 2014 being the worst year of MA reimbursement cuts from the ACA, and 2015 meaning the end of bonuses for plans below 4 Stars, plans are making significant investments to improve their ratings.
There was clear evidence that Stars incentives are working: 52% of MA plans are now at 4 Stars, up from around 37% of all MA plans. The average member weighted ranking for 2013 is 3.86, up from 3.7 in 2012. The biggest chunk of MA enrollment is now in 3.5 Star-rated plans: 30% or 4.4 million. There are now 16 5-Star rated plans up from 3 this year.
While tremendous progress is being made on Stars, GHG's analysis of the data also shows what a long, hard journey these performance metrics present to health plans. We have much improving to do in managing conditions like osteoporosis and mental health, where most plans scored badly. And the data shows a need to continually improve the service model, like providing interpreters, managing member complaints and coverage disputes.
MA plans in qualifying counties, mostly rural, can receive a "double bonus," the payment impact of which is significant. There are about 4 million MA members in double bonus counties, roughly 27% of the total MA population. Double bonus counties add about 100 basis points to payments across the entire MA program.
5-Star rated MA and Prescription Drug-only plans can enroll members year-round in 2014, rather than just during the annual enrollment period. This is a major strategic advantage for Star leaders, but one that few have taken full advantage of yet — and that's about to change. With big nationals finally attaining the honor, they'll be ready and hustling all year.
CMS has been very clear that it reserves the right to terminate MA contracts that are below 3 Stars for 3 consecutive years, citing its authority in an April 2012 final rule which became effective this year. About a half-million Medicare beneficiaries are enrolled in plans with less than 3 stars.
Resources:
Interested in seeing how your Plan's performance compares to others in your market? Download GHG's Star Ratings Database that combines the CMS-issued 2014 Star Ratings with those over the program's history from 2008 on.
Hear from GHG Stars expert Jane Scott on October 29th. GHG and AISHealth team up to present a 90 minute webinar: "Inside the 2014 Star Ratings for MA and Part D: Trends and their implications." Register now >>
Want to hear more from John? Decision-makers from Health Plans and Provider Organizations are invited to join GHG for a free webinar on November 19th: "The future of the Government sponsored health care." Register for this free event now >>
Innovation and Quality must go hand-in-hand
Plan sponsors are waiting with anticipation for their 2014 Medicare Star Ratings to be released. Just yesterday, Tufts Health Plan in Watertown, Massachusetts released the news that their Medicare Preferred HMO plan was awarded 4.5 out of a possible five stars. It reminds me of the old Ford commercial jingle where they said "Quality is Job 1". No truer words apply when it comes to maintaining high quality plan options for our nation's Medicare beneficiaries.
Recently I accompanied our founder and executive chairman on a field trip, where he enthusiastically addressed a large group of health plan decision-makers as part of their series on innovation. Now, innovation and quality do not always go hand in hand. I have purchased my share of aftermarket tech products to know that while a company might have employed innovation to make something less expensive, often times, it comes at the expense of quality. It's deflating when you finally get on your train with your discounted charger, plug your phone in, and you see the magical words: "not charging". Add it to the list of our countless first world problems, but it illustrates the point.
With the bonus payment going away for any plans earning less than a 4-star rating in 2015, 3.5 stars will not cut it, especially if you are counting on those funds or have incorporated them into your future year's budget. During his presentation, he drew our attention to outcome measures, and how heavily weighted they are. There are so many opportunities for a plan to innovate, not only for purposes of increased quality rating, but also for the most important factor of a plan: its membership. Loyalty can no longer be bought with just the $0 premium plan anymore. The customer service has to be stellar; their enrollment experience must be error-proof; and in times of sickness, when their utilization has to increase, the care management has to be more than just a pre-auth and a smile (and sometimes you don't get the smile). It is time to have a discussion in every department:
- What are we doing to be innovative?
- What are the best in the nation doing?
- What's low-hanging fruit and what requires more significant investment?
Our health plan partners are becoming more and more engrained in government programs, including Medicare Advantage, Part D, Medicaid, Duals, and the Marketplace. He also reminded us that organizations should be prepared for constant regulatory oversight, which comes with government-sponsored programs. True, some of the regulations are a challenge to implement, but when you've gotten to the point where you have met your compliance requirements, think about ways your organization can supplement that success to exceed a member's expectations - within the rules of course. Who is the town crier at your plan for the beneficiary's experience? Why can't it be you?
