Commonwealth Care Quarterly Update

1
CommonwealthCare Quarterly Update

• January 15, 2009

2
Agenda

• Enrollment Caseload
• Program Policy Update
• Call Center Implementation Status Member
  Experience

3
Enrollment Caseload Activity

4
Caseload Overview

• Focusing on activity from October through
  December 2008
• Slight increase in enrollment starting in
  December
• Closings continue to be largely due to
  redeterminations

5
Enrollment History (as of 1/1/09)
Increase in Enrollment starting in December of
2008
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Net Enrollment, (All Plan Types)Oct Dec 2008
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Enrollment by Plan Type 12/1/08
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Re-Enrollment Following Redet Closings 2/08
12/08
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Program Policy Update

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Eligibility

• CommCare eligibility is based on a number of
  factors
• Income is initial criteria
• No access to subsidized insurance, particularly
  ESI, is second
• Application process focuses on these areas
• Individuals self-report information
• Validation is done as part of MassHealth
  processing

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Program Integrity

• Once an individual is determined eligible there
  are a number of processes in place to continue to
  validate status
• Redeterminations collect relevant demographic,
  income and employment information
• Exception Forms focus on access, particularly ESI
• Matching, including with DOR, provides
  information on both income and employment
• These processes are in effect throughout a given
  twelve-month period

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Program Integrity, cont

• Information is collected through the application
  (MBR) and Eligibility Review Form (ERV)
• CCA is implementing a number of projects to both
  support members in these processes and ensure
  appropriate eligibility
• Key goal for CommCare is to make the processes
  supporting eligibility determination as
  user-friendly as possible

13
Solution Status

• Four proposals were presented in October to
  improve program integrity and the member
  experience
• CommCare-specific cover insert
• Implement additional tools for members
• Improve initial data collection
• Improve eligibility processes related to Employer
  Sponsored Insurance

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1. CommCare-Specific Insert
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CommCare-Specific Insert
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2. New Tools for Members
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3. Improve Initial Data Collection
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4. Improve ESI-Related Processes
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CommCare 1099HC

• CommCare is providing 1099HCs this year
• Required as part of Chp 58
• Individuals over 150 receiving actual 1099HC and
  explanatory letter
• Will starting mailing on 1/15/09
• Have built an extensive customer service platform
• Additional CSRs, web page enhancements, email
  communications to outreach community

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Call Center Implementation Status Member
Experience

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Implementation Status

• Perot Systems assumed responsibility for the Call
  Center on time (November 1st 2008)
• Responsible for majority of member-facing
  activities
• Call Support, Outreach and Communications
• Enrollment
• Premium Billing

22
Program Improvements

• Members realized immediate improvements as part
  of the transition
• Same-month billing (better reflects actual
  enrollment)
• Clearer and more informative invoices
• Integrated systems (member encounter, enrollment,
  eligibility) allows for better support of calls
  and inquiries

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Program Improvements, cont

• Members realized immediate improvements as part
  of the transition
• Utilization of imaging technologies (no more
  paper!)
• Waivers are reviewed on-line by CCA staff
• Has resulted in no backlog
• 100 call recording better customer service
• Critical for training, QC, and problem resolution

24
Implementation Issues

• Perot has experienced some problems around
  implementation
• Largely due to the complexity of the program and
  the short implementation timeline
• Two areas of focus abandonment rate and billing
  cycle changes

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Call Reasons 12/31/08
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Abandonment Rate Issues

• Abandonment rate has been significantly higher
  than contractual requirement
• 15.2 in November
• 19.4 in December
• Driven by a number of factors
• Change in invoice cycle
• Inadequate number of CSRs
• Call management processes
• Connector will be imposing financial penalties if
  improvements are not made

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Abandonment Rate Next Steps

• Perot is implementing an aggressive and
  multi-faceted plan to achieve improvements
• Perot Call Center leadership team has been
  enhanced to better support the complex nature of
  the program
• Greater focus on project implementation (its
  going to be constant)
• Additional management resources around premium
  billing and technology

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Abandonment Rate Next Steps, cont

• Continue to provide additional tools and
  resources to CSRs
• Goal of enhancing member experience and CSR
  productivity at the same time
• Focusing on call length and problem resolution
  processes
• New, CSR-driven quality projects provides better
  insight into operations
• Provides means to improve processes quickly

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Call Monitoring Tools
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(No Transcript)
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Billing Cycle Changes Issues

• Move to same-month billing uncovered some flaws
  in the system
• Runs for December and January were heavily QCd
  to look for issues
• Found problems early in process when they still
  could be addressed
• Any issues that were identified were addressed

32
Billing Cycle Changes Member Improvements

• Same-month billing reflects actual months
  enrollment
• Had previously billed 45 days in advance
• Re-designed invoices
• Provide better information
• Monthly balance, payments, adjustments, and
  health plan/plan type
• Now have ability to include detailed text
  messaging
• 80 reduction in billing question escalations

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Pre 11/1
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New Invoice
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Member Communications

• Heavy focus on member outreach through June (end
  of Open Enrollment)
• Lots of information to share (new program tools,
  health plan updates)
• Also starting to implement new tools
• Email will better support members and provide CCA
  an effective tool around program integrity
• Additional IVR options to support enrollment
  status questions
• Web site enhancements provide member enrollment
  history

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Member Enrollment History
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Member Letter

• On 12/31/08 I called your office I was received
  by a representative Her cheerful voice, her
  patience, her trusting manner and thoroughness
  was amazing. She is a true professional in every
  sense of the word. She really put me at ease
  through my nervousness and silly questions. She
  made sure I understood everything I needed to
  know. She was great!!! She is truly a fine
  representative.