Customer Service Week
As it is Customer Service Week and many companies across the country are celebrating the unsung heroes who answer calls and solve problems all day, this seemed like a good time to talk about the pitfalls and problems which can plague customer service centers. We have all had experience with customer service call centers at some point in our daily lives. Some positive, some not so much! Here are a few common issues which can occur in any call center — health care or automotive supplies:
• Miscommunication between the Customer Service Representative and the customer/member/patient
• Insufficient resources at hand for the representative to give a correct and informative answer to the caller
• Poor attitude on the part of the representative — not a true "People Person"
• Lack of empathy on the part of the representative — disengaged
• Lack of preparation and training for the representatives on the part of the company
• Outdated and/or lacking technical system for representatives to utilize
• Improper screening of new hires — starting out with the wrong individuals
A well run Customer Service center can make the difference for high or low grievance and CTM rates. Customer service representatives need a combination of skills — "Hard Skills" or knowledge based and "Soft Skills" or people and phone skills. Without this combination, a representative will not be equipped for the job. Calls should always be resolved the first time in an accurate and pleasant manner. Upset and ill-informed members will call back, file a complaint and call our friends at Medicare. This is not an easy department to keep running smoothly, but here are some tips for things to pay the most attention to:
• Training; there is no such thing as too much training! A three pronged approach works best —
1. Overall Company training - Compliance, Medicare, HIPAA, etc.
2. Specific training — AEP, new benefits, how to use resources, enrollment/disenrollment, billing, claims, Part D, etc.
3. Targeted issue related training — subjects where representatives seem to be struggling with answers, for instance SEP's or disenrollment periods, Part D details
• Technology; Review the systems being utilized by your customer service center. Is it adequate? Easy to use while speaking with a member? Does it access other systems within the company well? Claims? Referrals?
• Start in Human Resources; choose the right people to begin with. Use testing to find staff who can relate to people, who can stay calm with an irate caller, and who can do the required research under pressure.
• Coaching; if representatives are not displaying true customer service qualities, coach them on "Soft Skills" or the art of engaging with a customer or member.
• Always keep customer service in the loop with any changes or processes which may affect call volumes or need special talking points and available resources.
The call center is the face of any company. It should be your best foot forward. They are the people in your company that your customers or members will interact with the most. Make sure they have the training and tools to be successful and represent your company in the best manner possible.
Happy Customer Service Week!!
Selling Season is Nearly Here, Now what?
Most plans are in the process of onboarding their agents and preparing them to sell. Meanwhile, they've invested marketing dollars across various channels and different media. Now it's time to turn marketing dollars into members. With another AEP just around the corner, here are a few GHG best practice tips to keep in mind this season to help get the most bang for your buck out of those incoming leads.
- Cut down on lead distribution times as much as possible. This is one area that cannot be stressed enough; beneficiaries are not waiting for follow ups, if leads are not quickly & efficiently being converted into appointments another carrier could potentially get that all-important first meeting on the schedule faster. The industry is much too competitive, and the cost per lead is far too expensive to let any leads sit in today's marketplace. Statistics show that close ratios improve the faster the lead can be converted to an appointment and the quicker that meeting can be conducted by the agent. In an industry where the little details can matter, if this process is managed effectively there are additional members to be had.
- Once agent in-home appointments are in full swing, make sure to collect and document a disposition from the agent for EVERY meeting. A lot of good information can be collected about why a potential beneficiary chose to enroll or not enroll in a particular plan. That information doesn't only apply to the sales team. Share it with the benefit design team too, it will provide a real world perspective on why beneficiaries join, or more importantly, why they don't. Most plans are good at tracking dispositions for their employed sales force, but lack integrated systems to capture this for some independents. Consider adopting a mobile technology to capture the rest of the picture from the independent agents.
- Make every possible enrollment avenue available for potential beneficiaries. This means having a telesales unit, deploying a nimble sales force in the field, and finally in today's world, utilizing (hopefully creating one if not) the online enrollment process. The aging in Baby Boomer population requires us to provide a diverse number of channels for prospects to enroll. Missing one avenue could be detrimental to your sales numbers!
- Learn from your successes….and your mistakes! Improvement in years to come is only possible if there is an understanding of the effectiveness of current marketing campaigns, where enrollments are coming from, what return on investment various channels have yielded, and many more variables in play. Track…measure…assess….adjust…repeat!
As always, stay tuned to the GHG Blog and to the Point for more selling season tips later this month.
