Part D call lines, McClellan speech

Medicare is demanding some strict changes for insurer's call lines:

The call letters also address other issues, such as long waits for drug plans' toll-free phone lines. CMS said drug plans' call centers must answer 80% of calls within 30 seconds, and they must limit calls in which a caller on hold hangs up to 5% or less of total calls. Call centers also must be open whenever pharmacies participating in the PDP's plans are open, even if it is 24 hours a day, CMS said. The agency will issue weekly reports on call center performance. The call letters also said plans should create a "one-stop" area on their Web sites with information on how beneficiaries can appeal coverage decisions. The letter said CMS also "expects sponsors to develop and maintain information systems that accurately process updated enrollment information at least weekly"

Can anyone tell me where else regulations like this exist with consumer help lines?  They seem awfully strict.  Of course, given the disaster when the program first opened, I can see why CMS officials are being so  insistent on

Also, McCllelan gave a great speech last week encouraging more preventative care in Medicare:

McClellan, who visited Detroit as part of an ongoing nationwide tour that began last June, said changes to Medicare should focus on incentives for physicians to promote preventative care. "There's $300 billion in Medicare, and most of that money goes to treating complications," McClellan said, adding, "We could be doing so much more if we put just as much emphasis on keeping people well as we do on treating them." McClellan said Medicare should offer higher reimbursements for lower hospitalization rates and home care that replaces office visits for healthy patients.

Now if he could only get Medicare to adopt some of these changes, I might be a little softer on him in the future. 

Comments

[spike]

Those requirements actually aren't that strict. When I was doing quality improvement for a health plan, we were aiming for 98% of calls answered within 30 seconds (and we achieved that goal almost every month) and less than 2% abandonment rate (also easily met). The standards CMS is holding health plans to is actually pretty low for a call center, at least in my experience.

[john]

Ditto Spike.
Service Level Agreements (SLA's) for phone response time are normal practice when outsourcing any kind of service in the business world. The particular standards here are pretty undemanding, particularly since there seems to be no standard at all for average wait time (which means that you can manipulate the % answered within 30 seconds metric by NEVER answering after 31 seconds, but leaving those callers to wait forever until they hang up). This is not what you would call a best practices SLA.

The other service consideration that seems to have been ignored is how easy it is to get out of menu hell and speak to a person.

[Kate]

see? This is why commentors are awesome. I have no point of reference for what's reasonable and unreasonable with these standards, and now I do!