[Senate Hearing 110-829]
[From the U.S. Government Publishing Office]
S. Hrg. 110-829
1-800-MEDICARE: IT'S TIME FOR A CHECK-UP
=======================================================================
HEARING
before the
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
WASHINGTON, DC
__________
SEPTEMBER 11, 2008
__________
Serial No. 110-35
Printed for the use of the Special Committee on Aging
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
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SPECIAL COMMITTEE ON AGING
HERB KOHL, Wisconsin, Chairman
RON WYDEN, Oregon GORDON H. SMITH, Oregon
BLANCHE L. LINCOLN, Arkansas RICHARD SHELBY, Alabama
EVAN BAYH, Indiana SUSAN COLLINS, Maine
THOMAS R. CARPER, Delaware MEL MARTINEZ, Florida
BILL NELSON, Florida LARRY E. CRAIG, Idaho
HILLARY RODHAM CLINTON, New York ELIZABETH DOLE, North Carolina
KEN SALAZAR, Colorado NORM COLEMAN, Minnesota
ROBERT P. CASEY, Jr., Pennsylvania DAVID VITTER, Louisiana
CLAIRE McCASKILL, Missouri BOB CORKER, Tennessee
SHELDON WHITEHOUSE, Rhode Island ARLEN SPECTER, Pennsylvania
Debra Whitman, Majority Staff Director
Catherine Finley, Ranking Member Staff Director
(ii)
C O N T E N T S
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Page
Opening Statement of Senator Gordon H. Smith..................... 1
Opening Statement of Senator Herb Kohl........................... 4
Panel I
Statement of Kerry Weems, Acting Administrator, Center for
Medicare and Medicaid Services, U.S. Department of Health and
Human Services................................................. 5
Panel II
Statement of Naomi Sullivan, Medicare Beneficiary, Chico, CA..... 24
Statement of Michealle Carpenter, Deputy Policy Director and
Counsel, Medical Rights Center................................. 29
Statement of Tatiana Fassieux, Board of Directors Chair,
California Health Advocates, Sacramento, CA.................... 37
Statement of John Hendrick, Project Attorney, Elder Financial
Empowerment Project, Coalition of Wisconsin Aging Groups,
Madison, WI.................................................... 49
Panel III
Statement of John M. Curtis, President and Chief Executive
Officer, Vangent, Inc., Arlington, VA.......................... 55
APPENDIX
Prepared Statement of Senator Robert P. Casey, Jr................ 59
Kerry Weems Responses to Senator Smith's Questions............... 59
Michealle Carpenter's Responses to Senator Smith's Questions..... 62
Tatiana Fassieux's Responses to Senator Smith's Questions........ 63
John Curtis's Responses to Senator Smith's Questions............. 63
Statement by the Health Assistance Partnership................... 65
Testimony of Jettie Turner, Medicare Beneficiary, Tupelo, MS..... 67
Testimony of Colter McLellan, Medicare Beneficiary, Picayune, MS. 77
Testimony of Dawn V. Crouse, full-time volunteer SMP Counselor,
Mississippi Senior Medicare Patrol, Columbus, MS............... 86
Testimony of Frankie F. Ferguson, Medicare Beneficiary, Oxford,
MS............................................................. 92
(iii)
1-800-MEDICARE: IT'S TIME FOR A CHECK-UP
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THURSDAY, SEPTEMBER 11, 2008
U.S. Senate
Special Committee on Aging
Washington, DC.
The committee met, pursuant to notice, at 10:08 a.m., in
room SR-325, Dirksen Senate Office Building (Hon. Gordon H.
Smith) presiding.
Present: Senators Smith [presiding] and Kohl.
OPENING STATEMENT OF SENATOR GORDON H. SMITH
Senator Smith. Good morning, ladies and gentlemen. We
welcome you all to this very important hearing, 1-800-MEDICARE:
It's Time for a Check-Up. We're met in this historic room of
the Senate Russell Caucus Room. I don't know that Administrator
Weems will regard this as anything like the Watergate hearings.
We don't intend it to be. But a lot of historic things have
happened here.
Certainly one of the more historic things that Congress has
done in the last several years is the Medicaid reform, the
update that includes Medicare Part D. Medicare Part D is a
massive program to provide seniors with prescription drug care
as part of their Medicare benefit.
When we began to put this legislation together to provide
this reform and this new benefit, we recognized that it was a
monumental task. CMS, through Health and Human Services, has
certainly had an enormous job to do. Our focus here today is on
how we can do that job even better. This is not designed to
call into question anyone's motive or in any way to question
their sincerity, and Kerry Weems, who is the Administrator of
CMS, has been many times to my office. I appreciate that,
Kerry, and I appreciate your attention to this issue, and we
are grateful for your service to our country. You've spent a
lot of time in the Federal Government trying to get these
programs right, and that is the spirit in which we gather here
this morning.
When we began to put 1-800-MEDICARE together as part of it,
we did this because we heard predicted lots of problems that
may emerge in terms of customer service as seniors try to
navigate this very difficult path of getting enrolled and
getting the benefit that comes with Medicare.
So today's hearing is the product of a 3\1/2\ year ongoing
investigation into the performance of 1-800-MEDICARE. Since I
will be spending quite a bit of time during today's hearing
talking about findings from my investigation, I'm going to take
a moment to provide an overview of the committee's work on this
subject. To ensure operational readiness for the first Part D
open enrollment season, we commenced an inquiry into the
performance of call centers in early 2005. This investigation
has entailed the following: 500 test calls to 1-800-MEDICARE;
annual inspections of 1-800-MEDICARE call centers across the
country; interviews with 150 consumer service representatives
and management staff who work at the 1-800-MEDICARE call
centers; monitoring 200 hours of inbound calls; correcting
error-ridden scripts related to premium withholding errors;
reviewing call center performance data; exchanging hundreds of
phone calls and emails with CMS, its contractors,
beneficiaries, and advocates, subpoena of call center records
from the administration and Part D plans; exchanging hundreds
of--meetings with three separate CMS administrators, including
Administrator Weems who is here today, and we appreciate his
presence, as well as a former Social Security Commissioner.
I also raised call center performance failures and resource
issues at prior hearings of this committee and in the Finance
Committee where I serve. I've convened today's hearing with the
indulgence of the chairman. I appreciate Senator Kohl very
much, whom I thank for his support in the committee's ongoing
efforts to improve services at 1-800-MEDICARE.
To start the hearing on a positive note, I'll first comment
on what seems to be working well with 1-800-MEDICARE. See,
there's good to report as well, Kerry. My staff have
consistently had the highest praise for the professionalism and
courtesy of the customer service representatives and management
who work in the 1-800-MEDICARE call centers. The reports that I
have received reflect that on the whole the staff at 1-800-
MEDICARE are earnest, professional, and courteous and care a
great deal about providing the best service possible to
beneficiaries.
I'll be discussing this in more detail during the hearing,
but my conclusion is that the problems at 1-800-MEDICARE lie
more with the training and resources provided to call center
staff rather than with the staff themselves.
I have also been quite pleased with CMS's timely resolution
of individual beneficiary cases that my office has referred to
the agency. A further note. CMS recently implemented a
dedicated access number for the State Health Insurance and
Assistance Program, or SHIP, as it's known, and they did this
to streamline SHIP's access to 1-800 services. CMS also
recently hired an outside vendor to revise the training
curriculum and call scripts used by 1-800-MEDICARE service
representatives.
However, as you might conclude, if all were well we
wouldn't be here today. So let's delve into what needs to be
improved and what we're going to spend most of this morning
discussing. My investigation has revealed persistent problems
at call centers and they include:
One, confusing interactive voice response menu options, or
IVR, as it's called.
Another is unacceptably long waiting times, up to one hour
during peak call periods. I know that when you spread it,
Kerry, over a 24-hour period it takes the average down. But if
you look at the 8 hours of business calls, that period of time,
that's where it gets really, really long, and that's when
people are most likely to call.
Other problems are disconnected calls, technical and
infrastructure failures, inappropriate referrals to SHIP and
other entities, jargon-filled and error-ridden scripts that are
used by customer service representatives to respond to caller
inquiries, oversight inadequacies, training deficiencies, and
incorrect information routinely being dispensed by customer
service representatives.
Many of today's witnesses will share their firsthand
experience in trying unsuccessfully to utilize 1-800-MEDICARE.
These stories reveal much work remains to improve call center
services. As we'll hear in testimony today, the problems at 1-
800-MEDICARE are not mere inconveniences to beneficiaries. When
1-800-MEDICARE provides incorrect information, the result can
be devastating to beneficiaries.
An Oregon transplant patient in California nearly died
because 1-800-MEDICARE provided incorrect information about
coverage of anti-rejection medications. A senior in Florida
ended up in the emergency room after foregoing necessary oxygen
treatments because 1-800-MEDICARE provided her with incorrect
information about the durable medical equipment program.
Earlier this year I assisted beneficiaries who received
incorrect information about the Part D enrollment process.
These beneficiaries had been turned over to collection agencies
for past due premiums for a plan in which they were no longer
supposed to be enrolled. A cancer patient nearly died because
he could not receive assistance in locating a facility for
chemotherapy.
Hundreds of stories like these have been shared with my
office by tearful beneficiaries and advocates who are
completely exasperated by their experiences with 1-800-
MEDICARE. I've previously related to Administrator Weems my
belief that there are failures in the system that we need to
fix. That conclusion is informed by these test calls that we
have made and also by the Government Accounting Office and the
Department's own Office of Inspector General, as well as
information provided by the agency itself regarding call center
performance.
The population served by 1-800-MEDICARE is comprised of our
country's most vulnerable citizens. It is unacceptable to
subject the sick, frail, and elderly to long waits, hour-long
waits, disconnected calls, endless loops of referrals and call
transfers, and erroneous information about benefits and
services. It's imperative that we deliver this in a timely and
accurate way.
I want to just say as an aside that I was contacted by Good
Morning America on this hearing today and I basically told them
what I just said in this statement, Kerry. You didn't say it,
but I understand someone at CMS said that our investigations
were outdated. I don't believe they're outdated. My staff
placed 50 test calls over the past 4 weeks. On August 28 of
this year I received call center performance data current
through July 2008.
In June of this year my staff traveled with yours to the
Richmond Call Center. At that time your staff and mine made
test calls collaboratively onsite. During every single one of
these test calls--let me repeat that during every single one of
those test calls, CRS provided incorrect information. When
asked to assign a letter grade to those test calls, the call
center management assigned grades ranging from B-minus to F.
During that site visit my staff also conducted side by side
monitoring of live inbound calls. The service was less than
stellar. My staff raised several concerns to yours onsite that
day regarding what had transpired during those calls. After
that site visit and after you'd been informed about what
transpired during the June visit, I'm informed you made an
emergency site visit of your own to a Phoenix call center to
investigate, and I appreciate that.