Sales Oversight & Thoughts on CMS Updated Agent Training Guidelines
As you likely noticed, CMS recently released its updated Guidelines for Agent Broker Training and Testing for CY 2013 on August 21. Our in-house compliance experts have cross-walked the new regulations with the old ones from last year and here's our take: for the most part, the updated guidelines should be business as usual. However, it is interesting to take note of where CMS is going to greater lengths to provide additional clarity or requirements.
Here's our take on a few additions:
- Under the Beneficiary Protections section, new requirements were added on the education of agents on Aggressive Marketing. More specifically, you'll see requisites on things like what the potential consequences will be for engaging in Aggressive Marketing activities, report requirements, plan disciplinary actions, termination rules, and compensation forfeiture guidelines. Again, while this isn't new, it's now part of the training requirements and necessitates additional preparation, as plans now need to inform the agents about their specific disciplinary process up front. Agents now need to be educated on scenarios that clearly define, "if agent does X, the penalty is X." Plans should take the time to create an offense ranking matrix and a disciplinary scale that escalates based on number of infractions or severity, and educate their agents ahead of time. Of course there will always be new situations that pop up, but this is not a process that should be created on the go.
- There are quite a few updates focused on "do's and don'ts". We saw these added under Marketing for things such as scripts, health screenings, and contact information and again under a new section on Rewards and Incentives. This is in place to educate agents on what the process should look like in order to help identify any plans that try to get a little too "creative" in some of these areas.
Both of these additions are all about starting to compare processes across some of the (historically) more challenging areas for sales & marketing and compliance departments to manage. CMS fully encourages plans to forge their own respective path when it comes to agent oversight. They recognize it's not a one-size-fits-all solution, but with information like this now more accessible, it also allows them to start identifying more instances of what's working and what's not.
Stay tuned for the latest analysis on the updated training and testing guidelines. As always, contact us with questions and be sure to check out the Point -- launching in October.
Sales Force Oversight Ain't Easy
Selling season is nearly upon us, so with that in mind, here are some thoughts to help plans prepare. In this post, I'll detail some sales oversight and reporting best practices we've seen applied with success in a number of plans.
When creating an effective agent oversight program, keep in mind that agent oversight requires a program, not a process. There is really no single indicator that can identify all outliers. A successful agent oversight program requires a collection of metrics that - when combined - paint a clear and concise picture of an agent or group of agents' performance.
Some of the data we often see included in effective oversight programs includes:
- OEV Calls
- Secret Shopping
- SOA Audits
- Rapid Disenrollment
- Ride-alongs
- Sales Call Monitoring
One of the most challenging aspects of agent oversight is often that the data needed to execute powerful reports can originate from a number of different sources. For larger plans, this task is even more challenging because of divisions between departments. Therefore, don't try to reinvent the wheel when designing these reports; plans can create and track a number of different oversight metrics from data that is readily available from enrollment.
There are quite a few potent reports that can be developed to assess agent/broker risk, (at both the plan level and individual level). These can be created using just a monthly enrollment report (TRR & MMR) combined with various data points from the activities listed above that your sales management should be tracking. Keep in mind - whichever reports are developed — use them in unison: tracking by one data point must become a practice of the past.
Here are some simple best practice reports we suggest:
- Percentage of Direct Oversight activities not met (combined pass/fail from secret shops, OEV calls, SOA audits, etc.)
- Rapid Disenrollment Rate (set benchmarks)
- Complaints vs. Agent Assisted Enrollments (create acceptable thresholds)
Finally, once the oversight program is in place and agents are in the field actively selling, make an effort to run two self-perpetuating oversight processes. The first involves pulling a random selection of active oversight activities from the population to identify potential outliers. Then, once outliers are identified from either the random sampling process, or through adverse behavior, plans can administer more focused activities.
I hope these strategies were helpful. Stay tuned to the GHG blog for more tips for successful selling this season!
Join us Thursday for First in New Webinar series: Risk adjustment in the exchanges
On Thursday July 26th at 1pm ET we'll kick off our new webinar series, "Lessons from Medicare Advantage and Part D", a monthly webinar series around what we've learned in Medicare that can be applied to the exchanges and other aspects of health reform. We'll begin with a deep dive on risk adjustment in the exchanges.
