Open enrollment: HSS reports strong digital uptake but pauses off-site call vendor after integration problems

San Francisco's Health Service System reported an overall successful open-enrollment period while flagging problems with an off-site call-center vendor that led staff to pause the vendor contract at the start of the year.

Chief Operating Officer Ray Guillen told the Health Service Board that 88% of open-enrollment applications were submitted electronically and that the system served more than 79,000 subscribers this year. Staff reopened in-person support, ran 10 health fairs and 24 flu clinics, and handled about 6,571 member calls during the period.

Olga Velasquez, operations manager, described a recurring telephony integration problem between HSS and the contracted vendor VSA (Valerie Schlitt & Associates) that sometimes left members on hold and caused disconnected calls. Staff described a three-part mitigation approach: VSA attempted to call back identified disconnected callers (typically within about one hour), HSS reserved some queues for in-house staff (retiree and active-member queues) to reduce transfers to VSA, and the agencies are pursuing a shared AT&T platform to remove the technical barrier. Olga said the VSA contract will be paused beginning Jan. 1 under the current terms while HSS attempts to resolve integration problems before any future reengagement.

Commissioners pressed staff on transparency: some asked whether members knew when they were speaking to vendor staff (staff said the process was deliberately seamless so members perceived they were contacting HSS) and whether lost-call callbacks could be quantified; Ray Guillen said staff tracked lost calls and VSA attempted callbacks but could not provide an exact count of members who could not be reached by callback.

The board also heard operational metrics in the presentation: member services reported routing 4,277 of 6,571 open-enrollment calls to the off-site call center, handling 291 virtual consultations and assisting 470 in-person lobby visits. The presentation highlighted a significant increase in enrollment in the Health Net Canopy Care plan (slides referenced increases of 82% in one place and 50% in another), which staff said helps stabilize that plan's viability. Staff said they will continue pursuing process and customer-service improvements heading into 2024.

"We would not have been able to meet our members needs if we did not have this contract," Ray Guillen said, while acknowledging the vendor relationship required further work to improve the customer experience.