HEALTH ACCESS UPDATE
NEW “SECRET SHOPPER” SURVEY OF STATE HEALTH AGENCIES REVEALS RECIPE ON MEETING CONSUMER ASSISTANCE NEEDS UNDER HEALTH REFORM
Over 200 “mystery” calls made to four state agencies, with common consumer questions; California agencies largely met key standards,
But with crush of calls expected, need more consistent, coordinated, prioritized effort.
Groups argue consumer assistance needs to be a priority as millions of Californians get new options, new benefits and new consumer protections under health reform;
The report shows the right ingredients are there—but they need to be put together.
Budget (including May Revise) debate will include consumer assistance capacity;
Exchange to discuss consumer assistance and service center issues at June meeting.
- in the state budget allocations for each of the four departments (including those supported by federal funds and grants and by fees on insurers)
- in Administration’s revamping of the Office of the Patient Advocate as part of its implementation of SB922 (Monning) passed last year, and
- at the Exchange, which will begin unveiling its plan for their customer service call center at their June meeting.
- consumers should be able to reach a customer service representative (CSR) close to 95% of the time (Model Agency: CDI)
- agencies should answer calls quickly and ensure short hold times – the wait for a live CSR should be no longer than 4 min (Model Agencies: CDI, MRMIB)
- agencies should demonstrate ability to answer consumer questions without significant delay (Models: DMHC, DHCS)
- customer service representatives should be knowledgeable – score at least 4 out of 5 by callers rating CSR Knowledge (Model Agencies: MRMIB, DMHC)
- agencies should adopt continual training programs to keep staff informed of changes in policy and be able to provide up to date information reflecting any changes within 24 hours (Model Agency: MRMIB)
- agencies should continually monitor quality of call center operations and service (Model Agency: CDI) – CDI has clear mechanisms in place to evaluate the quality of the customer service their CSRs provide, with regular audits and evaluations
- agencies should provide consumers with excellent customer service, act as advocates for consumers, and provide warm hand offs when consumers need help from other places (Model Agency: DMHC)