The Challenge

Each year, the Centers for Medicare & Medicaid Services (CMS), the regulatory government organization that oversees health insurance providers’ Medicare practices, puts every customer care Medicare vendor to the test. Because CMS has the authority to revoke a company’s ability to sell their Medicare insurance plans, a poor showing can be devastating for the insurance providers they represent.

CMS’s goal is to ensure compliance with a set of prescriptive protocols when dealing with customers’ Medicare insurance inquiries and issues. It is a highly regulated process requiring vendor expertise in all facets of Medicare insurance, which they then gauge and rank relative to the industry.

Our client is a major regional health insurance company whose Medicare insurance plans account for a considerable percentage of their total revenue. They came to Harte Hanks after their incumbent customer care partner received an unimpressive annual CMS score of 2.5 out of 5.0, which pushed the company’s score so low they risked losing their ability to sell Medicare. Our immediate mission was to raise our client’s scores through better execution, knowledge, and reconnaissance of how to navigate through the CMS testing process.

Our Insights

Harte Hanks works with multiple clients in the healthcare space, many of whom are subject to CMS regulatory and compliance mandates. Throughout the years we have become adept at developing systems, training and procedures designed to navigate these highly complex landscapes. Preparing for CMS trials was more education than training, similar to prepping for a grad school entrance exam.

Above all, we taught our staff to distinguish CMS calls from general customer traffic, enabling them to instantly react and implement our prepared scenarios too quickly, and empathetically, resolve each of the many types of inquiries received.

Not only did our staff need to be immersed in all key aspects of Medicare programs and everything about our client’s insurance products, they needed to master how to “take the test.” We developed features including instantaneous technology triggers to alert them when translators may be required, or seamless alternative communication channels if encountering a hearing-impaired customer.

Our Approach

CMS contracts with other call centers to execute their test call program. Like the adage, “it takes one to know one,” we were able to recognize key paradigms to extrapolate the different types of calls.

Our proprietary technology platform acts like an early warning system, playing a critical role in identifying when a CMS test call might be coming in and notifying the team to implement our protocols.

We don’t just train operators. We educate them. Agents are grouped in small batches, two to three at a time, and we create mock situations that range from perfect calls to abject failures.  Our agents can experience a wide range of circumstances and learn to intuitively address each test call.

But we don’t just train. Our curriculum is an ongoing process that evolves with CMS changes and revisions. Constant improvement is not an aspiration, it’s a presumption. Every potential aspect in which we could lose points has been addressed.

Most intriguing is our ability to engage “predictive monitoring.” We created a solution that allows us to listen to and score calls based on key parameters. This enables us to dynamically predict our score, accurately and in real time. If we determine our score is faltering, we immediately isolate the reason and increase specific coaching or reconfigure our tech to raise our grades in the weeks to follow.

The Results

Essentially, we are the “CMS valedictorian.” We consistently achieve top scores every year.

One of our other clients acquired enough 5.0 ratings that they were granted the ability to sell Medicare plans all year round, not limited only to open enrollment.

While focusing on achieving the highest possible CMS scores is a priority, doing so has improved our speed and customer satisfaction ratings overall. The same dedication and enthusiasm we put into testing spills over into day-to-day customer care efforts for our clients.

CMS put us and our client to the test.

We’re happy to say, we aced it.


Score achieved in one year

We took our regional health insurance client from warning status to a perfect 5.0 in one year.