The Client: Our client is a leading Consumer Operated and Oriented (CO-OP) health plan which is largely member-led and directed. The client first started selling insurance in the fall of 2013 and quickly became a leader in the industry. It was also the only profitable health insurance CO-OP in the country through the plan period January 1st through September 30th, according to the credit rating agency A.M. Best.
The Challenge: The client wanted to ensure a successful 2015 Open Enrollment period. The previous year had been a financial success but the client recognized customer experience in 2014 did not meet their expectation. The 2013-14 Open Enrollment period brought multiple challenges. There were technical issues with healthcare.gov and many of the state residents where our client operates had difficulty with the purchase process. Also, enrollment was three times what was forecasted. The client’s call center was flooded with incoming calls and the team (less than a dozen agents) was swamped. It became “All Hands on Deck” as the client added individuals from every level of senior leadership, up to and including the CEO to help answer calls.
The COOP expected to enroll 15,500 new members, but in the end they had tripled that number. Ultimately, they led the ACA Marketplace enrollment in their state of operation capturing eighty-three percent of the Marketplace share. This represented fifty-seven percent of all individual health policies sold in the state.
The Solution: Based on the challenging 2014 experience, the client authorized and increased internal staff up to 32 customer service agents and 5 enrollment specialists. However, there was concern about appropriate staffing levels to provide quality membership support and service while minimizing long queue times. Being a CO-OP plan with close connections to the state and communities in which the plan operates, improvement options for the health plan were in-state expansion and/or outsourcer with in-state presence for overflow support. The client and Ameridial formed a partnership so we could collaborate with them in acting quickly and deploying a solution.
Ameridial was able to provide a geographic solution to staffing issues having an established call center in our client’s state of operation. The ability to keep membership communication and employment opportunities in-state where the plan operated was integral even in the client’s vendor selection process.
The established solution for the 2015 Open Enrollment period resulted in Ameridial handling, assisting, and supporting the call activity generated from the Marketplace Open Enrollments. Existing members of the CO-OP were supported by the internal call center.
Ameridial provided a Project Management and executive team with significant healthcare industry experience and a deep understanding of the client business objectives. We also assembled a team of customer service representatives who were formally educated on all aspects of the client health plan and business processes.
There is an ongoing and open partnership and exchange of information and idea sharing. The client and Ameridial have a common and unified vision to continuously improve the program, processes, and in developing the skill of agents.
• The client and Ameridial having formed a collaborative partnership. A customer service support model focused on the customer business requirements for membership support
• Surpassed 2015 membership goals with more than 72,000 members
• Significantly reduced queue times resulted by IVR technology branching new membership calls to Ameridial and existing member calls to the client’s internal center during Open Enrollment
• Dedicated staffing model providing flexibility and ability to adapt to varying call volumes
• Effective membership communication
• Reduced costs and increased quality
• Successful and mutual partnership resulting in on-going support from an in-state and community focused vendor