CSC Uses BPM to Capture the
Medicare Part D Market
Business Issue
Granted a license by the Centers for Medicare &
Medicaid Services (CMS) to provide prescription
drug coverage under the new Medicare Part D
plan, CSC was under a three-month deadline to
launch its program.
Impact
CSC needed a solution to handle the inquiries
and process the enrollments for hundreds of
thousands of potential members per month.
They needed to rapidly roll out a new call center
capable of handling complex processes and
procedures, one with the ability to swiftly adapt
and ensure compliance in an environment
subject to constant program and regulatory
change.
Solution
CSC used Pegasystems technology as the
foundation for its Medicare Part D BPO
operations. Customer Process Manager for
Member Services was rapidly deployed and then
easily extended to provide sales, service and
enrollment functionality that enabled CSC to
provide superior customer service and grow its
business exponentially.
Benefits
� Enrolled 1 million members in six months,
handling 60,000 calls per day with 600 CSRs in
peak periods, to become fourth-largest PDP
in the first year of operation
� In its second year, grew to be the third-largest
PDP plan among entrenched healthcare
giants, generating the second-largest
member gain, with a 50% reduction of CSRs
� Reduced training time by 50%, fulfillment
request cycle time by 40%, and enrollment
call duration by 60%
� Named #1 PDP plan for customer
satisfaction by Wilson Health
Information in 2007 and 2008
� PDP listed #1 on Inc.
magazine’s report of
fastest-growing
companies, with
growth exceeding
20,000%
A CSC is a global leader providing technology-enabled
solutions and services through three primary lines of
business: Business Solutions & Services, Global Outsourcing
Services, and the North American Public Sector. CSC’s
advanced capabilities include information technology and
business process outsourcing, Web and application hosting,
mission support, and management consulting. Based in Falls
Church, Virginia, CSC has deep healthcare expertise in both
commercial and government sectors.
Medicare Part D is a federal program created to subsidize prescription drug
coverage for Medicare beneficiaries. When it went into effect, it created a massive
new market, extending new entitlements to more than 40 million seniors; a
number that was expected to grow more than 25% by 2013.
Under the Medicare Part D program, the Centers for Medicare & Medicaid Services
(CMS) was able to grant licenses to prescription benefit managers (PBMs) in a
new category of plans called prescription drug plans (PDPs). Recognizing the size
and complexity of this new opportunity, CSC teamed with a PBM to submit its PDP
bid to CMS. CSC was one of only ten organizations to be awarded a national PDP
contract from CMS, and when the contract was approved, it had just 74 days to
become fully operational.
The Challenge
CSC had less than three months to assemble the infrastructure that would
enable it to start taking calls from PDP applicants. Besides the time constraint,
the situation involved several other significant challenges including a difficult
customer population, a complex new product, and a concentrated sales period
projected to generate enormous transactional activity. CSC needed fast deployment
and scalability. It needed a system that would guide new customer service
representatives through complicated sales and eligibility scenarios, as well as a
platform that it could quickly adapt to evolving CMS regulations.
CSC also wanted to create an operational foundation for ongoing success — a
system that could handle customer service inquiries once the applicant completed
enrollment and coverage went live. To CSC, deploying powerful,
game-changing technology was the only way to successfully
address these challenges and meet the deadlines. After
a thorough evaluation of marketplace alternatives, CSC
determined that teaming with Pegasystems and using Customer
Process Manager™ for Member Services (CPM-MS), its business
process management solution specifically designed for contact
centers in the healthcare marketplace, would give CSC the
advantage it was seeking.
Solution: Phase One – A Race to Success
Pegasystems provided the foundation that enabled CSC to
address its challenges, meet its tight implementation timeline
and capitalize on the enormous new market opportunity.
Operational in less than 90 days, CPM-MS was deployed in
CSC’s three separate call centers and in additional overflow call
center entities that ultimately included 600 Customer Service
Representatives (CSRs) handling more than 60,000 calls per day.
The solution provided call scripting and intent-led processing
that guided CSRs to take appropriate actions based on each
customer’s needs. It created caller-specific composites showing
eligibility information, previous calls, and information on people
who were calling on behalf of the applicant. The solution also
drove automation throughout the process — sending CMSapproved correspondence to applicants at multiple intervals,
per regulatory requirements; transferring enrollment data to
the back-end enrollment system; keeping track of mandatory
performance measures; and packaging call information so that
after-call wrap-up time was minimized.
As the Medicare Part D initial enrollment period got into full
swing, and the media pulsed with stories of seniors suffering
long call-wait times and being given inaccurate information, CSC
was deftly fielding its calls and enrolling beneficiaries through
its BPM solution. By the end of the first six months, CSC had
enrolled more than 1 million members and become the nation’s
fourth-largest PDP.
Solution: Phase Two – Empowering Market
Leadership
Having realized spectacular initial results, CSC now had to
protect and grow its market position by differentiating its service
from those of competitors. Moving quickly from a sales focus
to one that also incorporated member support and service,
CSC swiftly activated several of the prepackaged service flows
provided in CPM-MS. CSC was also able to easily add its own
process flows, such as Medicare-specific member maintenance
and billing requests. Using CPM-MS for customer service
resulted in significant efficiencies, including a 40% reduction in
time to complete fulfillment requests and a 50% reduction in
training time. This allowed CSC to reduce its CSR volume
by 50%.
CSC focused on the delivery of superior and efficient customer
service — optimizing every customer interaction and driving
consistency for high-quality service and regulatory compliance
— as its strategy for preserving and growing market share. The
company relied on CPM-MS to help tailor each user’s experience
and keep CSR performance at top levels. The results were
spectacular, including being named #1 PDP Plan for Customer
Satisfaction by Wilson Health Information and growing another
15% within the first year of operation. This growth, the fastest
among the top five national PDPs, catapulted CSC into the thirdhighest market share position.
CSC also chose to extend CPM-MS to streamline enrollment
processing and optimize the full work cycle for enrollment
transactions. A guided process workflow was created for
CSRs to gather all requisite Medicare data, eliminating the
need for callbacks to applicants. The solution was integrated
with InfoCrossing to get preliminary eligibility information
for pre-processing, and then the system communicated with
CMS to finalize enrollments and premium determinations. For
enrollments that were not successfully processed, CPM-MS
was used to control and manage exception inventory and do
exception processing. As a result, accuracy and enrollment
throughput improved and enrollment average call length was
slashed by 60%.
Using well-coordinated planning and intelligently automating
well-designed business processes through BPM technology,
CSC was able to enter a completely new market and take
a major share. Intelligently automated business processes
provided the basis for superior customer service and efficiency,
the foundation upon which CSC has built its long-term,
sustained growth as a PDP provider.
“We were able to capture a
major share of the prescription
drug plan market and grow our
business from $0 to more than
$1 billion in less than a year.”
For more information, please contact your Pegasystems representative, visit us on the Web at www.pega.com, or email us at
[email protected]. © Copyright 2010 Pegasystems. All rights reserved.
Andy Anderson
VP of Pharmacy Services
CSC