Agency easing Medicare contact centers' woes

The Centers for Medicare and Medicaid Services (CMS) have started overhauling their outdated and disjointed contact centers to relieve the headaches of callers and call takers alike.

CMS, the nation's largest health insurance provider, is shifting its 70 call centers to a common desktop application. The Next Generation Desktop, developed by AdminiStar Federal and using Siebel Systems Inc.'s Call Center software, will eventually improve experiences on both ends of the phone line. Beneficiaries and providers will receive consistent and prompt answers, and call takers will move through the application with greater ease.

"That's a huge change for them," said Frank Bishop, vice president and general manager of the public sector for Siebel. "It's really going to bring them a set of standards they haven't had in the past."

Fifty-nine contractors currently manage the 70 stand-alone contact centers. Under the old setup, the 40 million beneficiaries and 1.2 million providers had to call different contact centers, depending on their specific needs. If they had multiple questions, they made multiple calls.

The Next Generation Desktop gives the 3,000 customer service representatives access to the same information through a single virtual call center.

Using the new system, customer service representatives can avoid the bottleneck of flipping through as many as 28 screens, laden with coding and definitions, to get an answer. Lillian White, a call taker who has used the Next Generation Desktop since last fall, said the new system is efficient and consistent.

"It's very user-friendly. All the information is right there. It combines the screens, and it tracks and logs the information accurately," White said. "We all pull the information from the same screens or tasks or scripting. You're not going to get a different answer for the same question."

The new PC-based system replaces the various back-end, pre-Windows and pre- graphical user interface applications that required coding and were not fully electronic. Call takers will now follow scripted steps to reach a consistent answer each time.

"Everything is in plain English, so you don't need to know [programming] codes," said Mary Agnes Laureno, director of CMS' beneficiary information services group. "It makes it very intuitive for the customer service representative."

Because the previous systems didn't share information, chances were the answers to a caller's questions could change according to what center the call came into and which call taker answered. Furthermore, there was no way of logging the calls, so there were no records of a caller's previous questions.

"It's very time-consuming and error-prone," Bishop said. "The citizen has to start all over again when they call back in."

The new application has a complete electronic record for each interaction, so call takers know if there are items pending or can anticipate why a person is calling. "From the callers' perspective, they see CMS actually knows them, knows their activities," Bishop said. "It's a complete change in the way they were doing business."

AdminiStar Federal developed the Next Generation Desktop platform, tailoring a Siebel Call Center system to meet CMS' needs, said David Marshall, executive director of customer service at AdminiStar Federal. The company also provides the customer service representatives for CMS.

The desktop application is a step in the right direction, said Liz Boehm, an analyst at Forrest Research. The downside, however, is that with access to more information comes the need for training in all areas of a complex insurance system. Although the system is scripted and calls can be easily passed to specialized centers, call takers will need to get used to handling the full gamut of questions, she said.

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The cornerstone of the call center

The Centers for Medicare and Medicaid Services' Next Generation Desktop application will consolidate the 70 contact centers under one system to make handling the more than 4 million provider and beneficiary calls per month more efficient and consistent.

The centers are run by 59 contractors and each is managed as a stand-alone center with its own contact system. Before the consolidation, some centers were paper-based while the others used a handful of computer applications.

The Next Generation Desktop system was deployed at the first call center last October and the second will be running in the next few weeks.