Risk adjustment is the defining health care finance issue of the decade, and MA and Part D represent the largest experiments in risk adjustment on the planet. MA and Part D's risk adjustment system is the blueprint for ACOs, the exchanges, and a growing number of state Medicaid programs as well. We'll explore the risk adjustment provisions in the ACA and the final regulation, and apply what we've learned in the last 7 years to the future of health plan payment, with our partner Dr. Jack McCallum, CEO of GHG sister firm CenseoHealth. Bring your CFO, Chief Strategy Officer, CMO,Chief Marketing Officer, and your actuaries for a geektastic discussion on how to follow the money post-2013. In the coming months we'll examine other reform topics where the Medicare, Part D and Medicaid Dual Eligible experience shines a light: In early September: Distribution In and Around the Exchanges: Lessons from MA and Part D. We'll explore how individuals with subsidies and small groups will be sold the "metal" plans, especially in the Exchanges through Navigators and other impartial facilitators, to the deployment of brokers and sales management. Our focus will be on the Federally-Facilitated Exchange, which could operate in as many as 40 states, with updates on specific states as applicable. In late September: we'll explore the Nuts and Bolts of the Federal Exchange: Lessons from MA and Part D. We'll focus on how the Federal Exchange will function from a 10,000-foot level perspective, where the plan interfaces are and the broad strokes of anticipated reporting requirements. In late October: Product Strategy in the Exchanges: Lessons from MA and Part D. How subsidies will work based on income determinations; a landscape view of where states are on accepting ACA Medicaid expansion dollars in the wake of the SCOTUS ruling. For Red States: what the new "near-Medicaid coverage gap" means in those states that refuse the ACA funds. We'll examine how to segment the market for Platinum, Gold, Silver, and Bronze plans, and the allowability of supplemental insurance products (like dental) in the exchanges. What existing commercial and government programs provider networks mean to product pricing and strategy. The imperative for a database of local individual claims to wargame product designs on. More to come. The scars on our collective backsides in Medicare the last 16 years provide some great "teachable moments" for the new world post-ACA. We look forward to the discussion.
Times Are A-Changin'...Get Your Team to the GHG Forum June 12-13
In response to client requests, GHG is holding its first-ever Client Forum June 12-13 in Washington. With so much change in the air in government programs, the Forum is the perfect opportunity to get your team focused on the road ahead.
This isn't a disjointed lineup of vendors selling from the podium like at your usual industry conference: the presenters are all GHG's elite subject-matter experts, and the agenda is designed to be a silo-busting deep dive for government programs executive teams, with downtime built-in to allow you and your team to process and plan ahead. If you want answers, this is your gathering.
Change is a constant in the government programs world, and most of the folks who call us for help are those who are too busy these days to do anything but react. We have a motto at GHG: you can't react your way to excellence. Take two days to join us, bring your team leaders, and learn about how to get ahead of what's coming.
Don't waste your travel budget
We're less than three months from the GHG Forum. This is NOT your usual conference. We've developed a unique educational retreat for management teams working in government programs. I'm thrilled at the presentations our faculty are preparing: we're putting our senior consultants on the stage to deliver case studies, war stories and tales of best practices. But just as importantly, we're building in time for you to react to these sessions with your team--- to develop questions for your track faculty, compare notes, discuss implementing the best practices you've learned about.
We know it's a new concept in an industry that's become accustomed to sales people masquerading as subject matter experts. But we think that's it's badly needed. Many management teams we work with bemoan the lack of time and space to learn, collaborate and plan for success. In this environment, it's easy to simply react. But no one has ever reacted their way to excellence.
No doubt, if you send one to two people they will benefit individually. But isn't the isolation of our departments from each other central to our basic challenge of reforming our plans? We invite you to join other plans (some are sending as many as a dozen attendees) in making the GHG Forum your travel investment for the year. Send a team. We'll show you around.
Member Retention has an Exponential Effect on Revenue
The typical MA health plan, on average, loses eight percent of its members annually through voluntary disenrollment, and another four percent involuntarily. Let's assume that same health plan has a membership of 50,000 lives, and from a revenue perspective, typically realizes $1000 per member per month in premiums and Medicare payments to the health plan. That means that just a single percentage point improvement in member retention — going from an eight percent (4000 member loss) to a seven percent voluntary disenrollment rate (3500 member loss) — would result in a $6 million increase in plan revenue. Do the math. That's a 500 member difference, times $1000 PMPM… here are the results as the disenrollment rate improves by one, and even two percentage points.
| Disenrollment Rate: | 8% | 7% | 6% |
| Members lost | 4000 | 3500 | 3000 |
| Resulting Revenue Increase (improving from 8% industry average) | N/A | $6 million | $12 million |
*These figures are based on a health plan with 50,000 members, and $1000PMPM in payments to the plan
At the same time, today's sales & marketing budgets are getting smaller and smaller. If we move beyond a cursory assessment and look at the acquisition costs to replace that one percent (500 members) through sales, we can then see the additional impact that member retention can have on an organization's performance. Depending on your market, the acquisition costs to find a new member can be somewhere around $1,200, on average. This cost includes advertising & marketing costs, sales & marketing operations costs, salaries & benefits of those employees, and can even include software costs and services through other vendors. So assuming a $1,200 cost of acquisition, that one percent improvement in member retention (500 members) just saved your sales and marketing department $600,000 in what it would have cost to replace them. Furthermore, we can assume that $600,000 will still net the health plan another 500 members…and we just showed what that one percentage point was worth.
