New technology initiatives may help solve the service performance problems encountered in the controversial program to deliver health insurance services in British Columbia.
The B.C. Ministry of Health has levied hundreds of thousands of dollars in fines against the government’s outsourced health insurance services provider Maximus B.C.
In April 2005, Maximus B.C. took over the Health Insurance British Columbia (HIBC) program from the Ministry of Health, in a 10-year, $324-million contract.
Provincial officials were subsequently advised that call volumes to HIBC from the public were higher than normal, and higher than expected, said Leslie Wolfe, executive contract manager for the B.C. Ministry of Health.
“Within the contract there’s actually a requirement for them to report or notify if they think that they’re at risk of not meeting all of the service levels,” Wolfe said. “We weren’t totally surprised that there could be some growing pains associated with taking on such a big project and such a big program.”
Wolfe said new initiatives in development to help increase accessibility, and speed up processing times of various administrative services, include improving the website to allow B.C. residents to apply online for Medical Services Plan (MSP) Premium Assistance, and the implementation of new call centre technology to improve customer service.
The contract outlines specific service level requirements, including call wait-times, which Maximus failed to meet every month through the first eight months of the contract.
Problems included poor service – telephone wait times taking longer than the specified three minutes – and failure to process documents and applications within required timelines. As a result, fines were levied.
Wolfe would not confirm fine amounts saying that information is protected for “proprietary reasons,” and added that the Ministry and Maximus B.C. interact on almost a daily basis.
“Health Minister George Abbott did say that it’s up to hundreds of thousands of dollars,” said Wolfe. “The fines are material enough to motivate them to take corrective action.”
Mary Rowles, director of communications, campaigns and research for the British Columbia Government Employees Union (BCGEU), said that “proprietary reasons” are nonsense.
“That’s basic accountability for a 10-year, $324-million contract,” said Rowles. “Are they providing service or not?”
She said the person who assesses government services, whether there are risks and whether performance level requirements are being met is the auditor.
“And they won’t let him touch it,” said Rowles.
Rowles also questions the reason for the increase in the number of calls.
“They keep talking about the ‘volume of calls.’ Well, I question how many of those calls are people who gave up the first time and are calling back.”
Health Minister Abbot has said that call wait-times improved in the third quarter, during which HIBC received 376,000 telephone calls from the public with an average answer time of fewer than three minutes.
Unlike the first two quarters which saw consecutive monthly fines, the Ministry was pleased with improvements and “only one financial penalty was levied in the third quarter for missed service levels around document processing in October.”
But growing pains were clearly anticipated; Wolfe said that when the contract was signed, it allowed Maximus three to five months to get everything ready so that operations could be handed over.
“During that transition period there was an awful lot to do,” she said.
“There was a big learning curve for them to understand all of the legacy systems and applications, fully understand all of the policies and procedures for all of the stuff that they were going to take responsibility for… We also had to do a lot of recruitment of staff.”
She said that offers were made to the approximately 230 employees that were affected, a number of whom accepted employment elsewhere or took early retirement. But 206 stayed with Maximus.
However there were layoffs as well, according to Rowles, “Apparently Maximus issued layoff notices to approximately 32 employees in January. These were auxiliaries, not permanent staff, but under the collective agreement they would have some recall rights.”
Rowles added that the company then re-hired a few of the workers. But some workers had been informed that the company anticipates more layoffs.
“From our perspective it seems as if they are having difficulties planning for periodic increases in workflow.”
The length of the contract also concerns Rowles.
“Deloitte & Touche recently did a report on contracting, and they’ve shifted their opinion and are urging corporations not to get into long-term contracts,” she said. “There has been no response from the government as to why they won’t cancel the contract.”
“My assumption is they want it to work, and it’s sort of like the emperor has no clothes, they don’t want to be presented with the evidence, because they are wedded to taking that data management outside of government,” she said.
At the end of November, when Maximus claimed it was meeting service requirements, there were still calls being placed to the Seniors Hotline, where general members of the public can call and complain about service, said Rowles.
She said the seniors are still placing calls on the line; as recently as Feb. 27, there was a call from someone who said they spent 18 minutes on the phone.
“Is that just an anomaly?” questioned Rowles.
Wolfe maintained that by the end of November, Maximus was meeting all service level requirements.
“By December (Maximus) met everything, and that’s why we were so encouraged, because we had every reason to believe that they were going to succeed in accordance with that plan, and so that’s exactly what’s happened,” she said.
B.C. citizens have really seen the commitment in Maximus as well, because they’re part of the community now, and they want to do a good job, Wolfe said. She added that was really demonstrated in their response to the service level problem.
Wolfe said that over the next two to three years, they will be introducing new services and new channels to the public.
Within the next couple of months, she said, they will be introducing a premium assistance web application where people can apply online.
“This has never been available before.”
They expect more and more of these types of services to be introduced on the web.
“These are completely new … everything so far has been paper-based or phone-based, and it’s been kind of a cumbersome system, so they’re slowly turning that around.”
She said new call centre technology has been implemented, which Maximus will improve on over the next year with respect to interactive voice response applications, and ultimately the public will benefit from the improvements and new initiatives.
“What will be enjoyed by the public will be an easier way to interact with government programs.”
However, Rowles said that there’s still strong public opposition to these specific services being contracted out to a private company, “I think it’s the sense that the information is no longer really in the government’s control, and the privacy commissioner acknowledged that there’s a risk of release of data, so then you have to weigh is there a good business case for this … it’s hard to gauge what the real benefit is.”
She said BCGEU has filed a Freedom of Information request to learn what the exact performance levels are, “We’re in discussions right now with the government, mediated by the Privacy Commissioner to make sure that we actually have all the information.” Maximus did not return phone calls on this issue. 060770
Lisa Williams (firstname.lastname@example.org) is a senior writer with InterGovWorld.com.