Automation as the Next Big Disruptor?

Health Care Payers and Call Center Volumes – the Coming Storm

Despite the best efforts of many to deny the fact, the Affordable Care Act (ACA) – better known as Obamacare – will begin to take effect in 2014. As a result, health care coverage for many consumers will change substantially from what it is today. That means that between now and January, many consumers will have many questions regarding the availability of coverage, open enrollment, pre-existing conditions and other complex areas. How prepared are payer organization call centers to handle what will likely be an unprecedented spike in call volumes?

Unfortunately, evidence suggests that in most cases the answer is, “Not very.”

Many payers are planning for the anticipated surge in customer queries by ramping up staff augmentation efforts and providing script-based training so that agents can respond to specific queries. The basic problem with this approach is that the vast majority of questions customers will have will not lend themselves to specific, clear-cut answers. Moreover, at this point nobody really knows what kinds of questions customers will have.

Rather than taking a cookie-cutter approach, payers should focus on using the early days of the transition to Obamacare as a learning experience. Rather than trying to formulate answers to questions that can’t be anticipated, payers should seize the opportunity to analyze the data and insight that these questions – questions around choices, providers and payers – will provide. Based on this exercise of data gathering and analysis of calls, payers can develop “profiles of assistance” to more effectively guide their customers toward the answers they seek.

Given the complexity of the ACA and the complexity of the system it aims to reform, payers should take a long-term view and accept that a quick fix simply isn’t an option. The issue of call center volumes raises immediate tactical and operational concerns, but it also points to a larger strategic consideration – namely, how to respond to fundamental changes in health care delivery from a position of strength informed by meaningful insight into customer requirements.

About the author

Al Denis brings considerable experience in information technology (IT) to ISG clients in his role as Director, Healthcare Practice Lead for ISG. In his career, Al has delivered technical, sourcing and business services to Blue Cross and Blue Shield of North Carolina, Anthem, Kaiser Permanente, Sentara Health Systems, CareFirst, University of Pennsylvania Health System and Wellpoint. Al is among ISG's most accomplished experts in the evaluation of complex global sourcing alternatives, including solution evaluation and supplier management.