Further, throughout this week of investigation my staff
have interviewed Vangent, Briljent, and other contractors as
well as 53 advocates and beneficiaries.
In any event, I very much hope that this will be a positive
hearing. Part of our responsibility is to bring light and heat
to issues and problems as we see them, not to denigrate but to
build. So in that spirit, I thank you for being here,
Administrator Weems, and I turn the mike over to my colleague
Senator Kohl, the chairman of the committee.
OPENING STATEMENT OF SENATOR HERB KOHL
The Chairman. Thank you very much and good morning to all.
I thank Senator Smith for holding this hearing. Senator
Smith, you and your staff launched an investigation into 1-800-
MEDICARE nearly 4 years ago. Considering all your hard work and
due diligence, I am confident that today's hearing will lead to
improvements in the government's ability to help seniors get
the health care they need.
Consumer service is a critical component of navigating the
Medicare system. CMS currently estimates that 1-800-MEDICARE
will receive 34.5 million phone calls in 2009. Older Americans
use the help line to differentiate and decipher the
overwhelming number of plan options available, to ask questions
about coverage, to switch plans, and to file complaints.
Senator Smith's investigation shows that, in addition to
lengthy wait times and a failure to call participants back when
promised, much of the information disseminated by Medicare
customer service representatives is incorrect and inconsistent.
These can be grave errors. Misinforming Americans about their
Medicare coverage can cause them to pay much more out of pocket
than they should have to or, worse, leave them without the
treatment or medications that they require.
This committee worked side by side with CMS on many issues
and I appreciate the working relationships that we have. I hope
that we can all learn lessons from today's hearing and continue
to improve Medicare for older Americans.
I would like to particularly thank the Coalition of
Wisconsin Aging Groups for offering their expertise this
morning.
Once again I thank you, Senator Smith, for your leadership
on this very important issue.
Senator Smith. Thank you, Chairman Kohl.
Kerry Weems is the Acting Administrator of the Center for
Medicare and Medicaid Services, which administers and oversees
1-800-MEDICARE. He's here to discuss CMS's efforts to ensure
the overall success of the program and its working relationship
with Vangent, the company it contracts with to accept incoming
beneficiary calls. Kerry, take it away.
STATEMENT OF KERRY WEEMS, ACTING ADMINISTRATOR, CENTERS FOR
MEDICARE AND MEDICAID SERVICES, U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Mr. Weems. Thank you, Senator Smith. Good morning, Chairman
Kohl. I'm happy to be here to discuss 1-800-MEDICARE and how it
serves our 45 million Medicare beneficiaries.
Just stepping back for a moment, the Medicare program has
changed significantly since when I began my career in HHS in
1983. At that time the total number of Medicare claims
processed was about 325 million and most of that was on paper.
I'd just say parenthetically, at that time we didn't have PCs
on our desks; we had ashtrays. A lot has changed since then.
The total number of contractors that we had processing those
claims was 104.
So if a beneficiary had a question about a claim or a bill
or if they had questions about whether nursing home care or
home health services were covered, they might have to make up
to six phone calls, six different phone calls, to get answers
to those questions. For example, for hospital or nursing home
stay questions the beneficiary would have to make at least two
phone calls to fiscal intermediaries to find answers, depending
on what State they lived in. For physician questions, the
beneficiary would have to make at least one call to a carrier.
Some States, however, had two carriers, which would have
required an additional call depending on the service. For a
home health question, the beneficiaries would have to call the
regional home health intermediary, and if there are questions
about primary or secondary insurance they'd have to call the
coordination of benefits contractor. This was not only time-
consuming, it was frustrating and probably a poor business
model.
So fast forward to today. Today Medicare processes nearly
1.1 billion bills, over 99 percent of which are electronic. We
have about 49 contractors handling those bills now. That number
continues to decline. Most important to note is that
beneficiaries can call one number today to get the answer to
any Medicare-related question, and that number is 1-800-
MEDICARE.
By calling 1-800-MEDICARE, beneficiaries can check on claim
status, find a provider or supplier in their area, and find out
about primary or secondary coverage. So with few exceptions, a
beneficiary can have almost all their Medicare-related
questions answered by calling 1-800-MEDICARE, which also refers
beneficiaries to plans and to SHIPs for more personalized
service.
But the consolidation to 1-800-MEDICARE didn't occur
overnight. It was an evolution of a vision to simplify Medicare
processes under one roof, and it took hard work to get the
operation that exists today.
The 1-800-MEDICARE arm of our outreach strategy is a toll-
free number that beneficiaries can use to get help on all
aspects of the Medicare program. Services are available around
the clock 24 hours a day, 7 days a week. In fewer than 10 years
we've increased the operational capacity of 1-800-MEDICARE
almost eightfold. The phenomenal growth has been the result of
significant changes in the Medicare program and extensive
outreach to beneficiaries to teach them to call 1-800-MEDICARE
for their inquiries.
As it's matured, the number of calls handled by 1-800-
MEDICARE has grown dramatically. From 1999 to 2003, yearly
calls averaged 5 million or less. However, the enactment of the
Medicare Modernization Act of 2003, which included the creation
of a prescription drug benefit, changed forever the way that
CMS interacts with its beneficiaries. The expansion of choices
brought about by the drug benefit and by Medicare Advantage
meant that CMS and our partners would have to respond to many
more inquiries about a much greater range of topics.
As you can see from this chart on my left, with the
implementation of the Part D program the call volume to 1-800-
MEDICARE skyrocketed. In 2004 and 2005, call volumes were 20.2
million and 28.2 respectively. In 2004 the call volume was due
to the issuance of the Medicare approved drug discount card. In
2005 the annual election period for the Part D prescription
drug program significantly increased call volumes.
In 2006, the Part D program resulted in a dramatic spike in
call volume, all the way to 37.5 million calls. In 2007 call
volumes reached 30 million and we're on track to receive about
29 million calls in 2008.
As Medicare expanded and changed, so did our 1-800-MEDICARE
operations. In September 2007 all beneficiary call services
were consolidated into the beneficiary contact center, which
encompasses all of 1-800-MEDICARE operations. 1-800-MEDICARE
has existed in its current form for only one year.
Senator Smith, your review of the 1-800-MEDICARE operations
has led to changes in the system that will enhance callers'
experiences and ensure that callers receive accurate and up to
date information. CMS is committed to decreasing caller wait
times. Due to recent procedural and technological changes, the
average monthly speed of answer for this coming year, the
remainder of the year, will be 5 minutes or less.
As you can see from the next chart, we had contracted using
the old technology at about 8 minutes of average speed of
answer time. The implementation of that technology and those
procedural changes, at your urging, has made a significant
difference in our average speed of answer already. That will
continue throughout the year. In addition, your concerns on the
quality of answers callers receive have accelerated our review
of call scripts and customer service representative training.
As we get ready for the upcoming annual election period for
2009, we're reviewing and updating call scripts with the help
of a third party validator. As a result of this review so far,
some of the scripts were deactivated and others were
consolidated into a new Smart Script format. We've also made
changes to the content and the flow of the scripts. Make no
mistake, the Medicare program, the fee-for-service program, is
a complex program and many times difficult to explain. The
content and the flow are very important.
We've also given our customer service representative
training a closer look, thanks to your feedback. We're in the
process of expediting changes to the new hire training program
to ensure that our new customer service representatives are
better prepared to assist callers.
In response to feedback from the committee and others, CMS
has worked hard to improve all aspects of the caller's
experience. By employing new technologies, callers are able to
self-serve using the interactive voice response, or IVR,
system. As with virtually all call centers, callers to 1-800-
MEDICARE are greeted by an IVR. The new IVR provides callers
the ability to access certain prerecorded information to answer
basic questions, and it also routes callers who need specific
information to the right customer service representative.
The IVR allows beneficiaries to look up claims information
and hear their current deductible status, as well as last
year's deductible status. In addition, beneficiaries can hear
messages about a description of the various preventive programs
Medicare provides, how to enroll in a Part D program, how to
switch Part D plans, and how to apply for financial assistance.
Customer service representatives are charged with
understanding and explaining the Medicare program to
beneficiaries. We use a scripted content approach to provide
beneficiaries with consistent and accurate information. This
process assists customer service representatives to quickly and
efficiently find information on a vast array of topics, from
claims payment status to Medicare policies and procedures.
Like virtually all of our work, CMS uses contractor staff
to answer calls and manage the infrastructure of 1-800-
MEDICARE. You will hear from our contractor later. This
strategy allows CMS to be highly responsive to call spikes that
often accompany the annual election periods, various Medicare
campaigns that require rapid shifts of resources or other
special circumstances. We have the ability to reroute calls
from less busy call centers as well as shift customer service
representatives to phone duty who would otherwise be answering
the mail.
Our 1-800 number has planned and announced closing dates on
some Federal holidays. But, given contractor flexibility, three
call centers were open this Labor Day in anticipation of
greater call volumes due to the impending Hurricane Gustav. In
addition, CMS had call centers open on July 4 of this year due
to the expanded increase in call volume from the newly
implemented durable medical equipment program.
Overall quality assurance and monitoring activities help
ensure quality interactions occur between beneficiaries and
their families across multiple channels. Our activities focus
critical attention on customer service representative
performance across all channels, including telephone, written
correspondence, email, web chat. Calls are closely monitored
and the quality monitoring that is performed is then used by
the contractor to coach and teach and provide feedback to
individual customer service reps.
In our effort to continue to improve 1-800, CMS is working
to implement several enhancements to the system in order to
better serve callers. These will come on line through this year
and next. We're simplifying the prescription drug plan
enrollment algorithms to better identify beneficiary
eligibility during special election periods. A new virtual
callback option is being deployed which will allow callers to
call in to our system; if they have to wait, they can hang up
and the system will call them back while holding their place in
the queue. That way they can talk to a customer service
representative and not just hang on the phone.
An improved learning management system is being implemented
which will help us to identify the training needs of customer
service reps and disseminate information to those CSRs in call
centers.
Finally, as we begin our next release of the IVR we'll
begin playing proactive messages tailored to the beneficiary's
particular plan and enrollment, also attuned to the time of the
year that the beneficiary is calling.
We acknowledge that 1-800-MEDICARE is not perfect, but we
feel that it's successful in meeting the needs of our
beneficiaries and with continued attention on the part of CMS
and of this committee it will continue to improve. I'm happy to
answer any questions you have. Thank you for giving me the
opportunity to appear today.
[The prepared statement of Mr. Weems follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Smith. Thank you very much, Kerry. What I heard you
describe was an acknowledgment that we're making progress, but
we've got a way to go, and that you and CMS take responsibility
for that.
Mr. Weems. That's correct.
