Affordable Care Act Open Enrollment: An Industry Insider’s Perspective



Eventus Marketing Team

Cammie Blais is currently Vice President of Customer Engagement at Eventus Solutions Group and former Chief Financial Officer of Connect for Health Colorado. She graciously gave some of her time to answer some questions about open enrollment for the Affordable Care Act.

November 15, 2014 marks the second open enrollment period under the Affordable Care Act.  Contact centers are ramping up staff and getting ready for significantly higher call volume over the coming months.  Open enrollment lasts for three months, until February 15, 2015. The logistics behind getting prepared for this period began as soon as last year’s open enrollment was over.  Contact centers in every state, whether they are working with a state exchange or the federal exchange, have experience now and are ready to implement their strategy for an efficient and seamless customer-centric experience.

What is open enrollment?

Open enrollment is the period that everyone who needs health insurance, no matter their circumstances, can sign up for insurance.  Unless someone moves to a new state, marries, divorces or has a baby, open enrollment is the only time to sign up for individual health insurance under the Affordable Care Act.   Open enrollment lasts for three months, from November 15, 2014 until February 15, 2015.

Acting during the open enrollment period is vital for any individual who wishes to buy individual health insurance.  During open enrollment anyone who wants to purchase insurance through the public exchange has the opportunity to do so despite circumstances, such as health or age.  Outside of open enrollment it can be difficult to obtain insurance, either public or private, unless circumstances dictate.

What is different about this year’s open enrollment than last year’s?

Last year, the marketplaces experienced all the challenges of any new consumer-facing, retail business, but in addition to those “normal” issues that every contact center faces daily, they faced political pressures and the interesting position of being the entities in the midst of the broader, national health care reform policy.  It was a greenfield environment.   This year, with last years’ experiences and improved technology systems, open enrollment should provide an improved experience for all customers.

Also, this year people will be renewing their plans rather than just purchasing new plans.  While on the surface this sounds easier, it’s actually a lot more convoluted than most people realize.  The criteria for auto-renewal is set by each state’s insurance authority and may be extremely rigid; the renewal plan cannot differ much from the previous year’s plan.  In many cases the prices will fluctuate.  This renewal information requires additional customer support staff training at a different level than last year.  Auto-renewals are also not the standard for the simple reason that customers have to be told of any changes to their plan.  It would be irresponsible if we did not relay pertinent information about plans to every customer.

How are contact centers affected by Open Enrollment?

Contact centers really have to ramp up hiring.  The stats are pretty amazing.  Call volume during the three months, in one projection will be roughly 300 percent above where they are normally.  This requires at least four times more staff to field these calls.  At the same time, people will be using the website at a higher volume, which will require more technical staff ready to deal with any issues that might arise.  To handle this kind of uptick, contact center’s systems need to be upgraded in many cases, and quality controls not only need to be implemented for this year, but for the training sessions for the following year. 

How does Eventus Solutions Group work with contact centers to ramp up for open enrollment?

Eventus has many different roles when it comes to preparing for and operating through the open enrollment period.  Eventus helps with the procurement of additional labor.  We help with outsourcing where and when possible and have a big role in making sure the training is implemented correctly.

Just as importantly as making sure the labor force is prepared, we also work with the telephony.  There is a need for specialized call routing; for example, renewals versus first time policy buyers may need to speak with a different contact center representative.

During periods of labor fluctuation, processes will have to change.  We consult during the growth process, then analyze during the ramp-down period.  Call quality, training, personnel and systems all need to be studied to make sure that the best approach is taken the following year.

What is the best advice you can give to a contact center ramping up for Open Enrollment?

Don’t underestimate the needs of the customers.  There will be a lot of calls to handle and a lot of information to dole out.  It is much better to overestimate than underestimate your training and labor needs during this period.  And try to retain as much staff and bring back as much knowledge as possible from last year since these people are already prepared and have a great knowledge base to work from.  They’ll be beneficial to both the customers and new staff.

After weeks of hiring, training, and getting systems into place, open enrollment is only days away.  As you can see, this is a long arduous process that takes planning from the moment last year’s open enrollment ends to the day this year’s open enrollment begins. Improvements in processes and systems will even continue through the duration of open enrollment.  Experience, systems, training and of course the wonderful people who work with customers and systems at contact centers everywhere will make this a successful period.

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