So let's look at this in perspective. Even if our hypothetical organization is able to immediately replace every single one of the 500 members - representing the difference between an eight percent and a seven percent voluntary disenrollment rate - through new sales, recouping that $6 million in would-be lost revenue, that organization still had to go out and spend $600,000 of their own sales and marketing dollars to make it happen. Thus, if you're looking at this problem objectively, to get the most "bang for your buck", it makes sense to take a hard look at your member retention strategy before moving on to sales and marketing. Remember, retention's impact is two-fold; not only will it impact the bottom line on the payment side, but it will put sales & marketing dollars to more efficient use — where they should be — adding members, not replacing them. Retention doesn't always have to be a cause & effect of benefit design. There are other dynamics in play that beneficiaries take into consideration when choosing a plan. Knowing what those factors are - and ultimately what value your beneficiaries attach to them - can help keep the initial impact of aspects such as benefit structure or premium increases from sending existing members out in search of a new plan.
"Lean and Clean" is Key to Survival for Medicare Plans -- Join the exclusive GHG Compliance Forum November 2-4 in Las Vegas
New regs every other week. 500 HPMS notices a year. RADV audits and Star Ratings surveys. Intermediate sanctions and the threat of termination for poor Stars performance. And now a new, uncoordinated CMS Central Office/Regional Office audit approach that could result in multiple government reviews in a calendar year. "Lean and clean" must define a cultural and management revolution among Medicare plans. If you aren't on the compliance train in these next several years, you're going to be under it.
Tell your compliance staff about our latest Gorman Health Group Compliance Forum. This exclusive GHG event is designed for Medicare Advantage health plans and will provide an intensive examination of the state of compliance in MA, with focus on the changing regulatory environment surrounding both Parts C and D. The meeting is limited to GHG client health plan staff ONLY. No vendors, no CMS representatives, to ensure a frank and open discussion about the way forward.
You'll want your team to be in the room to hear the latest from GHG's compliance experts on:
- Practical tips for implementing a fully-integrated compliance program
- Best practice Sales Oversight strategies that have cross-functional impact
- Part D pitfalls and action steps for oversight and monitoring
- Lessons learned from risk areas in compliance, including sales/marketing, enrollment reconciliation and risk adjustment
For registration information and more details, click here.
To check out the preliminary event agenda, click here.
Have a question? You can always reach our team at ghg@ghgadvisors.com.
I'll look forward to seeing you and your team in Las Vegas.
Medicare Advantage Premiums Down, Enrollment Way Up in 2012
We've long said on these pages that all the predictions of the demise of Medicare Advantage following passage of the ACA and its steep cuts to the program were premature. Finally, confirmation from CMS: MA premiums will fall another 4% in 2012, and enrollment will grow by a brisk 10%.
The news was delivered Friday by Jonathan Blum, deputy administrator for the Centers for Medicare and Medicaid Services. Blum said health plans are also lowering co-payments and deductibles. He attributed the premium drop to the agency's strong negotiations with plans as well as the plans' continuing desire to serve the market.
Some color commentary on Blum's announcement:
- Government programs (Medicare and Medicaid in particular) are the only segments of the insured that are growing. MA, for instance, will grow over 7% this year, topping 12.5 million beneficiaries. Part D is approaching 20 million enrollees;
- Publicly-traded companies like MA leaders Humana and United are now dependent on Medicare, deriving twice their earnings from the program than they did a decade ago (average publicly-traded health plan earnings from Medicare in 1999: 13%; today, 26%, with some like HealthSpring and Universal American over 70%. Bottom line: the big boys ain't going anywhere.);
- Over 40% of beneficiaries aging into Medicare have enrolled in MA plans the last two years, indicating the Boomers are a much more plan-friendly population than the World War II generation given managed care trends in the commercial market (HMOs, PPOs and POS plans represent more than 90% of all insured Americans).;
- Market-leading plans are adapting to the challenges of the ACA by offsetting its payment cuts with intense focus on Star Ratings quality bonuses and mastering the new state of the art in risk adjustment: the prospective home advanced evaluation. It's working, enabling plans to hold the line on benefits and premiums, and maintaining the attractiveness of these products vs. Medigap or traditional Medicare.
As long as the Congressional deficit Super-Committee doesn't fire another broadside at MA plan payment rates this fall, 2012 is shaping up to be a VERY good year.