Senator Smith. I appreciate that, and that's the point of
this hearing, is just so the relationship we have between the
Legislative and Executive Branch is we're on the same page and
we're going the same direction.
Kerry, as I related in my opening statement, there are some
of the problems I'd like to get your response to. For example,
you've spoken to it a bit, but I'm worried that the scripts are
too technical and they presuppose programmatic expertise that a
caller won't have. I'm aware that this is contracted out and I
want to relate to you information that one of the new
contractors is providing.
The beneficiary in this scenario calls 1-800-MEDICARE with
a question. A tier one representative answers the call and
requests the beneficiary's Medicare number. The beneficiary
tells the first representative that he has lost his card and
all his paperwork and does not have his Medicare number
available. The beneficiary is then transferred to a tier two
representative, to whom he once again has to explain his issue.
The beneficiary also states numerous times throughout the
exercise that he has lost his paperwork and doesn't have his
Medicare number.
The tier two representative continues to tell the gentleman
that he needs to locate other documents that might contain his
Medicare number, even though he has already stated he does not
have these documents.
At the end of the call, the beneficiary never gets his
original question answered due to the fact that he does not
have his Medicare number available. Remarkably, throughout the
50-plus pages of this interactive training exercise, not once
during the mock call does the representative provide the
beneficiary with instructions on how to obtain a new Medicare
card. Instead, the beneficiary is sent on a scavenger hunt
throughout his house trying to locate documents that he has
already told the representative he does not have.
That scenario to me doesn't sound like the best response.
Mr. Weems. No, clearly it's not. Under the circumstances
where a beneficiary may not have access to their Medicare
number, one of the things that we are extraordinarily careful
about and I think you'll appreciate is disclosure of
information to people who are not the beneficiary. In fact,
that's one of the primary checks on a customer service
representative: Are they in fact talking to a beneficiary? Are
they talking to their representative? Has their representative
been designated?
Obviously, the situation that you describe is not ideal.
There are other ways that a beneficiary can show who they are
and receive the information that they need. Obviously, an area
where we need to improve.
Senator Smith. Kerry, are you persuaded that there's a
sufficiently robust training program for those on the consumer
service end?
Mr. Weems. Sufficiency is always in the eye of the
beholder, and in this case in the eye of the experiencer.
I think we can do better. Part of the third party
validation contract we have is to look at the training program
and provide additional training--provide targeted training to
customer service representatives.
One of the things that we've discovered with customer
service representatives, they come in and they get 3 weeks of
classroom training. Classroom training only works so well for
adults. Classroom training works well for other age groups, but
for adults you need to get them on the phone, you need to get
them to where they're starting to handle calls. That is our
training model, 3 weeks of classroom training, demonstrate
competency, move to the phones, but be closely monitored and
closely supervised until they're able to work on their own.
Senator Smith. Kerry, you and I have talked privately about
whether or not there is sufficient funding for 1-800-MEDICARE.
I have urged the agency to make the requests to the
administration to get whatever funding is sufficient to get
this job done, because my concern is that if seniors aren't
given prompt, decipherable, accurate information it may cost
them a lot in terms of late enrollment penalties that stay with
them for the rest of their lives. It may cost them, more
importantly, in terms of their health. We've seen many
instances where people were given wrong information or no
information and they suffered sometimes catastrophic health
consequences.
Yet you related to me something I think is important to get
on the record. You said to me that if we just give you blanket
more money, this wouldn't be the first priority.
Mr. Weems. No.
Senator Smith. I believe you said the fraud program would
be first.
Mr. Weems. Yes.
Senator Smith. What was the other one?
Mr. Weems. Survey and certification. Senator Kohl every
year works very closely with us to try and get the survey and
certification budget and the nursing home budget to where it
should be. Over the last 4 years, that budget has fallen $40
million short of our request.
Our total budget for the past 4 years has fallen about
900--this is our operational budget--about $928 million short
of the dollars that we requested, and over half--
Senator Smith. Is this because OMB is not asking for it or
because we're cutting it?
Mr. Weems. This is the difference between the President's
budget and what the Congress actually appropriates.
Senator Smith. So the President is requesting it?
Mr. Weems. Yes.
Senator Smith. But we have not been granting it?
Mr. Weems. That's correct.
Senator Smith. That's a very important thing. But what I
want to do, because I'm focused on 1-800-MEDICARE, is to say
that this shouldn't be the third priority. What I'm saying is
that all of those are important and what we need to make sure
is that you ask for what you need to do the job in a superior
way. Then we've got to get the job done and get the money to
you, because again this can be literally life and death issues
for seniors.
Mr. Weems. Yes.
Senator Smith. I appreciate you sharing that publicly for
the record because I think it's very, very important.
Chairman Kohl.
The Chairman. Thank you, Senator Smith.
Mr. Weems, as you know, I have long fought to improve the
safety of nursing home residents by requiring criminal
background checks of the workers who care for them. I was
pleased by the success of a recent CMS-sponsored pilot program
that enabled States to expand their screening programs, which
has kept thousands of known criminal offenders away from our
most vulnerable citizens.
However, I was disappointed to discover that the findings
of the report by CMS soon to be issued describing the success
of the pilot program have been fundamentally altered by your
agency. The report's estimates of the total costs of requiring
background checks for all current and prospective long-term
care workers was inflated by a factor of ten. How do you
explain such an extreme revision of the first report, one that
is at odds with the initial views of the report's authors?
Mr. Weems. Thank you for the question. CMS received this
draft report in May of this year. As is common for reports of
this nature and of this magnitude, the report is peer reviewed
by CMS among senior career officials within CMS. One of our
components noted that the report itself did not fully address
the potential costs of the background survey, and other
components looking at that peer review information agreed and
asked the contractor to take another look.
Importantly, CMS did not specify what that other cost
algorithm should look like. Instead, they said: We think you've
missed some things; take another look. The contractor took
another look, provided a methodology that they worked on
themselves--it was their own original methodology--brought that
back to CMS.
That methodology was again peer reviewed by the same career
CMS staff in CMS, and agreed to. The contractor then completed
the estimate using both methods, and both of those methods are
in the report. I'm satisfied that this is the work of senior
career employees using their best intellectual resources and
judgment available to them.
The Chairman. Well, the version of my background check
legislation was passed unanimously out of the Finance
Committee, as you know, yesterday. It does fall in line with
all of the points of consideration made in the soon-to-be-
released CMS report. Based on this, do you support the bill
that was passed yesterday out of the Finance Committee?
Mr. Weems. We certainly support the intent of the bill. We
have not taken a formal stance on it. The thing that we're
going to have to look closely at is how the costs of the
background checks would be allocated between the Federal
Government, State government, Medicare, and Medicaid.
The Chairman. Mr. Weems, as you're aware, I have a
continuing concern about the information conveyed to Medicare
recipients by Medicare Advantage sales agents. Yesterday in my
home State of Wisconsin a company was fined for selling
products with unlicensed agents. What measures have been taken
to specifically address questions about Medicare Advantage
marketing practices at the call centers?
Mr. Weems. At the call centers, a couple of things
happened. First of all, we have revised our scripts for the
enrollment-disenrollment process. Previously they had suggested
that enrollment would only be prospective. Now we ask a
question about, do you think that you'd like this to be--I'm
not quoting directly from the script--do you think you would
like this to be retroactive? So now a beneficiary has that
choice of actually being able to begin their disenrollment
retroactively.
Our customer service representatives are also trained to
ask questions about, did you know what you were getting into,
did you actually sign the paperwork--anything that might
suggest any kind of marketing misrepresentation. If they get
those answers, then the beneficiary can disenroll and enroll in
a plan that they wish. Further, that complaint is forwarded to
our complaints tracking module for follow-up by our regional
office. That's exactly what happened in that case.
I completely share your concern, Senator. As you know,
earlier in this year CMS proposed a new set of tough
regulations to deal with fraudulent marketing practices. The
Congress took those regulations, put them into law, and I will
tell you in the next couple of days, not weeks, those laws will
be ensconced in a new set of regulations that will make it
clear that that law and those regulations apply to the coming
marketing period.
Mr. Weems. Thank you.
Thank you, Senator Smith.
Senator Smith. Thank you, Senator Kohl.
Kerry, a couple follow-ups. To the timing on call waits,
you indicated CMS is going to reduce wait times to 5 minutes
for the remainder of the year.
Mr. Weems. Yes, or better.
Senator Smith. Is that 5 minutes calculated on a 24-hour
period or on the basis of an 8-hour work day?
Mr. Weems. It's calculated on a 24-hour period.
Senator Smith. So if you calculate it on an 8-hour work
day, what does it mean if somebody's calling during a work day?
Mr. Weems. I can give you an approximation of that, but one
of the reasons that you see this reduction here is actually
better management of calls during the peak periods. In the
June-July period we implemented a command center enrichment,
which I believe your staff had the opportunity to see, and
actually I've made a visit to Richmond subsequently. It's
really quite impressive and it's able to route calls from busy
call centers to less busy call centers. It's able to move
customer service reps who are doing other things, who might be
in training, to quickly move them from training to a tier one
line to start answering that phone call.
The contractor--and they can talk to you more about this
also--implemented a real-time compliance with the employees. So
we know, they know, what employees are doing at any given
moment.
Interesting: One of the things you can see in the command
center--and you've written me inviting us to go and you and the
chairman are welcome at any time and I'd love to do that. You
can see if a customer service rep has been on the phone for an
extended period of time, so you can go to them: Do you need
help? Why is this call--and either move the call to somebody
that can handle it, give them the help they need so that they
can shorten that call volume, give them the right answer, and
move on to another call.
Those are the kind of technological changes we've
implemented. Also a new smarter interactive voice unit, so that
it does ask you to put in your Medicare number, but it will
also ask you if it's a doctor claim or a hospital claim. So
when you get to the customer service rep--and I saw this in
Richmond--their name comes up, the name of the beneficiary
comes up on the screen, even before the call begins in the
CSR's ear. They can see the claim and they can begin working
with them the instant the call begins.
Senator Smith. We obviously want to get that wait time as
low as we can during that 8 hours of the regular work time.
Mr. Weems. Yes.
Senator Smith. If you can calculate what I think that would
be for us, I'd sure appreciate receiving that.
[The information referred to follows:]
Mr. Weems. The daily average speed of answer (ASA) is
calculated by adding up the wait times for each individual call
and dividing it by the total number of calls. When calculating
ASA on any timeframe, we county the total wait time spent in
queue for the time period over the total calls answered by
agents for the time period.
The ASA during the 8-hour workday for the month of August
2008 was 3 minutes, 58 seconds and for September 2008 was 1
minute, 20 seconds. (We defined the 8-hour workday as Monday -
Friday, 9:00am ET to 5:00 pm PT.) The overall ASA for the month
of August 2008 was 3 minutes, 44 seconds and for September 2008
it was 1 minute 16 seconds.
