South Florida Hospital News
Monday August 10, 2020

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September 2013 - Volume 10 - Issue 3


Health Insurers Face Enrollment Challenges, Opportunities with Affordable Healthcare Act

To some, the Patient Protection and Affordable Care Act (ACA) was envisioned as a way to solve many of the nation’s issues related to insuring millions of otherwise uninsured citizens.
For healthcare providers, hospitals and insurance companies in South Florida and nationwide, the Act presents challenges in efficiently and effectively recruiting, training and licensing teleservice insurance agents for enrollments and member service management.
While some areas of implementation have been delayed from the original 2014 launch, it’s a “when, not if” scenario. Millions of new insureds will be enrolled. Insurance providers will face the daunting task of ramping up marketing and enrollment services, followed by ongoing member service, retention / loyalty, and educational outreach efforts in support of ACA and Centers for Medicare and Medicaid Services (CMS).
Agents will need to be educated, trained and certified to market and sell insurance plans and programs – often in multiple or all 50 states for insurance providers who work in multi-state jurisdictions. Agents must know such nuanced details as whether an enrollee qualifies for subsidization – and to what extent. This could create mass confusion, particularly in the first year.
This will be especially challenging in states like Florida. As state insurance exchanges come online, agencies and providers will need to accelerate the creation of member service facilities to handle what is expected to be millions of customers.
Insurance companies must make a decision: should they handle the task of creating and staffing a member service center internally or should they outsource the function – as many already do – to a provider uniquely prepared for the challenge?
When making the decision, executives should weigh several variables:
- Is the organization prepared to hire, train and license scores – even thousands – of new teleservice agents, especially in government subsidized coverage? Educating agents to meet state certification requires specific training – often executed at an accelerated pace. Seek a vendor proven at training, certifying and reinforcing key messaging for launch, whether it’s for ACA Medicare, Medicaid, commercial or pharmacy applications.
- Does the organization have a compliance team well versed in ACA and CMS regulations? Such teams ensure ongoing training on healthcare law changes or updates, as well as modifications or changes to the insurance company’s own policies. With the implementation of state exchanges or new policy offerings, insurance providers will need to be prepared for even more changes.
- Will the creation, staffing, implementation and management of a member service center distract your organization from its core mission of creating insurance offerings ideal for the marketplace? Simply put, insurance providers often are best served insourcing what they do best – creating insurance programs - and outsourcing any function beyond that, like member support. Entrusted to a skilled provider, insurance companies can rest assured their members will be well served.
- If the market changes, can an insourced member support center shift or grow “on the fly” to accommodate dynamic realities? Some insurance providers have created in-house contact centers that can efficiently handle customer needs – even in a changing marketplace. Can yours?
To be sure, the Patient Protection and Affordable Care Act could help solve many of the nation’s issues related to insuring millions of otherwise uninsured citizens. The key is to demystify the challenge payers face in marketing and servicing millions of new members – and focus on delivering remarkable products in a dynamic and new healthcare environment.
Ken Epstein, Executive Vice President, Global Sales and Marketing, C3/CustomerContactChannels, can be reached at (954) 577-7710 or
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