Resources
Coming soon: GHG's updated star rating database. We'll send an alert when it's ready! Join our subscription list to be sure you know when this free download is available. In the meantime, take a peek at last year's database that combines the CMS-issued 2013 Star Ratings with those over the program's history from 2008 on.
Register to attend our October 29 presentation "Inside the 2014 Star ratings for MA and Part D: Trends and their implications."
GHG Pharmacist, Lynne Civin, outlines the benefits of daily dispensing requirements in a new article: Short-Cycle Dispensing for Long-Term Care. Lynne discusses key attributes in long-term care , and outlines critical items that warrant further discussion. Download the whitepaper today.
The percentage of plan with an average or below average star rating is staggering - and CMS has made it clear, average just isn't good enough. Learn how GHG can help your plan effect meaningful change in your Star Rating and beat the curve.
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
We created Sales Sentinel™ specifically to meet the needs of health care organizations operating in regulated government markets. Whether you operate within MA or the new Health Insurance Marketplaces (the Exchanges), Sales Sentinel offers a suite of solutions.
Listen as Senior Director of Product Operations at Gorman Health Group, Alex Keltner discusses GHG's Sales Sentinel, the solution to train, credential and onboard your sales force.
Bloom Marketing Group's call center is licensed in 48 contiguous states and offers marketing, call center and technology solutions to the healthcare industry. Bloom is a proud partner of Gorman Health Group, click here to learn more.
A Good Script Doesn't Sound Scripted
American film director Steven Spielberg once admitted that the only thing that gets him back to directing is good scripts. Good scripts help give a film structure, purpose and clarity. Good scripts are important in the insurance call center industry, too!
A well developed script should do more than comply with the rigors of regulatory compliance, however. A good script should engage callers, encourage rapport, capture key data and provide a path for closing sales or retaining members. So how does a call center successfully do all that?
- Explore the uniqueness of a company's products and processes prior to developing a script. Once identified, use those features as the cornerstone of the script and help direct the caller to the desired conclusion.
- Close collaboration is Key Collaboration is an important skill requiring effort from all parties, especially when communicating the complexities of health care choice. Collaboration with a proven script writing partner whose stable of experienced sales agents help execute the script is a big step towards a successful partnership. Additionally, ensuring all call center teams speak with the same voice is essential.
- Flexibility during the script writing process is essential Needs and demands often change during a sales and marketing campaign. It is important that all participants remain open to change as the process unfolds and different departments vet the script. Make sure you are using a script that allows for campaign flexibility while still meeting regulatory requirements and best practices. This is particularly important to all in the healthcare industry on the advent of the Affordable Care Act (ACA).
Remember, a successful script creates caller interest, provides the capturing of important data and offers a clear route to closing the sale. In short, a good script doesn't sound…scripted.
Resources
The Bloom Call Center is licensed in 48 contiguous states and offers marketing, call center and technology solutions to the health care industry. Since 2007, Bloom has participated in over 55 million conversations about insurance products, submitted over 200,000 applications for insurance, and set over 150,000 appointments for seniors to meet with Licensed Agents. Bloom is a proud partner of Gorman Health Group. Click here to learn more.
GHG's Software Sales Sentinel™ Achieves 97% Renewal
Gorman Health Group (GHG), is proud to announce that its software, Sales Sentinel™ has achieved a 97% renewal rate, never having lost a client due to performance or dissatisfaction.
Sales Sentinel™ supports more than 30 health plan clients across the U.S. and trains more than 30,000 agents each year. Already in 2014, Sales Sentinel™ has 33 clients on board, four of which are among the top 10 largest health care carriers in the US.
This software facilitates sales agent onboarding, credentialing and ongoing oversight, and it eliminates the labor-intensive agent onboarding process for both your Exchange and Medicare Advantage businesses.
To learn more about the software and its benefits, listen as Senior Director of Product Operations at Gorman Health Group, Alex Keltner discusses GHG's software solution to train, credential and onboard your sales force in a podcast on the Point.
Resources:
Learn more about GHG's software, Sales Sentinel™ in a free download available now on the Point >>
Simplfiy sales agent oversight with Gorman Health Group's software solution designed for health care organizations operating in regulated government markets. View a short video of the software tool available now.