Mr. Weems. We can estimate it, and then I would be happy to
report it as our experience continues.
Senator Smith. You have the budget sufficient to get it
down to an average of 5 minutes in a 24-hour period?
Mr. Weems. Yes.
Senator Smith. OK. Obviously, you're dealing with Vangent
as the prime contractor on this. My understanding is that below
them there are a myriad of subcontractors.
Vangent subcontracts to a company named Sensure, and it in
turn subcontracts to Palmetto. I don't know how much more
complicated it gets beyond that.
But my question to you is, what are you doing to ensure
oversight not just of Vangent, but their subcontractors? Are
they looped into this and do you have confidence that this
isn't so distantly removed in relationships that you're losing
control of it?
Mr. Weems. They are looped into it, and in fact some of
those arrangements that you mention have been concluded as a
matter of consolidation. The staff that exerts oversight over
this program I have not only considerable confidence in, but
considerable respect for. They speak to the contractor--they
will validate this--not just daily, but I think hourly. It is
an extraordinarily closely supervised contract.
Senator Smith. Kerry Weems, thank you so much for your time
and your public service. I do appreciate your acknowledgment,
the acknowledgment of CMS, that there are real problems. The
agency understands they need to come forward with real
solutions, and we're just here to encourage that, because we're
accountable as well.
I think I've heard your commitment today that you'll work
with us, with me, my staff, Senator Kohl and his, the entire
Aging Committee. We want to work with you, not at you, and
that's the spirit in which we need to get this right if we're
going to get it done for America's seniors.
So thank you very much.
Mr. Weems. Thank you for the opportunity to appear, sir.
Thank you, Senator. Good to see you.
Senator Smith. We'll now call up our second panel. We
welcome Naomi Sullivan, a dual-eligible Medicare beneficiary
from Chico, CA, who will offer her on-the-ground perspective
and experiences calling 1-800-MEDICARE. Then we'll have
Michealle Carpenter, the Deputy Policy Director and Counsel of
the Medicare Rights Center, who will discuss her experience
offering information and assistance with health care rights to
Medicare beneficiaries. Then Tatiana Fassieux, who will testify
in her capacity as the Board Chair for California Health
Advocates, also a program manager for the California Health
Insurance Counseling and Advocacy Program. Tatiana will share
with us her experiences in helping beneficiaries to navigate 1-
800-MEDICARE.
Would you like to introduce your Wisconsin witness?
The Chairman. John Hendrick is a Staff Attorney at the
Coalition of Wisconsin Aging Groups, where he directs the Elder
Financial Empowerment Project and also works with the Wisconsin
Prescription Drug Help Line in the Elderly Benefits Specialist
Program.
Prior to joining the coalition, he was a managing attorney
for 16 years of a statewide legal education agency, teaching
thousands of non-lawyers about their legal rights. He has given
numerous presentations throughout Wisconsin relating to elder
rights and Medicare and presented at the 2004 and 2006 National
Aging and Law Conference.
We're very happy to have you with us this morning, Mr.
Hendrick.
Senator Smith. Well, thank you. Why don't we start with
Naomi and we'll just go in that order. We'll be informal. We
may even break in and ask a question or two. But you've all
obviously heard Administrator Weems discuss recent changes at
the call centers and I'm hoping to hear if you've actually seen
those improvements and what you think of the testimony you've
heard.
Take it away, Naomi.
STATEMENT OF NAOMI SULLIVAN, MEDICARE BENEFICIARY, CHICO, CA
Ms. Sullivan. I'd like to thank you, Senator Smith and
Senator Kohl, for allowing me to come before the Senate and
explain my experience with Medicare. My name is Naomi Sullivan.
I'm 57 years old. I live in Chico, CA. I'm on disability and am
what is called a dual-eligible beneficiary. I am here today to
share my story, to give voice to those who don't know how to
speak for themselves. My hope is that the government will
understand that there are beneficiaries like me all over the
country who lack resources, are in dire straits, have turned to
1-800-MEDICARE for help, and aren't getting the assistance they
so desperately need.
A few years ago I was making over $60,000 per year salary.
I now live on less than $700 per month social security
disability and have had to make choices whether to eat or pay
my premiums and medications. A while back I went on what I call
a refugee diet because I couldn't afford to buy groceries and
pay all of my bills.
I am here today because in 2007 I decided to switch my
Medicare D plan from Humana to Blue Cross. I received an
information card in the mail from Blue Cross, returned it, and
shortly after received an application in the mail. I filled out
the paperwork to enroll in a Part D plan and thought I was good
to go. Little did I know what I was in store for.
It turns out that somewhere along the way I was
inappropriately enrolled in a PPO--you call it a Medicare
Advantage plan--instead of a Part D plan. I found out about
that the hard way when my doctor started to ask me for copays.
I never had to pay copays because I also had MediCal. Then I
started to get premium notices and billings, and throughout the
year I also got many bills from my doctors. I couldn't
understand why Medicare and MediCal weren't paying my medical
expenses the way they used to. But I knew I had to get this
straightened out as quickly as possible.
So I called 1-800-MEDICARE to get some answers and to try
to get out of the PPO, into a Part D plan I had enrolled with
in the first place. I called 1-800-MEDICARE over a dozen times.
I can't afford both a home phone and cell phone, so I have just
a cell phone. When I would call 1-800-MEDICARE, I was sometimes
on hold for up to 45 minutes at a time, and then I'd get
transferred and disconnected and have to start all over again.
Meanwhile, I was going over my cell phone plan minutes and
having to pay for minutes that I couldn't afford. Eventually it
got to the point where I simply could not afford to make one
more call to 1-800-MEDICARE.
All I can say is thank goodness I found Tatiana at HICAP
because honestly I do not know what I would have done. I just
wanted to give up. I felt like less than nothing. I felt like
the people at 1-800-MEDICARE did not have any interest in
helping me. I told them my story, that I was on disability and
barely making it on less than $700 per month and could not
afford the premiums for the plan that I had been
inappropriately enrolled it. One Medicare representative
suggested that I get a part-time job to help pay the premiums,
but they didn't offer any help. They didn't tell me about any
resources and they didn't tell me because of my situation I can
switch plans at any time. They just kept telling me to call my
plan and work it out.
I just needed a little help and some direction on how to
get things sorted out. I didn't get that from Medicare. So many
bills got turned over to collections, I subsisted on my refugee
diet and I couldn't get anyone to help me.
At last I went to my local Social Security office. They
referred me to Tatiana. She's helping me to get things
straightened out. I'm now enrolled in a Part D plan. I don't
have a clue how I'm going to pay for all the bills that mounted
up while I was on the wrong plan. I know that Tatiana is
working on that. But at least hopefully now I won't have to
worry about going to my doctor or getting my medications.
I feel that 1-800-MEDICARE should have an easier way for
people to live--I'm sorry. I feel that 1-800-MEDICARE should
have an easier way for people to get a live person, that they
should have proper training so that they can provide accurate
information, or at least refer callers to their local HICAP,
because I know they have the ability to help.
[The prepared statement of Ms. Sullivan follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Smith. Thank you very much, Naomi. That's firsthand
experience why we're having this hearing today, to try to get
better response.
Ms. Sullivan. Thank you.
Senator Smith. Michealle.
STATEMENT OF MICHEALLE CARPENTER, DEPUTY POLICY DIRECTOR AND
COUNSEL, MEDICARE RIGHTS CENTER
Ms. Carpenter. Good morning, Chairman Kohl and Senator
Smith.
Senator Smith. You want to hit your button there.
There you go.
Ms. Carpenter. Good morning, Chairman Kohl and Senator
Smith. I thank you for your longstanding and bipartisan
commitment to the common good and welfare of people with
Medicare.
The persistent failures of the Medicare consumer hotline,
1-800-MEDICARE, cause daily harm to the health and wellbeing of
older Americans across the Nation. The volunteers and staff of
the Medicare Rights Center confront the human hardship caused
by these breakdowns daily. We appreciate your efforts to shine
light on the hotline's failures as a necessary step toward
correcting them.
In recent years Medicare has become a daunting challenge
for consumers to navigate. Since enactment in 2003 of the
Medicare Modernization Act, a Wild West marketplace for
Medicare coverage was launched and a system rich with
opportunities to exploit people with Medicare has been
established. To no surprise, the older, frailer, and most
impoverished people with Medicare are most vulnerable to
exploitation. Without safety nets, they are the most harmed by
this exploitation.
Regrettably, the Centers for Medicare and Medicaid Services
has failed to provide the most basic tools to protect people
from the danger of this marketplace. Even as the market became
significantly more complex, repeated reorganizations of CMS's
bureaucracy have left CMS with neither a centralized consumer
education office nor a coordinated approach to consumer
education. At times CMS has mixed consumer education with
ideological propaganda. Consumers are harmed by information
that is colored by a preference for Medicare Advantage plans
and a political imperative to paint the prescription drug
program in the best light regardless of reality.
In addition to long hold times, callers often spend well
over an hour while a poorly trained operator tries to find an
answer to a simple question or resolve a problem. CMS's
customer service representatives lack proper training to answer
callers' questions or assist in resolving problems. The scripts
from which representatives read often lack meaningful
information. Even accurate information is often delivered in a
way that few people can understand. Representatives provide
false, misleading, and inaccurate information. While callers
often call with complex problems that require the
representative to have technical knowledge, representatives are
unable to answer even basic questions.
One area where 1-800-MEDICARE customer service
representatives consistently fail to provide accurate
information and assistance is when a beneficiary has been a
victim of fraudulent or misleading marketing by a private
Medicare Advantage plan. Because this problem is so widespread,
CMS has assured us that all customer service representatives
are well trained to handle these kinds of cases. This is not
the case.
In discussions with CMS last year, we were assured that
every caller who has been fraudulently enrolled in a private
Medicare plan will be assessed for retroactive disenrollment.
The importance of this cannot be overstated as thousands of
dollars may be at stake for a client who's left with unpaid
medical bills because they were enrolled fraudulently in a
plan.
In our experience, representatives are aware of the
exceptional circumstances special enrollment period which
allows people with Medicare to disenroll from a plan any time
during the year under certain circumstances. Unfortunately,
representatives appear only to understand how to help people
disenroll from the plan prospectively. On most occasions,
callers are not assessed for retroactive disenrollment. Even
more concerning, a representative recently told one of our
caseworkers that Medicare does not provide retroactive
disenrollment even for marketing fraud cases.
When our caseworkers attempt to help clients request a
retroactive disenrollment through an exceptional circumstances
SEP, we are transferred from one representative to another and
often stay on the phone for more than an hour awaiting a
resolution. In the end we are usually told this issue will be
transferred to the regional office for a decision and that the
client will receive a call within a week. More often than not,
that call never comes.
