The fourth quarter of 2013 and the first quarter of 2014 will provide a jolt to the healthcare and customer service industries, the likes of which have not been seen since Medicare Advantage was introduced to Americans in 1965. The Patient Protection and Affordable Care Act, which includes 90 provisions that are described in a 2,400-page document, took four years to enact. It is larger and more complex than the US Tax Code, thanks to the folks at the Health and Human Services department.

The new system, which has been created to guarantee health care to all citizens and expand Medicaid benefits, is built around health insurance exchanges (HIX). These “exchanges” can be organized by individual states of the Federal government, depending on what arrangement those states prefer. (A few states – including Massachusetts, Utah and New York – are already operating their health insurance exchanges.)

Each insurance carrier operating within an “exchange” is required to have trained experts, known as “navigators” and “assisters,” available to all citizens to explain the details of the transition. Each health care exchange must be prepared to enroll individuals, quantify tax credits and verify overall eligibility using the skills and technology of contact center personnel.

Business implications: employers who have over 50 employees must offer full-time employees (and their dependents) the opportunity to enroll in affordable, minimum “essential coverage” under an eligible employer-sponsored plan.

Contact centers should examine their readiness for this transition in four areas: 1) Market readiness; 2) Technological readiness; 3) Operational readiness; 4) Regulatory compliance. This video summary of a presentation given by Dr. Klein at PACE, a customer experience trade association event provides more detail.

Contact EPIC in order to assure that your firm is truly prepared for this transition.