By Betsy Imholz, Special Projects Director, Consumers Union

Think of the last time you called your cable company to respond to the latest promotion or to ask a billing question. Recall the ache in the pit of your stomach, the cringing expectation you’d be put on hold, shuffled from person to person, denied the promised price? This is exactly the opposite of what those working to create new state health care “Marketplaces” want consumers approaching them to find as they undertake the important task of applying for health insurance coverage.

Now think of the fun you had getting a ticket for travel on, say, Southwest airlines. One call and you’re done—or, even easier, an on-line experience that got you your ticket in 10 minutes.  Imagine if getting health insurance coverage were that painless?

The Affordable Care Act aims to give consumers applying for coverage a world-class experience. But turning that lofty goal into reality requires a lot of heavy lifting to create the infrastructure to make it all happen “behind the screen,” outside of public view, and without consumer hassle. Using a single, streamlined application, the state Marketplaces and the federally-facilitated exchange (FFE) are charged with the job of creating a simple system for consumers who most often will not—and need not—know in advance what they are eligible for: Medicaid, the Children’s Health Insurance Program, subsidized private policies at a new health insurance Marketplace, or unsubsidized private plans through the Marketplace. Anyone coming in to apply on-line, by mail, in person, or on the phone should be able to do so without concern for which “eligibility silo” they fit in.  And if they phone in, which we can expect a substantial proportion will do in the first year, they should not get busy signals, dropped calls, or requirements that they call back another time.

Based on our experience in California trying to help set up a system with a top-flight “shopping” experience for all, a coalition of consumer groups created a set of  “Customer Service Principles and Performance Standards for Exchange Call Centers.”   This paper draws from the commercial world of customer service standards, as well as public program accountability, to urge the new Marketplaces to adopt basic consumer precepts for their call centers and for measureable performance standards.  The adage is “what gets measured gets done,” and it applies in setting up health insurance Marketplaces as well.  We urge states and the FFE to create performance measures for all parties involved in handling insurance applications—new health insurance Marketplaces, any outside vendors, state and county agencies—and to measure and report on whether those standards have been met. All the outreach and advertising in the world won’t work to get people enrolled unless the people who need health insurance coverage can easily get into the system to apply and enroll.

There are apt to be bumps along the way, especially in the first year of operation, but we need to aim to not have too turbulent a flight—and, like any good business would do, to put the customer first, measure progress, get ongoing consumer feedback, and make continuous quality improvement.