So what should be done? For starters, CMS must increase
oversight of the 1-800-MEDICARE contractor. CMS must
reestablish an independent office focused on communication with
people with Medicare that reports directly to the CMS
Administrator. This office should have direct oversight over 1-
800-MEDICARE and should be responsible for developing training
materials and scripts for 1-800-MEDICARE operators.
It is our understanding that representatives are not
trained on Medicare policy, but rather on how to search a
database for the proper script to read to a caller. Customer
service representatives must have at a minimum a basic
understanding of Medicare. All representatives should have
regular training on topics callers most frequently call about.
This is how we train our volunteers and staff that answer our
hotlines. This training must be reinforced with more frequent
testing to ensure continued understanding and ability to answer
questions accurately.
In addition to providing better training and scripts to 1-
800-MEDICARE customer service representatives, CMS needs to
make a concerted effort to fix the data exchange systems
problems that plague the privatized sectors of Medicare.
Admittedly, these data exchange systems are complicated and the
solution is not an easy one. But it's been 3 years since
Medicare Part D began and 5 years since the expansion of
Medicare Advantage.
Simplifying and standardizing Medicare choices is
absolutely necessary. But 1-800-MEDICARE cannot wait for that
day to come. People with Medicare must be allowed the helping
hand that we pay 1-800-MEDICARE to offer.
Thank you.
[The prepared statement of Ms. Carpenter follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Smith. Michealle, did you take much comfort in what
you heard the Administrator say this morning?
Ms. Carpenter. I think a lot of the changes that are to
come will be beneficial. They seem to be mostly about the
technology and less about the training, which is where most of
our concern lies.
Senator Smith. So yours is technology, not the training?
Ms. Carpenter. No, ours--we believe the training.
Senator Smith. The training, not the technology.
Ms. Carpenter. We are heartened by the technological
improvements that will be made and we think they will be
helpful to people with Medicare.
Senator Smith. Very good.
Tatiana.
STATEMENT OF TATIANA FASSIEUX, BOARD OF DIRECTORS CHAIR,
CALIFORNIA HEALTH ADVOCATES, SACRAMENTO, CA
Ms. Fassieux. Good morning. Good morning, Chairman Kohl,
Senator Smith, and other distinguished members of the
committee. My name is Tatiana Fassieux and I am the Board Chair
of California Health Advocates and also a Program Manager. I
represent the boots on the ground of Medicare beneficiaries in
California.
California Health Advocates is a nonprofit organization
dedicated to education and advocacy on behalf of California
Medicare beneficiaries. I've been in that role for about 4\1/2\
years. But I also represent the 24 HICAPs, the SHIPs, in
California serving more than 4 million Medicare beneficiaries.
In my neck of the woods, northern California, I serve five
counties, rural counties, with about 45,000 Medicare
beneficiaries under our program.
But I do want to thank the committee for inviting me for
the opportunity to speak. I do want to focus on some of the
topics discussed, the 1-800-MEDICARE, of course, the myriad of
problems with the call centers' performance, the resulting
impact on the SHIPs, and of course in California in particular,
and above all the impact on Medicare beneficiaries, and I'll
suggest some recommendations.
We believe that 1-800-MEDICARE reflects the credibility of
the agency it represents, that is CMS, and the regulatory
process that established it. So that credibility must be upheld
quite at a very high standard.
The SHIP network has come to rely frequently on the help of
1-800-MEDICARE and we have the expectation that our Medicare
beneficiaries will have accurate and timely information. In
many instances both clients and SHIP counselors have had good
successful contacts. We must agree to that.
We are also pleased by the recent implementation of the
special SHIP direct, or I should say back door, number into 1-
800-MEDICARE. We still have to go through the protocols and the
IVR system, but we have a pseudo-back door way, and California
has just now implemented that.
However, as I will illustrate, credibility has been shaken
frequently. Medicare beneficiaries and SHIPs have had
unreasonable wait times, frequent disconnects, misinformation,
and what troubles us is the difficulty in resolving hard cases.
That lack of faith in prompt resolution is what concerns us.
Beneficiaries continue to complain about the IVR system.
They say: I wish I could get a live person, because they're
very frustrated by that technological feature. We're still
dealing with 1930's, 1940's seniors, who technology is just
frightening to them. On a good day, it takes us about 10 to 15
minutes to get to the first level of CSRs.
The disconnects are particularly egregious, especially when
we as SHIP counselors are trying to assist clients with the
assistance of 1-800-MEDICARE. Where that first level cannot
help, we get transferred to the second level, and during that
transition we get cutoff.
Misinformation of course can do tremendous harm. Clients
have told us that, I wish Medicare had told us that I could
change plans any time, when they discovered that they were in a
plan that they should not have belonged in. They were locked
in, according to the Medicare representative, but in reality
they were not.
In an instance where you mentioned, a southern California
transplant patient was incorrectly told by a CSR that nobody
gets lifetime anti-rejection medication, and it was because of
our persistence we escalated and we were able to assist the
client.
As you heard with Naomi, her case--I am personally handling
her case--the reason she is on such low income is because she
felt she had to get a job and Social Security reduced her
income, which was sort of a double whammy.
Another counselor had reported that when we were trying to
file a complaint we were actively discouraged, saying that a
complaint is serious.
Now that 1-800-MEDICARE is the single point of entry for
all issues dealing with Medicare, including our efforts in
dealing with very complex issues, we may have to contact a
subcontractor. It just particularly gives us a little more
problems in getting to the right people.
So we appreciate that we have been given additional
funding, but of course in California with the budget that
funding hasn't come through yet, and in my neck of the woods
it'll just be a few thousand dollars. $15 million globally
sounds like a lot of money, but when you break it down to the
individual HICAPs it's just a little bit of money.
So we would like to propose the following actions.
Definitely additional training, better scripts. It has been
inferred also that they get State-specific information.
Absolutely better CMS oversight. Who knows, a better friendly
system in responding.
It was good to hear from Mr. Weems about that new response
system. The California CALPERS instituted that and it's working
quite well.
But one more thing I would like to suggest is that we form
a task force that includes SHIPs, beneficiaries, CMS, and any
other advocacy organizations to review those scripts, to review
the training, because sometimes I think that the SHIP
counselors definitely know more than the CSRs.
Thank you for letting me speak.
[The prepared statement of Ms. Fassieux follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Smith. Thank you very much. That's excellent.
John Hendrick.
STATEMENT OF JOHN HENDRICK, PROJECT ATTORNEY, ELDER FINANCIAL
EMPOWERMENT PROJECT, COALITION OF WISCONSIN AGING GROUPS,
MADISON, WI
Mr. Hendrick. Thank you, Senator Smith, Chairman Kohl. My
name is John Hendrick. I'm a staff attorney with the Coalition
of Wisconsin Aging Groups and it's my privilege to speak to the
committee on behalf of the coalition and share our experiences
with Medicare's toll-free consumer service. We supervise a
network of over 100 trained staff throughout the State of
Wisconsin and as part of their duties they help older adults
with the Medicare program through the State Health Insurance
Assistance Program. For some reason that's abbreviated
``SHIP.'' So we have a lot of experience with 1-800-MEDICARE.
Based on our experience, we have found that 1-800-MEDICARE
service has improved since 2006 and we appreciate that. Wait
times outside the busy annual enrollment period can be as
little as 5 to 10 minutes and there are many knowledgeable and
experienced customer service representatives who are able to
resolve most beneficiary problems in a timely and accurate
manner. Many are doing a good job. Some are not. Also, in our
experience we've had a high level of success with what I guess
they call the tier two representatives that are able to deal
with the more complex problems, and so we appreciate that
success.
We do have some serious continuing concerns. I would say
our greatest concern is representatives providing consistently
accurate information, and we have found that that is not always
the case. There are a couple recurring problems with specific
issues, but our biggest concern is that the bad information
doesn't seem to relate to the complexity of the issue. It's
just which representative you get. So if you get the wrong
person you get the wrong answer. That makes it hard to predict
and it's very hard for us to deal with.
The second area of concern would be technological problems.
For example, at busy times the average waits are over 30
minutes. There's occasional buzzing on the line, which makes it
difficult for beneficiaries to hear the representative. As has
been mentioned repeatedly, senior beneficiaries have difficulty
dealing with the telephone prompt system.
Lastly, the area of programmatic problems, which appear to
result either from management decisions or from training. For
example, the customer service representatives do not leave a
phone number when they return a call. They don't leave any
information. They just say they're returning a call. Unless the
beneficiary happens to pick up the call at that moment and get
that call directly, they have to start all over again and go
through the wait time and explain their situation all over
again.
At times we find as many as one-fourth of the cases have to
be forwarded to the tier two representatives because the
customer service representatives can't resolve the issues. That
seems like a high percentage to us. Beneficiaries when they
file a complaint about Part D enrollment or Medicare Advantage
enrollment are told that they will be called back within 5
days, and that is not the case. In our experience those calls
never come.
Senator Smith. Not later than 5? They just never come?
Mr. Hendrick. Never.
Finally, the customer service representatives frequently
don't know that they can talk to the SHIP representative. As
everyone here has mentioned, a way of resolving problems is for
a well-informed SHIP representative to get on the phone with 1-
800-MEDICARE and sometimes that's what works it out. But
unfortunately the tier one representatives sometimes will
refuse to talk to the person unless the beneficiary is actually
present, and that's not what the rules are. So that's an
important mistake.
I'd just like to mention a couple of our suggestions for
improvement. I think you could increase the number of customer
service representatives. The increased training which has been
mentioned would improve the quality of the information. You
should continue the SHIP-dedicated phone number. That has
helped a lot to allow the SHIP representatives to get through
and to resolve some of these problems.
I believe the General Accounting Office secret shopper
program was mentioned earlier. That should be continued. That
is helping to evaluate the quality of the service and the
accuracy of the information.
Our final point, which isn't actually about 1-800-MEDICARE:
We believe that all prescription drug and Medicare Advantage
plans should be required to have their own SHIP-dedicated
contacts. With the plans that have a separate contact for SHIP
counselors to contact, those plans are resolving problems with
their own plans in a much more effective way and taking the
burden off 1-800-MEDICARE.
In conclusion, we'd like to thank you for this opportunity.
We hope for further improvements in 1-800-MEDICARE, and I'd be
happy to answer any questions.
[The prepared statement of Mr. Hendrick follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Smith. When you heard the Administrator, do you
have more reason to hope?
Mr. Hendrick. Certainly some of the things that he
described sounded promising, and I'm always amazed by what
computers can do today. The training I think would still be a
concern to us. The customer service representatives that are
taking those calls, if they are not correctly trained, are not
able to give out the correct information, and I don't think
that what we heard today is going to fix that.
