2.) 3.) Using the standards and targets, CMS  evaluates the contractor’s performance three times a year. While generally meeting the required  standards for the three access-related performance metrics, the 1-800- MEDICARE contractor consistently met the target for only one of the  three access-related performance indicators we analyzed. 4.) The 1-800-MEDICARE contractor met its  unhandled CSR call rate standard, keeping the number of unhandled calls  within the required standards, in 11 of the 13 months we analyzed and,  because of a waiver granted by CMS, was considered by the agency to  have met the standard in 12 of 13 months. 5.) Three of the indicators are particularly related to callers’  telephone access: (1) the average amount of time CSRs spend assisting  callers, referred to as average handle time; (2) agent occupancy—the  percentage of CSRs answering calls; and (3) forecasting of call volume  going to CSRs. 6.) Efforts to Provide LEP Callers Access to 1-800-MEDICARE Have Led to Shorter Wait Times for Spanish-speaking Callers, on Average, but Are Not Consistent with All LEP Plan Elements

CMS has made efforts to provide LEP callers with access to services  through 1-800-MEDICARE by requiring the contractor to provide services  in either English or Spanish and to provide interpretation services for  callers speaking other languages. Officials  from the Office of Beneficiary Services (OBIS)—the CMS office with  primary responsibility for 1-800-MEDICARE—said they were not aware of  the HHS LEP Plan when awarding and assigning the current 1-800- MEDICARE contract and CMS has not identified an office responsible for  acting as a point of contact for its management of the LEP Plan. Nonetheless, steps CMS has taken to provide services to LEP callers are  consistent with some elements of the HHS LEP Plan adopted by the  agency without modification, such as the element related to oral language  assistance, but not others, such as the Plan’s element for assessing quality  and accessibility, which identifies the need for complaint mechanisms for  language issues. Spanish-speaking callers who speak with bilingual CSRs frequently  experienced shorter average monthly wait times to reach a CSR than their  English-speaking counterparts. Without an office or official  responsible for management of the Plan, staff lack a source of guidance  that could assist them in taking steps consistent with the Plan to provide  services to people with LEP. CMS Uses Common Management Practices to Oversee Callers’ Access to Services and to Accurate Information from 1-800- MEDICARE

CMS uses all six of the management practices we identified as commonly  used by contact centers to oversee 1-800-MEDICARE callers’ access to  services and to accurate information. These practices are addressed in  the current 1-800-MEDICARE contract and reflected in CMS’s ongoing  oversight of the help line. Clearly defining performance metrics and indicators. Customer satisfaction surveys. Ensuring accurate information. Evaluating CSR interaction with callers. Capacity planning. Validation of contractor reports. Conclusions

To date, the current 1-800-MEDICARE contractor has met most of CMS’s  performance standards and some of the performance targets designed to  ensure callers’ access to services from the help line. These written materials may include paper and electronic  documents such as publications, notices, correspondence, web sites and signs.”  “Each agency, program, and activity of HHS will have in place specific written policies and  procedures related to each of the plan elements and designated staff who will be  responsible for implementing activities related to these policies.”  “Each agency, program, and activity of HHS will proactively inform LEP customers of the  availability of free language assistance services through both oral and written notice, in his  or her primary language.”  “Each agency, program, and activity of HHS will train front-line and managerial staff on the  policies and procedures of its language assistance activities.”  “Each agency, program, and activity of HHS will institute procedures to assess the  accessibility and quality of language assistance activities for LEP customers.”

Appendix II: Average Caller Wait Time by Type and Complexity of Call and Language of Caller, September 2007 through July 2008

This appendix provides more detailed information on the average wait  times experienced by callers depending on the type of inquiry—general  Medicare and claims—and complexity of their call or the language in  which they need assistance for the period September 2007 through July  2008 of the current contract. Federal Contact Centers: Mechanisms for Sharing Metrics and Oversight  Practices along with Improved Data Needed.
Why GAO Did This Study

The Centers for Medicare & Medicaid Services (CMS) is responsible for providing beneficiaries timely and accurate information about Medicare. Receiving nearly 30 million calls in 2007, 1-800-MEDICARE, operated by a contractor, is the most common way members of the public get program information. The help line provides services both to English-speaking and limited English proficiency (LEP) callers. In this report, GAO describes (1) the extent to which access performance standards and targets have been met by the current contractor, (2) the efforts by CMS to provide LEP callers access to help line services and wait times experienced by these callers, and (3) CMS's oversight of callers' access to 1-800-MEDICARE and the information's accuracy. To conduct this work, GAO reviewed documents and analyzed help line data through July 2008. In addition, GAO interviewed agency staff, industry experts, and officials at four federal agencies with high call volume contact centers.

What GAO Found

The 1-800-MEDICARE contractor met most standards and some targets for the required telephone performance metrics and indicators CMS designed to ensure callers' access--from July 2007 through July 2008. The 1-800-MEDICARE contractor's performance met the standard for each of the three access-related metrics--the average amount of time callers wait to reach customer service representatives (CSR), the percent of unhandled calls, such as abandoned calls, and the percent of calls transferred among CSRs--in 10 of 13 months analyzed. Because of waivers granted by CMS, the contractor was considered by the agency to have met the standards in 12 of 13 months. During that time, the contractor met the target for only one of three access-related indicators--the percent of CSRs answering calls. Other indicators were the average amount of time needed to respond to callers' inquiries and the accuracy of CSR call volume forecasting. CMS's efforts to provide LEP callers with access have led to shorter average wait times for Spanish-speaking callers, but are not consistent with all elements of the HHS LEP Plan. CMS requires its help line contractor to provide services to Spanish-speaking callers by employing bilingual CSRs and to provide interpretation services for other LEP callers, which the contractor does by using telephone interpreters. In 20 of the 32 months reviewed, Spanish-speaking callers waited less time, on average, to reach a CSR than English-speaking callers. CMS officials with primary responsibility for 1-800-MEDICARE said they were not aware of the LEP Plan when awarding the current contract, and CMS has not identified an office responsible for acting as a point of contact for management of the LEP Plan. Without a responsible office or official, an internal control for federal agencies, CMS staff lack a source of guidance to assist them in taking steps consistent with the LEP Plan when considering the needs of people with LEP. However, CMS has taken steps consistent with some elements of the agency's adopted LEP Plan, such as the element related to oral language assistance, but not others, such as the element identifying the need for complaint mechanisms for language issues. To oversee 1-800-MEDICARE callers' access to services and accurate information, CMS uses all six commonly used contact center management practices. Based on GAO's review of the literature and interviews with federal agencies and industry experts, these management practices are: (1) clearly defining performance metrics, (2) performing accurate capacity planning, (3) conducting customer satisfaction surveys, (4) ensuring information for CSRs to reference is accurate, (5) evaluating CSRs' interaction with callers, and (6) validating contact center performance reports. These practices are addressed in the current 1-800-MEDICARE contract and reflected in CMS's ongoing contract oversight.