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Commonwealth Care Quarterly Update

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2. New Tools for Members ... New, CSR-driven quality projects provides better insight into operations ... Also starting to implement new tools ... – PowerPoint PPT presentation

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Title: Commonwealth Care Quarterly Update


1
CommonwealthCare Quarterly Update
  • January 15, 2009

2
Agenda
  • Enrollment Caseload
  • Program Policy Update
  • Call Center Implementation Status Member
    Experience

3
Enrollment Caseload Activity

4
Caseload Overview
  • Focusing on activity from October through
    December 2008
  • Slight increase in enrollment starting in
    December
  • Closings continue to be largely due to
    redeterminations

5
Enrollment History (as of 1/1/09)
Increase in Enrollment starting in December of
2008
6
Net Enrollment, (All Plan Types)Oct Dec 2008
7
Enrollment by Plan Type 12/1/08
8
Re-Enrollment Following Redet Closings 2/08
12/08
9
Program Policy Update

10
Eligibility
  • CommCare eligibility is based on a number of
    factors
  • Income is initial criteria
  • No access to subsidized insurance, particularly
    ESI, is second
  • Application process focuses on these areas
  • Individuals self-report information
  • Validation is done as part of MassHealth
    processing

11
Program Integrity
  • Once an individual is determined eligible there
    are a number of processes in place to continue to
    validate status
  • Redeterminations collect relevant demographic,
    income and employment information
  • Exception Forms focus on access, particularly ESI
  • Matching, including with DOR, provides
    information on both income and employment
  • These processes are in effect throughout a given
    twelve-month period

12
Program Integrity, cont
  • Information is collected through the application
    (MBR) and Eligibility Review Form (ERV)
  • CCA is implementing a number of projects to both
    support members in these processes and ensure
    appropriate eligibility
  • Key goal for CommCare is to make the processes
    supporting eligibility determination as
    user-friendly as possible

13
Solution Status
  • Four proposals were presented in October to
    improve program integrity and the member
    experience
  • CommCare-specific cover insert
  • Implement additional tools for members
  • Improve initial data collection
  • Improve eligibility processes related to Employer
    Sponsored Insurance

14
1. CommCare-Specific Insert
15
CommCare-Specific Insert
16
2. New Tools for Members
17
3. Improve Initial Data Collection
18
4. Improve ESI-Related Processes
19
CommCare 1099HC
  • CommCare is providing 1099HCs this year
  • Required as part of Chp 58
  • Individuals over 150 receiving actual 1099HC and
    explanatory letter
  • Will starting mailing on 1/15/09
  • Have built an extensive customer service platform
  • Additional CSRs, web page enhancements, email
    communications to outreach community

20
Call Center Implementation Status Member
Experience

21
Implementation Status
  • Perot Systems assumed responsibility for the Call
    Center on time (November 1st 2008)
  • Responsible for majority of member-facing
    activities
  • Call Support, Outreach and Communications
  • Enrollment
  • Premium Billing

22
Program Improvements
  • Members realized immediate improvements as part
    of the transition
  • Same-month billing (better reflects actual
    enrollment)
  • Clearer and more informative invoices
  • Integrated systems (member encounter, enrollment,
    eligibility) allows for better support of calls
    and inquiries

23
Program Improvements, cont
  • Members realized immediate improvements as part
    of the transition
  • Utilization of imaging technologies (no more
    paper!)
  • Waivers are reviewed on-line by CCA staff
  • Has resulted in no backlog
  • 100 call recording better customer service
  • Critical for training, QC, and problem resolution

24
Implementation Issues
  • Perot has experienced some problems around
    implementation
  • Largely due to the complexity of the program and
    the short implementation timeline
  • Two areas of focus abandonment rate and billing
    cycle changes

25
Call Reasons 12/31/08
26
Abandonment Rate Issues
  • Abandonment rate has been significantly higher
    than contractual requirement
  • 15.2 in November
  • 19.4 in December
  • Driven by a number of factors
  • Change in invoice cycle
  • Inadequate number of CSRs
  • Call management processes
  • Connector will be imposing financial penalties if
    improvements are not made

27
Abandonment Rate Next Steps
  • Perot is implementing an aggressive and
    multi-faceted plan to achieve improvements
  • Perot Call Center leadership team has been
    enhanced to better support the complex nature of
    the program
  • Greater focus on project implementation (its
    going to be constant)
  • Additional management resources around premium
    billing and technology

28
Abandonment Rate Next Steps, cont
  • Continue to provide additional tools and
    resources to CSRs
  • Goal of enhancing member experience and CSR
    productivity at the same time
  • Focusing on call length and problem resolution
    processes
  • New, CSR-driven quality projects provides better
    insight into operations
  • Provides means to improve processes quickly

29
Call Monitoring Tools
30
(No Transcript)
31
Billing Cycle Changes Issues
  • Move to same-month billing uncovered some flaws
    in the system
  • Runs for December and January were heavily QCd
    to look for issues
  • Found problems early in process when they still
    could be addressed
  • Any issues that were identified were addressed

32
Billing Cycle Changes Member Improvements
  • Same-month billing reflects actual months
    enrollment
  • Had previously billed 45 days in advance
  • Re-designed invoices
  • Provide better information
  • Monthly balance, payments, adjustments, and
    health plan/plan type
  • Now have ability to include detailed text
    messaging
  • 80 reduction in billing question escalations

33
Pre 11/1
34
New Invoice
35
Member Communications
  • Heavy focus on member outreach through June (end
    of Open Enrollment)
  • Lots of information to share (new program tools,
    health plan updates)
  • Also starting to implement new tools
  • Email will better support members and provide CCA
    an effective tool around program integrity
  • Additional IVR options to support enrollment
    status questions
  • Web site enhancements provide member enrollment
    history

36
Member Enrollment History
37
Member Letter
  • On 12/31/08 I called your office I was received
    by a representative Her cheerful voice, her
    patience, her trusting manner and thoroughness
    was amazing. She is a true professional in every
    sense of the word. She really put me at ease
    through my nervousness and silly questions. She
    made sure I understood everything I needed to
    know. She was great!!! She is truly a fine
    representative.
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