Senator Smith. Senator Kohl.
The Chairman. Thank you, Mr. Hendrick, and we appreciate
all that you've done with the Coalition of Wisconsin Aging
Group for the people of our State.
Would you offer the observation if you were asked that, if
1-800-MEDICARE were in competition with another organization
providing the kind of service that we find in competition in
the private sector of our country, they'd be out of business?
Mr. Hendrick. Well, Senator, I often say in regard to many
government programs and people who are complying with
regulatory requirements: What would you do if you really wanted
this to work? If your intention was to run a business and to
provide good customer service so that people would come back, I
think you would get these problems solved.
The Chairman. Mr. Hendrick, your testimony identified a
number of problems with Medicare call centers. If you could
name one, which is the single worst and most persistent
problem, and what is the most important improvement that CMS
could implement to enhance the service of the call center for
the recipients?
Mr. Hendrick. I think our biggest concern is the apparently
random provision of incorrect information. This happens with
the tier one customer service representatives. I don't know the
exact solution, but it seems to me that if people knew that
they didn't know the answer and they could refer it to someone
who could and then that call got through without being
disconnected during the transfer, I think that would solve a
lot of the problems that we see.
The Chairman. Thank you so much.
Senator Smith. Very good suggestion.
Thank you all very much. I think that concludes our
questions. You've added human context, put a human face on this
problem, faceless problem of 1-800-MEDICARE. Naomi, your story
will be remembered. So thank you all.
Our third panel and our only panelist is John M. Curtis. He
goes by ``Mac'' and Mac is the President and CEO of Vangent,
the company contracted by CMS to accept incoming beneficiary
calls. He'll discuss his company's efforts to ensure Medicare
recipients are receiving accurate and timely information when
calling 1-800-MEDICARE.
Mr. Curtis, thank you for coming.
STATEMENT OF JOHN M. CURTIS, PRESIDENT AND CHIEF EXECUTIVE
OFFICER, VANGENT, INC., ARLINGTON, VA
Mr. Curtis. Thank you, Senator, Mr. Chairman. Good morning.
My name is Mac Curtis and I am President and CEO of Vangent.
For over 30 years we've been a provider of mission-driven
systems and strategic business process outsourcing services for
the Federal Government in the U.S., and around the world,
Fortune 500 companies, health care organizations, and
educational institutions. Our company is headquartered in
Arlington, VA.
I was invited here today to talk about Vangent's role in
the 1-800-MEDICARE program. I'm not here to say that problems
never occur or to refute the experiences described here today.
But I can tell you about our steadfast commitment to quality
service for all Medicare beneficiaries and offer some context
for the issues described by the previous panel. Of the 30
million calls received each year, the vast majority work fine.
But we're focused on the small minority of calls that don't.
First let me explain how the system works. Our job is to
manage the call center facilities and the workforce that
answers the calls that come in to 1-800-MEDICARE. Vangent has
been working with CMS on this program for over 6 years and
we're proud of the work we do.
Callers into the system are prompted by the interactive
voice response unit to provide their Medicare number and to
select the issue they're calling about. If a customer service
representative is not immediately available, a call is routed
to the queue where, depending on when they call, they may have
to wait a few minutes, sometimes longer, for the next available
CSR qualified to answer their question. The caller is then
connected to the CSR, who works with them to answer their
question.
Our contract with CMS provides that we maintain an average
speed to answer at or less than 8\1/2\ minutes, which we
consistently meet. Our average speed to answer during the month
of August was 3 minutes and 40 seconds. Do we always hit the
mark? With 30 million calls a year into the system, not every
call is perfect. But the hard work to continuously improve and
make the system and experience better is what we're dedicated
to.
Our workforce is well trained, closely monitored, and
highly motivated to help people. CSRs undergo continuous and
rigorous training based on industry standards and best
practices. Vangent, in partnership with CMS, has successfully
trained thousands of CSRs, who answer millions of beneficiary
inquiries using this training program. Instructor-led classroom
training is combined with multiple forms of recurring on-the-
job training to ensure continuous improvement. Every CSR is
regularly monitored to identify trends and to measure
individual performance. Responses are evaluated by multiple
checkpoints for quality and accuracy, which again are based on
industry standards and best practices.
We also survey our callers to measure their satisfaction
with the service they receive. What are the results of the
monitoring and the surveys? Of the thousands of calls evaluated
each month, over 90 percent meet the requirements of our
rigorous quality reviews for accurate responses and customer
interaction. In the customer satisfaction survey, the results
we receive show that 85 percent of the callers are satisfied
with the service, a score that's above the industry average of
about 70 percent for contact centers.
We're continuously working to improve the people, the
process, and the technology that drives the 1-800-MEDICARE
program.
Today we've heard from the SHIPs and other advocates about
concerns they have with the 1-800-MEDICARE system. We
appreciate the difficult job the SHIPs have. They assist the
neediest beneficiaries with very complex problems. We've worked
with CMS to provide the SHIPs with tools such as--and we've
heard about it this morning--a customized IVR and a dedicated
800 number to make their jobs a little easier. We want to
continue working with CMS to find additional ways we can
improve our service to the SHIPs and their clients.
We spent a lot of time with your staff in our call centers
discussing how the system works and how it can be improved. We
applaud the dedication and the zeal, Senator, they have shown
toward improving 1-800-MEDICARE. There's no question about it.
In summary, the vast majority of the 30 million calls
received by 1-800-MEDICARE are handled well and correctly. But
the issues identified here today are very important to us.
Continuous improvement is a hallmark of this program and we
strive to provide Medicare beneficiaries the quality of service
they deserve.
Thank you, Senator. I'm happy to answer your questions.
Senator Smith. Mac, your surveys show that 85 percent like
the service they got?
Mr. Curtis. Yes, sir.
Senator Smith. Eighty-five percent. So we're really dealing
with 15 percent. Can you tell when you get a call whether it's
a person without any agenda just needing help or one of my
staff calling and testing you?
Mr. Curtis. Well, normally--let me answer your question
this way, Senator. With regard to someone calling with a
specific question of the 30 million inquiries that come in a
year, 98 percent--
Senator Smith. Are we the 15 percent?
Mr. Curtis. We're working on that, Senator. [Laughter.]
That's good because we're trying to improve. There's no
question about the value that your staff has provided.
But back to my answer, Senator, of the 30 million inquiries
we receive a year that come in to the IVR, 98 percent of those
inquiries come with their Medicare number. So as we've talked
about, one of the improvements that CMS has made is the
beneficiary gets on the line, reaches the IVR, and they're
asked their Medicare number. They put their Medicare number in
and the record shows up on the screen for the CSR. The CSR goes
through and they validate the beneficiaries birthday, their
Medicare number, and then deals with the callers specific
issue.
So that's really where the balance of the calls come from
with regards to a specific issue associated with the Medicare
number. So what we are dealing with here today is the
percentage that have very complex calls. I think your staff
will attest to this, that the typical call is with a Medicare
number, and it's also maybe one issue or one question. The
reason why we know this, Senator, is that when we look at, on
an annual basis, the number of scripts the CSRs actually go to
to provide the scripted response, on an average call it's 1.2
scripts per call.
So what we're really focused on are the multiple question
calls, where sometimes we're going to 4 to 12 times the number
of scripts or the number of questions, and also those calls
that don't have the Medicare number.
Senator Smith. It is possible that someone has called in
not from my office without a Medicare number?
Mr. Curtis. That happens. Yes, sir, it does happen. That's
about--from our record, that's about 2 percent that call
without a Medicare number, that's correct.
Senator Smith. So the other 13 percent are my staff?
Mr. Curtis. The other 13. Well, one of that percent is
probably my mother.
Senator Smith. But what you're telling me is if my staff
calls with a Medicare number they're going to be completely
satisfied?
Mr. Curtis. You know, Senator, I'm not going to tell you
that out of 30 million transactions every one of them is
perfect. I'm certainly not going to tell you that. But what I
will tell you in all sincerity is we want all of those 30
million transactions to go well. But no, I'm not going to say
every one is perfect. I'm not going to say every CSR always
gives the right answer. We've heard situations today that, a)
are heartbreaking and, b) that's the percentage that we've got
to get right. Every one of these calls has got to be right.
But I think what we do focus on is the quality monitoring.
When we're at spike we're talking about close to a little under
4,000 customer service reps, and the quality monitoring we do
on a monthly basis--we record calls. They're evaluated in three
areas: Are they dealing with Privacy Act data correctly, what
was the completeness and the accuracy of the answer on their
call, and what are their customer soft skills?
So it's thousands of calls a month that are recorded. The
calls are evaluated and there's a side by side discussion with
each CSR. We go through how well they performed.
Now, the independent TQC contractor that Administrator
Weems is talking about is also now evaluating additional calls.
So we're trying, like the CSRs, to make sure that there's
quality there and that they're answering accurately and
completely.
Not everyone's perfect and clearly from what we've heard
today there are some issues. We like to get the feedback. By
the way, I agree, establishing an organization with the SHIPs
and the beneficiaries and CMS to support the content review I
think is a very good idea.
Senator Smith. The timing of this hearing, Mac, is
intentional because we're coming up to a new enrollment period.
That new enrollment period, for any seniors watching that want
to enroll, starts in November. Are you representing to us that
you're ready for this enrollment period? Because if a senior
gets trumped up in the enrollment period and they have to
start--they start assessing about a 1 percent penalty a month,
and that could be a 12 percent penalty, and that 12 percent
penalty stays with them. It's not a 1-year penalty. It's just
they made a mistake and they live with it the rest of their
lives.
Even more important than the money is obviously if they're
given the wrong information and that may have a health
consequence to them that I know you don't intend. But we've got
to get it right.
So you're representing to us that you're ready for this
next enrollment period?
Mr. Curtis. We are getting ready, absolutely, Senator. As
you know, the enrollment period is November 15 through December
31. Your staff has been to our centers. One of the things I do
want to represent is, in all of our the facilities our CSRs
have other opportunities and other places to work. We have a
workforce that is passionate about helping people. So I think
the attitude is certainly one we should all be proud of and
reassured by.
I think you've heard about improvements in the training.
One of the things I think that CMS has indoctrinated into the
training curriculum is the whole notion of Medicare Advantage
and how to deal with that. I think we're always looking at ways
to improve that training to make sure we have the right
answers.
So we are getting ready, Senator. We're doing the
recruiting, we're doing the training, and we've begun and we'll
be ready for the spike.
Senator Smith. Well, it's very important. Obviously,
Naomi's case is an example that it isn't just my staff that's
calling. Those are the people who are the focus of this hearing
and Naomi puts a human face on it. So I want to in the
strongest but friendliest terms as possible emphasize just how
important it is to get systemically right all these things, get
the training, get the processes worked out in the system, so
that those even who are technically or high tech challenged--
I'd include myself in that number--can manage this system. I
think that it's a huge challenge, but you took the contract.