Ensure you are audit ready, all the time. Learn the benefits of Sales Sentinel here >>
GHG named the Blue Cross and Blue Shield Association's national sourcing partner for onboarding, credentialing and conducting ongoing oversight for your sales force. Read more here >>
How to Convert Marketing Calls to Leads and Sales
The marketing pieces for your sales campaign have been delivered and the response has been tremendous. Your call center partner must now convert those inbound marketing calls to leads or sales. What should you expect?
You should expect an inbound call process that is CMS-compliant. Callers should be fully qualified for eligibility by the call agent. Phone agents should patiently educate all callers on available plans and provide excellent customer service.
There are 2 ways most call centers begin the lead generation process and/or proceed to the telesales process. A select few call centers offer a third option:
- Agents can set personal appointments for field agents Call center agents can schedule appointments for field agents as they do when scheduling a seminar reservation The call center can relay the appointment to a field office manager or, with proper protocols, directly to the agents via mobile device or smart phone.
- Prospects can talk with a licensed and plan-accredited phone agent During a sales call the agent should: 1) Review all appropriate plan details, read the required disclaimers and obtain the prospect's confirmation if they choose to enroll; 2) Minimize data entry errors by using an electronic application that integrates seamlessly with the data captured during the sales presentation; 3) Submit the application via secure protocols and provide the customer a confirmation number; 4) Review the CMS-required information and set expectations for the OEV call and delivery of material.
- Warm lead delivery Select call centers may offer a lead delivery system that utilizes technology advancements. "Agent Connect" is such a tool and is powered through a mobile platform on Ascend. This lead delivery system allows phone agents to warm transfer callers to field agents at the moment the caller is ready to set an appointment. The field agent can then schedule an appointment in real-time, complete a scope of appointment on the same call, and immediately begin building rapport with the caller.
Every inbound call that fails to yield a sales appointment or enrollment is a wasted opportunity. Protect your marketing campaign with careful selection of a call center that will best meet your needs.
Resources:
The Bloom Call Center is licensed in 48 contiguous states and offers marketing, call center and technology solutions to the health care industry. Since 2007, Bloom has participated in over 55 million conversations about insurance products, submitted over 200,000 applications for insurance, and set over 150,000 appointments for seniors to meet with Licensed Agents. Bloom is a proud partner of Gorman Health Group. Click here to learn more.
Agent Oversight Improves Quality and Customer Experience
If you're like most health plans, you rely on key "glue folks" to keep operations running smoothly. You know the ones: staff members that embrace their role, mind the details and ensure behind-the-scene efforts improve outcomes. They may or may not communicate one-on-one with customers, but their efforts contribute in a positive way to the overall customer experience.
For many, the partners and team members that manage the oversight of field and call center agents are the very glue of the sales and marketing activities inside a plan.
Consider agent oversight in three parts: Compliance, Operations and Quality. They're three distinct functions of equal importance. When synchronized, Agent Oversight aids in seamless performance of an organization's sales and marketing efforts.
What do we mean by three distinct functions? Consider the three-legged stool:
Compliance is more than a disciplinary function. The compliance department should work directly with Operations to ensure open channels of communication exist with all sales agents. Effective communication of regulatory requirements through training can mean prevention of compliance missteps and disciplinary actions.
Operations should be proactive regarding agent oversight functions. With careful monitoring of agents and frequent status reports, agent issues can be addressed promptly and directly. Simplify the process with technology to monitor sales meetings anywhere and anytime and assess agent performance in real time. Oversight recommendations may include additional training, corrective action or require immediate termination. Regardless the action, the result must be swift.
Quality programs should offer metrics on evaluating agent performance. There are a number of ways to rate agent performance in the development and implementation of Quality programs: grading, coaching or performance reporting. At Bloom, we use all of those tools — as well as call review, call scoring and calibration for each call center agent. Plans should work closely with their call center partner to develop, implement and assess a customized Quality program that best meets their needs. A strong partner can work with a plan to implement an existing program or to craft a new one.
Resources
The Bloom Call Center is licensed in 48 contiguous states and offers marketing, call center and technology solutions to the health care industry. Since 2007, Bloom has participated in over 55 million conversations about insurance products, submitted over 200,000 applications for insurance, and set over 150,000 appointments for seniors to meet with Licensed Agents. Bloom is a proud partner of Gorman Health Group. Click here to learn more.