The nation’s call centers are gearing up for a challenge of federal proportions: implementation of the healthcare exchanges mandated under the Affordable Care Act (ACA, or “Obamacare”). One of the most prominent features of the ACA is the development of new health insurance marketplaces called “exchanges,” that will enroll both private citizens and some businesses in health insurance coverage for the 2014 plan year beginning in October of this year. The Affordable Care Act intended that states, with the help of federal grants, will develop and run their own exchanges. For states choosing not to do so, -- and so far this is about half the states -- the federal government will establish exchanges for those states’ residents.
Connecticut is the latest state to declare a partner in the program. Access Health CT, Connecticut’s Exchange, has chosen MAXIMUS, Inc., an administrator of government health insurance programs, to run its consumer contact center operation and help Connecticut residents through the process of enrolling in a health insurance program.
MAXIMUS is headquartered in Reston, Virginia, but it will be tasking contact centers in New York City and Hartford, Connecticut to support Access Health CT. Access Health CT, Connecticut’s Exchange, was created by the Connecticut Legislature in 2011 and is a quasi-public agency established to oversee the requirements of the Affordable Care Act.
Access Health CT’s toll-free customer contact center will begin accepting calls in September of this year to answer preliminary questions and provide information. The call center will begin enrolling Connecticut residents in health programs beginning October 1st. MAXIMUS says its contact center representatives will be fully trained about the Exchange and the health insurance options being offered. The call center will also provide access to representatives who are culturally competent and bilingual, being able to converse in Spanish, Chinese and more than 100 other languages.
Thus far, 17 states and the District of Columbia have begun to set up their own healthcare exchanges, according to the New York Times. Since the exchanges must be fronted by an active customer support process, many states are choosing experienced call centers with special skills to be the front end of the exchange programs. Not only do the call centers need to be well versed in the ACA, they must be multilingual, sufficiently staffed to support high traffic and well versed with federal and state laws that govern patient privacy (such as the Health Insurance Portability and Accountability Act, or HIPAA) when it comes to sensitive medical information.
There are significant fines and penalties for call centers that fail to comply with HIPAA policies or experience breaches in customer data security. Due to strict HIPAA privacy requirements, call centers participating in the exchange (as well as other healthcare functions) must guard against improper disclosure of customer information and safeguard its data storage to comply with regulations. Under HIPPA rules and regulations, call centers need to incorporate secure voice and data processing as well as encrypted data record storage to enhance call monitoring, tracking, data management and reporting.
Given the fact that the ACA is a new program, the initial rush to enroll may task contact centers substantially, which is why it is critical for states to pick HIPAA experienced contact center organizations that are well versed in the rules and regulations of the Affordable Care Act.
Edited by Brooke Neuman