Mr. Curtis. Yes, sir, we did. Yes, sir, we did.
Senator Smith. My admonition is do it, get it right.
We want to be your cheerleaders, not your critics.
Mr. Curtis. We're committed to doing that, Senator.
Senator Smith. Well, thank you all very much. This has been
a most informative hearing. We hope it helps. We're not here to
pick a fight. We're here to find a solution.
Thank you, Mac, for your presence, and I hope that you got
a handle on all your subcontractors, too.
Mr. Curtis. One comment. We are the prime contractor we
would only use the subcontractors if we had to in a spike.
Senator Smith. But you feel like you've got control of it?
Mr. Curtis. Absolutely, there's no question about it. It's
simpler now than it was before CMS consolidated the contract
center operations.
Senator Smith. So you're managing them, too? You're
accountable for that?
Mr. Curtis. Absolutely, if we use them.
Senator Smith. Ladies and gentlemen, thank you.
We're adjourned.
[Whereupon, at 11:35 a.m., the hearing was adjourned.]
A P P E N D I X
----------
Prepared Statement of Senator Robert P. Casey, Jr.
I would like to thank Senator Smith for organizing this
important hearing on the 1-800-Medicare number and the service
it offers Medicare beneficiaries and their families. This
hearing is the product of an extensive investigation that
Senator Smith and his staff began in 2005 into 1-800-Medicare
and the concern that our older citizens and other Medicare
beneficiaries are not receiving accurate information from the
customer service representatives who answer these calls.
1-800-Medicare, the general customer service number all
Medicare beneficiaries call with questions or problems, is
often both the first and last resort for many Medicare
beneficiaries. Sometimes these calls involve life and death
issues. Accordingly, we must ensure that beneficiaries and
their families receive accurate and timely information.
There are currently almost 45 million Medicare
beneficiaries in this country, including almost 2.2 million in
Pennsylvania. Millions more are on Medicaid. Many of these
individuals are easily confused by the choices Medicare offers
and the multiple choices and decisions they must navigate to
enroll in various plans and programs. As result, they call 1-
800-Medicare looking for simple answers to often complex
questions. The results can be far from helpful.
While 1-800-Medicare is available 24 hours a day, seven
days a week, callers can experience lengthy wait times before
speaking to a customer service representative. Once they speak
to a person, beneficiaries have reported representatives can be
difficult to understand because they are too technical or
presume knowledge about the Medicare program the caller does
not have. At times callers are simply given wrong information.
Hubert Humphrey used to say that one of the things we and
society should be judged on is how we treat our older citizens.
Are we providing them with appropriate help in their time of
need? From the evidence before us at this hearing, it seems we
are not.
Bottom line, Mr. Chairman, our older citizens, and all
Medicare and Medicaid beneficiaries who utilize the 1-800-
Medicare number need timely answers to their questions and they
need accurate answers. It is estimated that 1-800-Medicare will
field 34.5 million calls in 2009. CMS and Congress should
strive to make this process better, shorten wait times and
provide customer service representatives with the tools they
need to give accurate and complete information to callers.
We all know Medicare is a complex program. Our older
citizens call this number with the expectation that the
customer service representative on the other end will be able
to provide them with correct and helpful information be it
explaining the difference between traditional Medicare and
Medicare Advantage or helping them choose which prescription
drug plan best meets their needs. It is our job to ensure they
find the answers they are looking for and that those answers
are correct. I look forward to hearing the testimony of
Administrator Weems and our other witness. Thank you, Mr.
Chairman.
------
Kerry Weems Responses to Senator Smith's Questions
Question 1. The New 5 Minute ASA
It was encouraging to hear the plans that CMS has for
reducing wait times at the call centers. Will CMS be formally
revising the call center contract to require a 5 minute average
speed of answer (ASA)?
Answer: CMS modified the contract with Vangent effective
October 1, 2008 to lower the ASA from 8 minutes down to 5
minutes through the current option year which ends May 31,
2009.
Question 2. Hiring of Briljent
In December 2007, CMS contracted with Briljent to revise
the training curriculum and call scripts. Why did CMS remove
these responsibilities from Vangent and reassign them to a new
contractor?
Answer: We conducted a full and open competition for the 1-
800-MEDICARE contract and its support services as the prior
contracting vehicle was expiring. As part of the competitive
bid process, we set aside certain activities for small
businesses. The training, quality, and content support services
were determined to be appropriate for a small business set
aside. Therefore, Vangent was not eligible to compete for those
activities. Briljent, as a small business contractor, was
successful in its bid for this work.
Question 3. Taskforce
I have serious concerns that CMS and its contractors are
unable to assess call center performance from a beneficiary's
perspective and do not understand the challenges confronting
beneficiaries when they try to use 1-800-Medicare. Though I was
initially encouraged to hear that CMS had contracted with
Briljent to revise CSR training and scripts, I remain concerned
that this contractor's work product thus far does not
adequately address the problems identified by my investigation.
Therefore, to provide better feedback to CMS and its
contractors in developing call center training curricula and
scripts, is CMS willing to implement the advisory taskforce
recommended by witnesses at the September 11, 2008 hearing? If
no, why not? If yes, by what date can we expect to have that
taskforce in place?
Answer: CMS does not believe an advisory taskforce is
necessary for 1-800-MEDICARE training materials and scripts.
The quality, scripting and training development contractor
works very closely with CMS staff and subject matter experts to
ensure materials are relevant and up-to-date. We also obtain
feedback from our CSRs to ensure scripts and training materials
provide CSRs with subject matter knowledge and address the
caller's need. CMS has consistently made available 1-800-
MEDICARE Part D scripts to CMS Partners via the www.cms.gov
website.
Additionally, CMS already has two committees that provide
feedback on beneficiary education, including 1-800-MEDICARE.
The Advisory Panel on Medical Education (AMPE) is governed by
the Federal Advisory Committee Act and exists for the broader
purpose of advising CMS on beneficiary education matters. In
the past the APME has given general suggestions and comments
about 1-800-MEDICARE, which have included topics such as wait
times and non-English language issues. The National Medicare
Education Program (NMEP) Coordinating Committee has also
addressed partner questions and comments regarding 1-800-
MEDICARE at its meetings.
We believe that these combined efforts provide sufficient
opportunity for feedback and forming an advisory taskforce
would duplicate our existing efforts.
Question 4. Other Items that Need to Be Improved at 1-800-
Medicare
Despite CMS' plans to reduce the ASA from eight minutes to
five, I did not hear much at the hearing by way of planned
improvement that would address other technological issues and
adequately address problems with respect to the accuracy of
responses provided to callers. Can you please explain CMS'
plans for improving the following:
The interactive voice response system, or IVR as it is
called, is challenging for seniors to navigate.
I would ask that CMS revise the IVR to provide an option to
go directly to an agent.
Answer: We do not currently offer a prompt that sends a
caller directly to an agent and have no plans to implement such
a change. As it is currently set-up the IVR technology improves
the efficiency of our operations and enables some callers to
``self-serve'' and receive the information they need without
having to speak with a CSR. In situations where we cannot serve
the caller via the IVR, the caller is seamlessly routed to the
CSR who is best able to handle the specific topic.
It also should be easier to reach an agent and obtain
service for beneficiaries who do not have their Medicare number
at hand.
Further, the IVR should provide choices that better align
with callers inquiries.
Answer: While a Medicare beneficiary does not need to have
a Medicare number at hand in order to obtain information from
1-800-MEDICARE, having this number allows both the IVR and CSRs
to quickly access the beneficiary's specific information and
more efficiently serve the caller. Less than 2% of calls coming
into 1-800-MEDICARE are from callers without a Medicare number.
The new 5 minute ASA is encouraging. But I still feel
strongly that CMS should contract for wait times specific to
peak call periods.
By what date can we look for CMS to revise the call center
contract to reflect an ASA specific to peak call periods?
What resources will it take (including additional funding)
to accomplish this?
Answer: No, CMS will not be revising the call center
contract to mandate an ASA specific to peak call periods.
Scripts still are too technical and presuppose program
expertise that most beneficiaries likely do not possess.
Scripts also tend to be siloed by issue and do not provide
common-sense responses for questions that cut across multiple
issues.
What steps does CMS and its contractors undertake to ensure
content is comprehensible by beneficiaries?
Further, is CMS willing to implement focus group testing on
scripts?
Answer: We recently completed an extensive review and
update of all the 1-800-MEDICARE Part D scripts. As a result of
our review, we have reduced the number of Part D scripts from
53 to 25. Notably, we have updated the overview script that
CSRs use to help triage caller issues and quickly access the
most appropriate Part D script. We expanded the questions/
linkages on that script and incorporated examples to help CSRs
assist callers. We have completed a similar review of all of
the MA scripts and have reduced the number of MA scripts from
28 to 2. In addition, we have reduced the previous 10 Low-
Income Subsidy (LIS) scripts into one consolidated script to
make it easier for CSRs to respond to various LIS questions.
All 1-800-MEDICARE scripts are scheduled to be reviewed and
updated by the end of January 2009.
We have implemented a process by which 1-800-MEDICARE
scripts are reviewed and focus tested by CSRs before being
fully implemented.
1-800-Medicare customer service representatives (CSRs) have
complained to my staff that their three week general training
does not adequately equip them for the scenarios that they
encounter on the phone during live calls. What specific
improvements can we look for in CSR training and oversight over
the next six months? Specifically:
CMS might consider incorporating a more robust program of
test calls in to its quality assurance program.
Answer: As part of the 1-800-MEDICARE quality assurance
program, our contractors will continue to conduct test calls to
examine readability, content flow and logical placement of
content. Vangent regularly conducts test calls by topic with
its CSRs for implementing comprehensive script updates. In
addition, both Vangent and Briljent perform calls for new or
key initiatives such as the Prescription Drug program to
determine whether the script addresses the caller's need and
provides a consistent answer. When making test calls, Briljent
and Vangent test callers are provided specific call
instructions and use pre-written scenarios. As before, CMS
staff members will continue to listen to actual recorded calls,
but will not make test calls.
On the topic of training, customer service representatives
currently have four calls per month reviewed. Call center
management have referred to this review process as ``a routine
mechanical checklist that lacks common sense and does not
provide adequate insight in to whether a representative has
appropriately identified a caller's issues, answered those
questions and closed the loop for a caller.'' CMS must do a
better job ensuring that representatives are appropriately
identifying and resolving callers' issues.
