The Patient Protection and Affordable Care Act (ACA) was signed into law four years ago. It represents the most significant overhaul of healthcare in the US since the enactment of Medicare in 1965. Among other things, there is an individual mandate that requires anyone not covered by an employer-sponsored health plan or public insurance policy to secure an approved private-insurance policy for healthcare, or face a penalty. The result during the first open enrollment season: eight million people are now covered who were previously uninsured (or held policies that were discontinued because they could not meet the minimum requirements of ACA).
The open enrollment period that just concluded was unlike anything that had happened in the past for healthcare payors and providers. Even the most skilled planners were surprised at the outcome for many reasons:
- The ACA is a big, complex set of regulations that few people understand.
- Many of the deadlines specified under the act changed; while that widened the window of opportunity, it also caused confusion for payors and individuals seeking coverage.
- Many of the people needing coverage may never have had experience with health insurance, and therefore had many questions about how it worked prior to making a selection.
Where payors in the past had been accustomed to one or two calls from prospects prior to enrollment, the new group covered under ACA could be making upwards of a dozen calls—many of them to payors who might not even have an offering that was suitable for the prospect. That had a significant impact on the cost of sales, and resulted in a frustrating customer experience.
Now that the open enrollment season is over, there are three critical sets of questions payors must grapple with as they prepare for the next one:
- Before: What did you think open enrollment was going to be like, and how did you plan for it? Who was involved in the planning process? What methods and tools did you rely on for forecasting anticipated workloads? What resources did you identify that could be tapped for help? What contingency plans were considered if workload exceeded the forecast?
- During: What really happened? Were there spikes in volume, and if so, what drove the spikes: things within your control, or not? Was your operational team able to adjust to unanticipated increases/decreases in volume? What was the ratio of contacts to conversions? Was there a portion of the demand that should never have been handled by you?
- After: What did you learn from the experience that can be applied to the upcoming open enrollment period? Is there a way to improve the information available to shoppers to help them make decisions prior to calling, thereby reducing handle time and improving conversion rates?
The next open enrollment period will be here soon—are you ready for it?