Healthcare Access, Eligibility & Enrollment Unit (HAEEU) and 1 more...less...

Customer Support Center

% of Calls Answered within 24 seconds

90%Sep 2020

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Partners

DVHA-HAEEU's Tier 1 Customer Support Center is contracted through Maximus. Vermonters who need to apply for health benefits can call the Customer Support Center, as can members who need to ask questions or report changes to their accounts. A Service Level Agreement (SLA) in the contract between DVHA and Maximus calls for Maximus to receive a performance bonus for any months in which they answer at least 75% of calls within 24 seconds and have an abandoned rate of no more than 5.0%. It also calls for a financial penalty if fewer than 60% of calls are answered within 24 seconds. Tier 2 Customer Support is run directly by DVHA, handling eligibility-related questions and other escalations.

Story Behind the Curve

Call volume for each of the first nine months of 2018 was down from the corresponding month in 2017. This low volume combined with ample staffing levels at Maximus to result in prompt answer times for callers. Maximus met its targets for every month from February through October.

This experience changed in November as Maximus struggled to retain the staff needed to meet staffing level targets. Combined with DVHA's success in encouraging members and Open Enrollment's call volumes, the result was long waits and missed service levels in November and December.  

On the positive side, there was a decrease in the percentage of calls that Maximus was unable to assist and needed to escalate to DVHA. Only 5% of December 2018 calls had to be transferred to DVHA’s Eligibility and Enrollment staff, down from 6% in both November 2018 and December 2017. This figure would have been even lower if its transfers were limited to calls that didn't need to be escalated. Instead DVHA took additional calls during high volume times in order to alleviate Vermonters' wait times. 

Strategy

DVHA has taken a two-fold approach to mitigating the impact on Vermonters, first by allocating state staff to assist with phone calls in the short-term and second by pushing Maximus to increase staffing levels, whether it be in their Burlington call center or with a satellite support center. DVHA leadership has held daily calls with Maximus to ensure progress.

DVHA continues to work with its insurance carrier partners to help unsubsidized members understand the benefits of direct enrolling with the carriers, an option that they can take even outside of Open Enrollment.

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