Every year, Medicare Advantage organizations enter a period of predictable operational intensity — and every year, that predictability still produces longer waits, repeat contacts, and frustrated members. In *”Beyond the AEP Surge,”* TLCx Chief Commercial Officer Bryan Gray argues that AEP and OEP are known operating conditions, not surprises, and health plans that treat them that way can turn seasonal pressure into a genuine advantage.
Bryan Gray’s starting point is simple: AEP runs October 15 through December 7, and OEP runs January 1 through March 31, every single year. Members’ questions during those windows — network status, prescription costs, benefit changes — are entirely predictable too. So the leadership question, Bryan Gray writes, shouldn’t be “how do we handle the additional volume?” It should be “what should we design differently because we know this demand, and the reasons behind it, are coming?”
That reframe matters because, as Bryan Gray points out, members don’t separate administrative service from clinical care. A call about a denied claim or a confusing benefits letter can materially affect whether a member can navigate the healthcare system at all. That means first-call resolution, language accessibility, quality assurance, and escalation management aren’t just contact-center metrics — they’re part of the broader member-care ecosystem.
Bryan Gray also challenges a long-standing industry habit: optimizing purely for speed. A longer call that fully resolves a complicated issue, he argues, often creates more value than a fast call that generates a second contact or a complaint. He proposes a broader hierarchy of performance for enrollment season — can the member reach us, do we understand their actual need, can we resolve it completely, and did we eliminate the reason for another contact — which shifts quality assurance from checking script adherence to diagnosing why contacts fail in the first place.
Complaints, repeat contacts, and escalations get a similar reframe. Rather than treating them as scores to minimize, Bryan Gray describes them as an early-warning system: if hundreds of members ask the same question, the problem probably isn’t the members — it’s a workflow, a knowledge gap, or a digital experience that isn’t actually resolving anything.
On CMS Star Ratings, Bryan Gray draws a subtle but important distinction: plans that manage the *experience* that creates the score tend to outperform plans that manage the score directly. With CMS streamlining its 2027 measure set to sharpen focus on clinical care, outcomes, and patient experience, that distinction is becoming more consequential, not less.
The paper organizes AEP/OEP readiness around three leadership imperatives: **Anticipate** — using historical demand and call-driver analysis to prepare not just for volume but for *why* members will call, with contingency plans for when the forecast is wrong; **Resolve** — giving frontline teams the authority and tools to solve problems completely, rather than letting efficiency targets encourage incomplete interactions; and **Learn** — capturing call reasons, complaints, and quality findings together, fast enough to change operations mid-season rather than just documenting them afterward.
Bryan Gray is clear that AI and automation can amplify this model but can’t replace it. Automating a confusing process, he writes, just creates faster confusion. The starting point has to be the member need — where friction is occurring, which problems should be prevented, and where technology can be deployed safely against those questions.
His closing argument is a reminder as much as a strategy: behind every service level is a person waiting, and behind every Star measure are individual members whose experiences created the result. AEP and OEP will always be predictable. Bryan Gray’s case is that clarity, resolution, and confidence for the member should be just as predictable.
Download the White Paper: Beyond the AEP Surge: Designing Medicare Advantage Around the Member
