In the spotlight

Abstract

This federal shared services center was established to provide insurance and other human resource support for federal government employees – not the general public. But its mission changed after the Affordable Care Act was signed into law. This act required that states provide pre-existing condition insurance coverage for their citizens – but more than 20 states asked the federal government for help.

With less than 60 days until the deadline, a federal government agency was charged with launching the federal Pre-Existing Condition Insurance Plan (PCIP) to fill the gap. However, the agency did not have the change management experience and resources required, so they turned to Deloitte for assistance with this high-profile national project. Deloitte’s experience helping state and federal government organizations meet their technology, human capital and operational challenges allowed the agency to accomplish what many thought was impossible: launching the new insurance program on time and substantially under the planned budget.

The Challenge

In late April 2010, the federal government agency was given the responsibility to execute the federal PCIP with a mandated deadline requiring the plan to allow participants to enroll by Aug. 1, 2010. If the agency failed to meet the deadline, the federal government would not be in compliance with the new law and thousands of uninsured citizens would continue to lack access to health coverage.

The agency’s progress was closely followed by the White House, Congress and major media. A national health insurance program of this type – with the sole purpose of providing coverage for uninsured people with often life-threatening medical conditions – had not existed before in the U.S. Within 60 days, the agency needed to design and launch the federal PCIP that included:

• Easy-to-use website that provided eligibility and coverage information and allowed citizens to create and submit applications for coverage,
• Effective way to process citizens’ applications for coverage,
• Efficient billing and payment systems, and
• Convenient and effective call center staffed with knowledgeable, empathetic representatives ready to answer citizens’ questions and concerns.

The law that mandated PCIP did not include details about how the insurance program should work. Instead, this responsibility fell on two other federal agencies. Because of the tight timeline, these two agencies were creating the plan’s rules and regulations while the federal government agency and Deloitte designed the plan’s administrative systems, processes and training. Practically every day, the agency received new and modified rules that had a direct impact on plan processes, requiring changes to technology systems, call center scripts, website information, employee training, application processes and more.

How We Helped

The agency’s first instinct was to subcontract with a third-party benefits administration company to provide the technology needed to administer their plan. While this approach would be fast, it would not be flexible or cost effective. The agency would not own the technology, so that it could not be leveraged for future insurance projects, plus the administrative fees would be much higher.

Deloitte had a better idea. They had designed an enrollment and applications processing approach for a US state insurance plan that could be adapted for the federal plan. Deloitte contacted their client and led negotiations that allowed the federal agency to use the Deloitte-designed technology, providing them with greater flexibility, expansion capabilities and customization. And the cost was right – free.

Even with this technology solution, there was no time to waste. The tight deadline required the team to launch PCIP service delivery in stages using manual processes while the automated solutions were being customized for the federal plan. This approach allowed the team to meet the mandated deadlines and still allow time for creating the underlying technology that worked correctly the first time. Within 60 days, the team accomplished these activities:

• Launched a public website: The public website that provided eligibility information and the application for coverage was launched by June 15. The fast launch was required to allow time for people to complete and submit applications in time for coverage to begin August 1.
• Opened a call center: Deloitte helped the agency in its efforts to contract with a call center vendor to answer customer questions and concerns beginning in June. Deloitte prepared the representatives to effectively serve the public by conducting training, creating call-center scripts, and programming interactive voice response systems.
• Created application processes and procedures: Deloitte worked with the agency to develop and implement manual processes for initial application intake and processing. Deloitte provided extensive staff training and guidance for quality control.

Project management processes were established to allow the team to respond to PCIP changes efficiently. At the beginning of the project, specific process maps were developed that described the agency’s required actions at each point in the application review and approval process. These maps proved to be invaluable in helping the team track complex modifications to processes and procedures resulting from the policy changes. In addition, human capital specialists led the call center staff through intensive training sessions and role plays so they could be prepared to respond to questions, allowing citizens to have a positive application experience.

After the initial launch, Deloitte continued to provide operational guidance, employee training and technology enhancements to comply with continually evolving health care regulations, while reducing administrative costs.

Solution

Under intense national scrutiny, the team accomplished their objectives on time and significantly under budget, allowing the agency to save federal taxpayers $25 million from the original anticipated budget. After the launch, Deloitte worked with the agency to find ways to reduce the program’s administrative costs by 30 percent without affecting customer service or essential program operations.

The White House and major national media have recognized the team’s extraordinary achievement. However, more satisfaction comes from the letters of gratitude from the more than 14,000 Americans living in 23 states and the District of Columbia who now have access to life-saving care.

As used in this document, “Deloitte” means Deloitte Consulting LLP, a subsidiary of Deloitte LLP. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.