The Center for Medicare and Medicaid Services (CMS) places a high priority on member satisfaction. Their quality initiatives state that, “CMS is working to build a health care delivery system that’s better, smarter, and healthier – a system that delivers improved care, spends healthcare dollars more wisely, and one that makes our communities healthier.”1

As part of ensuring that Plan Sponsors support the mission of member satisfaction, CMS expects oversight of communications, specifically associated to Medicare Part D (Part D), required metrics. Part D Call Metrics include 80% of calls answered within 30 seconds and less than 5% of calls abandoned or disconnected. As many Plan Sponsors delegate call center services to their Pharmacy Benefit Manager (PBM), it is especially vital that oversight is performed for these metrics.  To demonstrate CMS required surveillance, oversight of call center delegated functions should include listening to a sample of calls to determine:

  • Appropriate transfer
  • Foreign-language callers connected to an interpreter as needed
  • Caller had an appropriate appointed representative confirmed
  • Call categorized appropriately in the PBM system
  • PBM conducted the call with professionalism and completed any requests with a one-call resolution if possible

PillarRx offers Call Center Oversight reporting on a monthly basis, that will encompass CMS-required metrics as well as these additional member-centric aspects of Part D call center services. We work with the PBM on a Plan Sponsor’s behalf to address any issues that may emerge and ensure that communications are performed to performance guarantees and CMS standards. When properly managed, this type of oversight will contribute to member satisfaction and CMS compliance.