October 1st is approaching quickly and opening the marketplaces on time represents the Obama administration’s biggest challenge to fulfill the affordable healthcare promise to extend coverage to uninsured Americans, including those who have been denied coverage in the past because of pre-existing conditions. Since the Supreme Court upheld the law last June, though, officials have had to overcome many hurdles, from states’ reluctance to participate, to critics’ predictions of unaffordable coverage, to unexpectedly tight budgets and the simple lack of infrastructure and support. Some see chaos, a few see entrepreneurial opportunities and others are taking a “wait and see” approach how Obamacare will be administrated in its first round.
A quirk in the law provided generous funding for consumer outreach in states with their own marketplaces, but little for states with a federal exchange. That could be a problem since polls show that most Americans know little about how the new affordable healthcare law affects them. Many that are confused about who to call and how will affect them include the young, the elderly and those that do not speak English.
There are also technical challenges: supporters of the new law like to compare shopping on the exchanges to buying an airplane ticket on Expedia or Priceline, but building the back-end system is far more complicated, requiring systems at state and federal agencies to be able to talk to one another in real time to verify an individual’s income and citizenship status, and determine eligibility for federal subsidies or Medicaid, the state-federal insurance program for the poor. That system also needs to connect with the computers run by insurance companies to accept the enrollment and process accordingly.
Thus a healthcare call center has several challenges in assisting new enrollees into the process between systemic connectivity and a robust knowledgebase that is user friendly to assist those seeking enrollment. With little time remaining and lack of know-how, outsourcers are scrambling to reach out to assist as a potential turn-key solutions provider. Several large traditional government contractors have been awarded massive contracts but have little experience in the design, set-up and deployment of call center operations. Clearly the initial enrollment process will be flawed with errors and technical issues. The challenge for the outsourced call center will be in adapting through a hectic new process and platform with little time to develop SOP’s as regulations and policies continue to change.