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3 reasons PPACA exchange call centers could freeze up

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Managers of some state-based public health insurance exchanges are thinking harder about the exchange coverage renewal process and wondering if they have enough live humans on staff.

The service center staff at Connect for Health Colorado, Colorado’s state-based Patient Protection and Affordable Care Act (PPACA) exchange, talk about the call volume forecasting issue in an analysis of service center budget and staffing needs.

Connect for Health Colorado has enrolled a total of 148,300 people in individual exchange qualified health plans (QHPs) and 2,521 people in Small Business Health Options Program (SHOP) QHPs.

The exchange has 1,026 brokers certified for 2015 and can say that brokers have helped with 47,638 QHP enrollments for 2014.

Managers originally expected the exchange to handle 98,182 renewal calls from 69,835 customers during the 2015 open enrollment period. The managers now expect to handle 158,656 calls during the enrollment period — 72 percent.

To learn why call volume could be so heavy — and why the exchange managers think brokers could help save the day — read on.

A happy note on a computer

1. Many of the QHP enrollees like their coverage and want to keep it.

Originally, Colorado exchange managers assumed that 69,835 customers would want to keep their QHP coverage, and that 41,901 of those customers could auto renew, without getting all that much help from live humans.

The exchange assumed that only half of the customers auto renewing would try to talk to live humans at the service center. They assumed 90 percent of the people renewing manually would end up talking to live humans at some point.

Now, the managers are assuming that 101,147 people will be renewing their coverage. They’re assuming that 77,005 will auto renew, but that, even in that population, 90 percent of the enrollees getting financial aid will want to talk to live humans.

See also: For tax preparers, PPACA may bring a paperwork feast

Rising stairs

2. Rates are rising.

When customers receive notices about QHP rates rising, “that will stimulate questions about current coverage and prices,” exchange staffers say.

They now expect 30,000 people to call the exchange twice.

People writing

3. The exchange is still automating some tasks, and members of the staff will have to do some processes that could be computerized manually.

In some cases, exchange staffers say, they may be able to speed up calls by using an automated system to handle simple questions, training workers to answer common questions quickly and accurately, and making good call scripts and job aids available.

The exchange is hoping brokers will help it mitigate a surge in call volume.

The exchange is trying to train brokers to help with renewing consumers’ coverage as well as enrolling new customers, and the automated message for callers who are on hold will encourage the callers to contact local brokers as well as encouraging them to seek out enrollment events and fixed brick-and-mortar nonprofit assistance sites.


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