Changes. Fear. Hope. Uncertainty. Confusion. Questions? With all of the confusion and misinformation surrounding the ACA, the contact center is taking on an increasingly important role as the primary knowledge resource for many managed care providers.

1. Four Member Service Representative
Readiness Strategies
to Contend with the Affordable Care Act

2. Changes.
Fear.
Hope.
Uncertainty.
Confusion.
Questions.

3. With all of the confusion and misinformation
surrounding the ACA, the contact center is
taking on an increasingly important role as the primary
knowledge resource for many managed care providers.

4. INTRODUCTION

5. Managed care providers are transitioning from a “let’s wait and see what happens” mindset to
the definitive reality and associated preparations for the new healthcare system brought forth
by the Affordable Care Act (ACA). These organizations are quickly evaluating and assimilating these
changes as new laws come into effect. There is an enormous amount of complexity surrounding the
ACA from all perspectives – government, business, and citizens.
With all of the confusion and misinformation surrounding the ACA, the contact center is taking
on an increasingly important role as the primary knowledge resource for many managed care
organizations. There are millions of people being added to the system. Many of these people must
buy health insurance for the first time and may have little to no knowledge of how the system works.
Pharmaceutical, hospital, healthcare insurance and medical services companies that span this massive
industry are relying on the contact center to serve as the frontline to the many questions related to the
ACA, its many complexities and evolving policies and laws. While a number of these companies have
been able to set up self-service channels such as Web and online portals to handle the tremendous
influx of inquiries, the number of calls into many of these contact centers has skyrocketed. In
response, managed care providers are rapidly increasing staffing levels to handle the high volume of
calls to these service centers.
As these companies add significant numbers of new member service representatives (MSRs), it is
critical that they have a strategic plan for fast-tracking these new employees so they are trained in
the most efficient and effective way possible. This is not easily done. Here are four tips and ideas to
consider for fast-tracking MSRs so they are trained and have the tools available to deliver a world-class
service experience.

6. Complex Desktop Agile Desktop Simplified
OPEN DASHBOARD
CUSTOMER
INFORMATION
SIEBEL CLAIM APPLICATION
MEMBERSHIP
Project
Group #
New Package ID
Copy Source
Line of Business
Effective Date
Plan ID
Standard Short Description
Narrative
Project Details
JANE-0123456789-0
0123456789
CloneSearch
OS-000
HMO
ER Visit
HMO FEDERALLY QUALIFIED-PLAN03
OV$5, SG$5/OP50, ALY$5, ER$50, PAD$250
MIN$OP$25/SA15, OOP$1500/3000
Standard OSQ*03****N
04/23/14
QHP
First Name Jane
Last Name Automation
Policy # 0123-456-789
Contract ID # 0123-456-789-IN
Street
City
State
Zip
1101 Michigan Ave Date of Claim 04/16/2014Type of Claim
AllID AllMC Type MedicalCovered
$250 Rule ID CP5OSCopay AmountLogansport
IN
46947
Desktop complexity can hinder
MSR performance.
An agile desktop aggregates key policy
information for easier access.

7. OPTIMIZE THE DESKTOP
Even before the ACA emerged, managed care providers struggled with MSR onboarding. Most of
this was attributed to desktop complexity. Most MSRs are required to work in multiple disparate
applications and systems to perform basic functions, like locating policy information, state regulations,
or other mission critical data. From a training perspective, requiring MSRs to learn numerous different
back-end systems that are disconnected and non-intuitive drives up training time. As a result, the MSR
spends more time in training on each system, and is not on the floor answering calls.
How can you simplify the desktop and make the interaction between the MSR and member a more
pleasant and efficient experience? Consider an agile desktop solution that aggregates all of the key
policy information into a single view. This allows you to continue to use your legacy systems, while
simplifying and streamlining the user interface and information presented to the MSR, so they spend
less time navigating systems and more time answering the caller’s questions. Eliminating system
complexity and simplifying worker processes enables MSRs to work smarter, engage more effectively
and have the right information at the right time, transforming the member interaction and transaction
at the desktop.
READINESSSTRATEGY1

8. Tier 1 Contact Center
BEFOREAFTER
300 Calls
per day
300 Calls
per day
Tier 2 Contact Center
200+60 Calls
per day
250+15 Calls
per day
Back Office
200+80 Service
requests per day
250+20 Service
requests per day
Escalation
60 calls
Escalation
15 calls
Escalation
80 calls
Escalation
20 calls
• Reducing escalation numbers
• Increasing throughput
• Increasing customer experience
• Increasing worker engagement
8 Processes Automated
12 Processes Optimized
SOLUTION

