In the six years since the Patient Protection and Affordable Care Act (PPACA) passed, finding success within its framework has been our industry’s goal.

It is an extremely multifaceted initiative, compounded with state-to-state differences and deep regulatory considerations, to say nothing of the politics and marketplace dynamics surrounding the law.

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Certainly, there are challenges for health plans today related to PPACA that can’t be ignored.

But in the years that my firm has worked within this landscape, we’ve found several key components that health plans must have in order to successfully engage in PPACA-related service or sales by phone and other channels.

For a look at three of those key components, read on.

"Open call" hiring sign

1. Smart staffing

Staffing has proven to be one of the most critical, cornerstone elements of a strong PPACA program.

Contact centers and other providers need to be experts in this area, and keep pace with marketplace and other dynamics that dictate staffing changes. In particular, being able to readily flow into and out of open enrollment staffing has a tremendous impact on overall service / sales efficiency and ROI.

It’s critical that health plans staff contact centers strategically and fluidly – don’t pay for staff on hand you don’t need, and don’t run the risk of not having enough people readily available thus missing crucial targets and opportunities.

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Classroom

2. Superior training

Health care is complex, and communicating with health plan members even more so. Training representatives is critical, and needs to be handled in a nuanced way.

By nuanced, I mean you cannot over train. Rather than spending time and resources on every small piece of the PPACA / health care puzzle, arm representatives with practical knowledge and resources to dig deeper when necessary.

Focus on natural delivery of information, on finding the proper brand voice / representation, and on real empathy. And train continually as information and policies change.

Another important factor is cross-training individuals, so that as the PPACA open enrollment period subsides, representatives are not lost (and then re-hired) each year.

We have absolutely seen that individuals with previous PPACA experience are particularly effective, and they should be retained.

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Puzzle

3. Ownership of the minutia

Plans need to take compliance seriously, and contact centers and others must follow suit. Build compliance into training and make sure that compliance experts are deeply involved in not just planning, but also execution of a sales or service program. Another critical element to keep top of mind is data security, which goes hand-in-hand with compliance.

Finally, drive toward technology integration and seamless data flow between health plan and service provider (e.g. the contact center) to lessen administrative and other work and focus on results.

Focusing on these three elements is critical, but, at the end of the day, plans looking for PPACA success need strategic partners, not vendors, who can bring the best possible components and expertise to the table.

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