As part of its efforts on behalf of some 42 million Medicare beneficiaries, the Centers for Medicare and Medicaid Services (CMS) operates the Medicare Helpline, a 24x7, 2000 seat call center. The operation provides general information about Medicare benefits and paid claims; fills requests for publications; helps beneficiaries enroll and drop various Medicare plans; and troubleshoots complex enrollment, premium, and other issues. The Helpline often shapes beneficiaries’ critical first impression of (and continuing relationship with) a program that will be essential to their healthcare for the rest of their lives. CSC was responsible for Medicare Helpline content management from 2003 through 2006. It has managed the Helpline’s Reference Center, the Helpline’s third, final, and most complex tier handling the most difficult calls continuously since 2003.
Re-engineering for Caller and Client Satisfaction
Helpline information and services must be accurate, consistent, and timely. Given these considerations as well as the need for cost effectiveness and quality, CMS elected to use a scripting rather than a training model. Older Medicare call center operations relied on experienced and well trained Customer Service Representatives (CSR) to handle Medicare inquiries from the public. This approach requires the hiring of skilled employees and more investment in their training before they could be productively deployed. The training covered a broad range of frequently changing Medicare eligibility, coverage and payment policies. A CSR frequently had to resort to hard copy policy manuals in three ring binders, hand-written post-it notes, and other haphazardly accumulated reference materials. Even with trained staff there were serious continuing problems for Medicare to provide accurate, consistent and timely information to the public and very limited ability to quickly staff up for new program initiatives.
CMS adopted a knowledge management approach to call center operations which builds on providing a script and web-based tools for CSRs to use in responding to inquiries. Scripts are created to cover all aspects of Medicare eligibility, coverage, and payment policies. CSRs are required to read these scripts verbatim after first assessing a caller’s question or questions. The scripting approach puts less emphasis on specific Medicare knowledge and instead focuses on the customer service skills necessary to understand the caller’s issue and to quickly locate the correct information. This approach allows Medicare to use lesser skilled employees, provide less costly and time-consuming training and still improve the accuracy, consistency and timeliness of its service.
A traditional Medicare claims processor developed the first Helpline scripts. The results were technically accurate but difficult for Customer Service Representatives (CSRs) to navigate, difficult for callers to understand, and cumbersome to maintain.
When CSC assumed responsibility for Helpline content management, we immediately assessed the content we inherited. Applying our commercial business knowledge of health insurance and our business process management skills, we re-engineered the Medicare Helpline content. Our goals were to:
- Provide callers with clear and concise information
- Increase caller satisfaction
- Improve CSR morale
- Increase CSR understanding of callers’ issues
- Decrease CSR training time
- Reduce the duration of calls
CSC’s re-engineering proceeded in two phases. First, we limited the number of scripts that CSRs had to navigate, eliminated duplicate or outdated information across multiple scripts, and improved the consolidated scripts with CSR input. Second, we engineered a fresh approach to managing calls and organizing scripts. We called the approach IPA – Issue, Plan, Action:
- Issue: Identify the caller’s issue as quickly as possible
- Plan: Identify the type of plan – traditional Medicare, Medicare Health Maintenance Organization (HMO), or Medicare supplemental insurance – related to the issue
- Action: Serve the caller by providing information, mailing a publication, or taking other appropriate steps
This process is supported by creative use of hypertext that links probing questions to the appropriate action or information that meets the caller’s needs.