9. INTELLIGENT CROSS-TRAINING
Everyone has to start somewhere, and most MSRs start by handling only the most basic types of
inquiries. However, there are often opportunities to expand the skill set of these tier-one MSRs by
implementing process automations that intelligently guide newer MSRs through more complex
processes. The alternative is to have tier-one MSRs handle only the most basic of inquiries and
then transfer everything else to an escalated, tier-two group or a back office. This common practice
increases transaction volumes, and significantly increases the elapsed time for transactions. Instead,
we recommend cross-training the tier-one MSRs, and using intelligent guidance to usher them step-by-
step through the more complex processes.
One additional point here is that as new ACA regulations are mandated, contact centers must be
compliant to these standards. Intelligent guidance can also be used to help contact centers maintain
compliance with new ACA regulations by enforcing adherence to new processes immediately after
they are introduced.
READINESSSTRATEGY2

10. OPEN DASHBOARD
CUSTOMER
INFORMATION
SIEBEL CLAIM APPLICATION
MEMBERSHIP
Project
Group #
New Package ID
Copy Source
Line of Business
Effective Date
Plan ID
Standard Short Description
Narrative
Project Details
JANE-0123456789-0
0123456789
CloneSearch
OS-000
HMO
ER Visit
HMO FEDERALLY QUALIFIED-PLAN03
OV$5, SG$5/OP50, ALY$5, ER$50, PAD$250
MIN$OP$25/SA15, OOP$1500/3000
Standard OSQ*03****N
04/23/14
QHP
First Name Jane
Last Name Automation
Policy # 0123-456-789
Contract ID # 0123-456-789-IN
Street
City
State
Zip
1101 Michigan Ave Date of Claim 04/16/2014Type of Claim
AllID AllMC Type MedicalCovered
$250 Rule ID CP5OSCopay AmountLogansport
IN
46947
1
4
2 3
5
6
1
4
2
3 5
6

11. READINESSSTRATEGY3
THINK SEAMLESS… AND AGILE
Regardless of the amount of planning and preparation, there are still many changes and uncertainties
related to the ACA that force you to be on your toes at all times. With each new regulation, contact
centers must be prepared adapt their systems to provide MSRs with the tools they need to either
communicate or capture accurate information.
The key to success is providing MSRs with the resources and information needed to accurately and
immediately respond to inquiries. Using intelligent taskbars that integrate to back-end systems to
quickly capture contact information or automating copy and paste tasks from system to system make
MSRs more efficient during the call, and automating post-call notes eliminates time-consuming
wrap-up. When changes need to be made to the back-end systems, the intelligent taskbar can still
maintain its familiar look and feel. In this manner, new regulations and procedures can be easily
assimilated without requiring wholesale changes to existing technology infrastructure or additional
MSR retraining.
Having a trusted technology partner that provides these flexible and agile technologies allows
managed care providers to adapt and extend existing technology assets to align with the rapidly
changing business needs.

12. How are you engaging your MSRs?
Establish Effective Rewards
and Recognition Programs
Encourage MSR
Feedback
Cultivate a Collaborative
Environment

13. ENGAGE, ENGAGE, ENGAGE
Onboarding and staffing new MSRs is time-consuming and costly, so once you have trained them, you want
to keep them. Unfortunately, most contact centers generally run at a 35% per annum attrition rate. The key
to minimizing attrition is to focus on MSR satisfaction and engagement – so it is important to establish a
collaborative culture at the start of onboarding so employees know their feedback is important.
Of course, this means that there really must be a collaborative culture and MSR engagement must be a
critical part of your service strategy. Is the MSR empowered to act on behalf of the company to solve a
caller’s issue? Do employees have the tools necessary to perform all of the work activities required? Are
these tools optimized for maximum performance? Does the company ask for employee feedback on a
regular basis? Is there a system for communicating the success of new programs and publicly praising
the employees that suggested them? These are all critical questions when considering MSR engagement
as part of an overall member service strategy. Recent studies have shown that as employee engagement
increases, so does service quality. Therefore, establishing and encouraging a strong dialogue with contact
center employees should be an important part of the training and onboarding experience.
READINESSSTRATEGY4

15. CONCLUSION
As the fog lifts off the horizon and the ACA becomes a clearer picture for everyone, organizations are
having to adjust and adapt as policies and laws evolve into this very different system of healthcare.
While this evolution plays out, managed care providers must continue to strive for operational and
service level excellence. Creating strategic training and onboarding programs to successfully ramp up
MSRs to staff these centers is a mission-critical corporate initiative. By implementing these four aspects
of the onboarding experience, MSRs can spend less time navigating complex systems, paperwork and
bureaucracy, and more time helping the caller and delivering excellent service.

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