Answer: Each fall as we near the Annual Enrollment Period,
a Readiness Plan is developed and implemented. As part of this
Readiness Plan, all drug plan scripts are reviewed and updated
and specific Readiness training is provided to the CSRs. We
model our scripts and Readiness Plan on how Medicare
beneficiaries and their caregivers ask questions. Based on
prior years experience, we use a combination of instructor-led
and self-paced refresher training. The complexity of the
subject determines whether CSRs receive instructor led or self-
paced training.
As part of our script review, we updated several scripts,
which improved the CSRs' ability to navigate within the script.
We also updated terminology in the script to match the 2009
Medicare & You handbook language.
CMS also must drastically improve the process by which
information is captured and recorded by the 1-800 Medicare
system. Each time a beneficiary is transferred to a new
representative, and each time a beneficiary calls to follow up
on a prior call, they are forced to recount their entire story
over and over again to each person with whom they speak.
Further, customer service representatives rarely seem to be
able to provide any useful information on the status of
complaints and other inquiries. What improvements can we look
for regarding the foregoing?
Answer: CSRs have access to caller activity and history
through the CSR desktop application. CSRs can also determine
what scripts were used during the call. Where applicable, CSRs
provide additional insight through the use of the CSR comment
field in the CSR desktop application.
Additionally, effective September 19, 2008, CMS implemented
a more streamlined approach for the retro-disenrollment
process, minimizing the number of CSR transfers.
Currently, 1-800-MEDICARE CSRs have the ability to
determine whether a Part D complaint has been filed, and
whether the complaint has been resolved or is pending. We are
trying to obtain more information on the status of complaints
and have made a formal request for additional data. The request
is currently being reviewed within CMS.
What additional levels of funding will CMS require to
accomplish the foregoing improvements?
Answer: Given CMS's competing priorities, such as claims
payments, program oversight, and quality improvement, the FY
2009 requested funding level for 1-800-MEDICARE is appropriate
within that context. In fact, we've ensured that 1-800-MEDICARE
spending has remained steady despite budget cuts in other
areas. In addition, we have identified efficiencies in call
center operations that have achieved savings in the past year.
These savings are allowing us to bring down our caller wait
times.
------
Michealle Carpenter's Responses to Senator Smith's Questions
Question 1. What Is the Top Priority Fix
Based on your experience, what is the one item that is the
most pressing priority that you would ask CMS to first address
to ensure seniors get reliable answers and prompt service
during the 2009 plan enrollment period, which starts in
November.
Answer. 1-800-Medicare Customer Service Representatives
(CSRs) hold great responsibility and, in this key role, they
are affecting people's lives significantly. For this enrollment
period, beginning November 15, 2008, CSRs must be given a
standard operating procedure that allows them to assess how
callers are currently receiving their coverage and whether they
need to make a choice going forward. CSRs must be able to
determine whether the caller had creditable coverage and
whether the caller wishes to continue with that coverage. If
the caller needs to choose a plan, because he or she does not
have creditable coverage, is new to Medicare, or needs to
evaluate whether his or her current MA-PD or PDP plan will
continue to meet his needs, only then should the CSR begin to
research available options. To do this, the CSRs must be able
to use the plan finder websites to assist callers in selecting
the most appropriate plan. This will also require the CSR to
know how to find important information on the plan finder
website. These websites are not often easy to use, requiring
people with Medicare to look through pages of information
before they locate which doctors are in a MA plan's network or
which services are excluded from an out of pocket maximum. CSRs
should also be cautioned against steering callers to any
particular type of plan, such as a Medicare Advantage plan over
original Medicare. This will require that the CSR have a basic
understanding of Medicare, the available options, and the
benefits and consequences of each.
Question 2. It has been represented to the Committee that
most calls to 1-800-Medicare are simple, single-question calls.
In your extensive work with seniors, do you find that to be the
case?
Answer. The simple answer to the question is no, people
almost never call with just one simple question. The very
nature of the Medicare program makes a single, simple questions
unlikely. Even if someone does call with what appears to be a
simple question, the answer is rarely simple and often requires
additional follow up questions. But beyond that, we have found
that CSRs often are unable to handle what should be straight
forward questions.
Question 3. Complaints About 1-800-Medicare
CMS and Vangent have represented that that they are not
aware of significant complaints about service at 1-800-
Medicare. My office has received numerous complaints regarding
difficulties in filing complaints at 1-800-Medicare--either
complaints about service at 1-800-Medicare or complaints about
plans or other issues. In your casework with seniors, have you
experienced these problems? Further, in your experience, after
a bad experience with 1-800-Medicare, are seniors going to take
the time to call back in to 1-800-Medicare to file a complaint
about their service at 1-800-Medicare?
Answer. Generally, people with Medicare are unaware that
they are able to make a complaint about 1-800-Medicare or about
their plans or other issues. In our experience, by the time a
person with Medicare comes to us, they are very frustrated with
1-800-Medicare and do not want to call the number again if they
do not have to. To resolve this problem, 1-800-Medicare should
institute a quality improvement measure that allows seniors to
automatically complete a satisfaction survey after the call or
to have they survey sent to them via the mail to complete and
return.
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Tatiana Fassieux's Responses to Senator Smith's Questions
Question 1. What Is the Top Priority Fix
Based on your experience, what is the one item that is the
most pressing priority that you would ask CMS to first address
to ensure seniors get reliable answers and prompt service
during the 2009 plan enrollment period, which starts in
November.
Answer. During the upcoming Annual Coordinated Election
Period (AEP), many Medicare beneficiaries will be seeking
information about their options to change Part D and Medicare
Advantage plans. One of the most frequently requested types of
information will be an analysis of Part D options in a given
state based upon a beneficiary's drug needs. When a beneficiary
calls 1-800-MEDICARE for such information, usually a response
is mailed to the caller that includes the ``top three'' or so
plans that best meet an individual's drug needs. Instead of
relying upon this information, though, 1-800-MEDICARE customer
service representatives (CSRs) must be able to explain specific
formulary issues, such as when a prescription is shown as ``not
on formulary.'' This type of analayis is necessary, as it could
give beneficiaries the opportunity to choose different plan
options. In addition, CSRs must be able to explain additional
Medigap rights that might be available to callers from
different states, or, alternatively, affirmatively refer
callers to a local SHIP in order to obtain such information.
Question 2. It has been represented to the Committee that
most calls to 1-800-MEDICARE are simple, single-question calls.
In your extensive work with seniors, do you find that to be the
case?
Answer. In our work, we find that often the question is
simple but the answer can be complex. Many questions that we
receive require analysis, including a rephrasing of the
original question (e.g. ``I want to know if I can change my
drug plans turns into ``What are my options to change plans,
what should I look for when comparing coverage between plans,
etc.''). Medicare beneficiaries regularly seek our assistance
with complex issues, and presumably, also call 1-800-MEDICARE
with similar issues. While we are unable to provide a breakdown
of simple vs. complex calls that either we or 1-800-MEDICARE
receive, we strongly urge CMS to give more attention to the
calls it deems to be complex.
Beneficiaries and SHIP counselors alike are frustrated with
their inability to get back to the same 1-800-MEDICARE CSR,
requiring starting the process/explanation all over again each
time a call is transferred or dropped--with no assurances that
all notes are being taken. CSRs do little check of callers'
understanding, and there is still an ongoing frustration with
the IVR; beneficiaries need to get a live person on the phone
at the outset.
Question 3. Complaints About 1-800-Medicare
CMS and Vangent have represented that that they are not
aware of significant complaints about service at 1-800-
MEDICARE. My office has received numerous complaints regarding
difficulties in filing complaints at 1-800-MEDICARE--either
complaints about service at 1-800-MEDICARE or complaints about
plans or other issues. In your casework with seniors, have you
experienced these problems? Further, in your experience, after
a bad experience with 1-800-Medicare, are seniors going to take
the time to call back in to 1-800-Medicare to file a complaint
about their service at 1-800-MEDICARE?
Answer. As discussed in our testimony, we are more prone to
hearing about problems with 1-800-MEDICARE than successes. In
our experience, we have certainly encountered many complaints
about the difficulties in filing complaints at 1-800-MEDICARE--
both about the hotline itself and plan or other issues. After a
bad experience with 1-800-MEDICARE, we have found that Medicare
beneficiaries often do not take the time to either call them
back or file a complaint. All too often, beneficiaries will
reach their local SHIP program after a frustrating experience
with 1-800-MEDICARE and a subsequent referral from Social
Security or a non-Medicare related agency. Such contacts often
occur after much time has elapsed following a caller's initial
attempt to reach 1-800-MEDICARE, which can further exacerbate
the individual's problems.
Thank you for the opportunity to provide these follow-up
comments.
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John Curtis's Responses to Senator Smith's Questions
Question. What problems have you identified that need
immediate attention, and what steps do you plan to take to
remedy these problems and deliver drastic improvements before
the start of the 2009 enrollment period, which starts in
November?
Answer. Vangent takes its responsibility to Medicare
beneficiaries seriously, and is approaching the 2009 Annual
Election Period with a strong emphasis on continuous
improvement and quality service.
Each summer, Vangent develops and implements a readiness
plan to ensure that we are prepared to meet the increased
demand of the Annual Election Period. This plan covers all
aspects of the BCC operation and is a cornerstone of our
approach to providing high quality service during the fall
``spike'' period.
The following are just a few examples of the steps we are
taking to improve service:
Lowering Wait Times and Supporting Our Infrasture
We have implemented a number of operational technology
improvements to minimize the time required for a beneficiary to
reach a CSR trained to answer his or her question. In
September, we opened an additional call center to accommodate
the increase in call volume associated with the Annual Election
Period.
We have also implemented a BCC ``Command Center'' that
monitors wait times 24 hours a day, seven days a week, and
shifts workforce as needed to meet incoming call volumes.
The Command Center monitors network and phone systems at
each site to quickly identify and address any problems that may
arise.
As stated by Acting Administrator Weems, we are committed
to maintaining an average monthly speed of answer of 5 minutes
or less through the remainder of the year.
Training and Scripting
In preparation for the Annual Election Period, CMS works
with Vangent and the Training, Quality and Content contractor
to review and update all drug plan scripts, and provide
specific training to CSRs.
We are also taking every opportunity to review ``frequently
asked questions'' with CSRs to ensure that they are prepared to
respond accurately and effectively to these questions.
Finally, CMS has implemented an improved Learning
Management System that will allow us to better identify
training needs of CSRs and disseminate information to those
CSRs and call centers.
Quality
Throughout the Annual Election Period, we will reinforce
our commitment to quality. We will continue to closely monitor
calls and aggressively address any opportunities for
improvement identified by our Independent Quality contractor.
We recognize the important role that 1-800-MEDICARE plays
in helping Medicare beneficiaries make informed decisions about
their benefits. We take that responsibility seriously, and are
committed to providing high quality service not only during the
Annual Election Period, but throughout the year.
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