New Hire Member Services Curriculum: Horizon Medicaid
Anatomy of a Performance-Driven Curriculum
A single curriculum — the New Hire Member Services program for a Medicaid managed-care call center — built and measured across four phases of development, showing exactly where the Standard Block Method, Instructional Support Frame, Learner Development Index, and Point System Measurement of Proficiency each do their work. The frameworks are not theory layered onto a course after the fact; they are the structure the course is built from.
The structure the program is built on — how content is sequenced, scaffolded, and tied to objectives from the outset.
The bridge between content and audience — making specialized material accessible without lowering the standard.
Structured observation during delivery — seven markers that surface gaps while there is still time to intervene.
The base rubric — every score maps to an observable stage of development and a prescribed next step.
How the system fits together
The SBM provides the structure. The ISF builds the contextual scaffolding inside that structure. The LDI measures developmental progress as the program is delivered. The PSMP scores proficiency at every checkpoint — making the whole system evaluable. Used alone, each is a functional tool. Used together, they form a complete structure for designing, delivering, and measuring performance-driven learning.
Defining the Problem Before Designing the Solution
The engagement opens by separating the request ("rebuild the curriculum") from the problem (inconsistent facilitation, knowledge-transfer gaps, and QA scores below standard). A qualitative analysis of call-performance KPIs and trainee results confirms the gap is largely knowledge- and skill-based — which makes a redesigned curriculum the correct intervention rather than the assumed one. No framework is "applied" yet; this phase establishes the PBMS anchor points the entire build will trace back to.
1.1 Statement of Need → Results-Based Reframe
The vendor's opening ask was an updated curriculum. Dialogue surfaced four root concerns: incomplete materials and scattered files, call-resolution protocol gaps, an abrupt COVID-19 shift to ILT-only assets, and obsolete content from the 2017 build.
- Scope shifted from "produce materials" to "close a measurable performance gap"
- Training confirmed as the primary — not the only — facilitator of improvement
1.2 Needs Assessment & Readiness Gap
QA Scorecard data localized the gap to three competencies, each tied to a missing or outdated curriculum section:
- CC3 Complete/accurate solution — 78.3% → no Consultative Services training
- CC4 Correct documentation/disposition — 76.4% → too little mock-call & role-play time; no Medicaid-based calls
- CC6 Hold/transfer/dead-air procedure — 71.1% → no systems review
Building the Structure & the Bridges Into It
With the gaps confirmed, the SBM establishes the program's spine and the ISF determines how specialized content — health-insurance mechanics, Medicaid eligibility, Facets navigation — is made reachable for new hires with no prior background. The PBMS objective hierarchy is set at every layer so design decisions stay anchored to outcomes.
SBM Structure — Backward Design Across the Module Design Sequence
Design runs from Policy (what the program must produce) backward through four Event Segments, each anchored by a PBMS objective tier. Delivery is governed by Management — the facilitation guidelines that protect the designed program in the room.
ISF — Contextual Scaffolding Across Four Modes of Engagement
The same content delivered to agents with meaningfully different baselines — without redesigning per audience. The ISF builds the bridge into the content; it does not simplify it.
Visual
Diagrams and scaffolded models that expose structure before technical complexity.
Auditory
Specialized language translated into familiar terms, with deliberate pacing and repetition.
Kinesthetic
Applied scenarios where the principle is discovered by doing, not by being told.
Written
Annotated models and scaffolded texts that make relationships between elements explicit.
The Full Curriculum, Built & Measured in Motion
Development produces the complete 16-day program across four modules. As it is delivered, the LDI tracks seven developmental markers across three dimensions, and the PSMP scores every checkpoint. The curriculum below is annotated to show which framework is doing the work at each module.
Orientation & Overview of Health Insurance
Consultative Training, MCO fundamentals, cultural competency, medical terminology, and Coordination of Benefits. Heavy instructional support; concept formation through ILT and WBT blends.
Medicaid Plan Deep Dive · Facets Functionality & Navigation
Facets demo and hands-on practice, documentation, EMEVS training and role play, eligibility policy. Guided practice with declining support as agents begin applying systems to cases.
Post-Enrollment Member Services Calls & Procedure
"Putting It All Together" reviews, Top 50 call types and role plays, mock calls, crisis calls, abuse reporting. Independent application under realistic, unpredictable conditions.
Nesting & Supported Live Calls
Agents take live calls while monitored by leads and coaches. Self-directed performance with minimal support — the program's competency demonstration.
LDI — Seven Markers Tracked Across Delivery
Progress is measured as it happens. By the time the final assessment reveals a gap, it is usually too late — the LDI surfaces conditions at the intervals where intervention still works.
What impedes completion at the earliest stages.
Where learners spend the most time, and why.
Adherence to prescribed standards and benchmarks.
Applying skills across varied contexts and conditions.
Depth and originality of individual contribution.
How feedback is folded into revision over time.
Cumulative — does the body of work meet prerequisites.
PSMP — Two Assessment Tracks
Most rubrics produce a score. The PSMP produces a stage — and every stage maps to a prescribed next step. The same point value means the same thing across trainers, eliminating interpretive drift between assessors.
Closing the Gap & Making the Program Evergreen
Evaluation returns to the Phase 1 benchmark and asks whether the gap actually closed. The LDI and PSMP data gathered during delivery feed directly back into the ISF and SBM — so the next cohort's scaffolding is shaped by this cohort's evidence, not by guesswork.
The Performance Gap This System Was Built to Close
Friction Check
Can agents use the training and its job aids without unnecessary friction? LMS and observation data confirm.
Engagement Check
Is the program relevant to the job as predicted? Surveys and LDI engagement markers validate Kirkpatrick L1–L2.
Performance Check
Do agents perform better on Medicaid simulations over an acceptable period? PSMP stages tracked against benchmark.
Conversion
Program institutionalized with monthly cross-functional review and incremental updates — never a full overhaul that disrupts live cohorts.
The Quilt, Not the Patches
No single framework built this curriculum. The SBM gave it a spine that runs from concept to competency. The ISF made specialized Medicaid and systems content reachable for agents starting from zero. The LDI turned delivery into a stream of actionable data. The PSMP made every checkpoint mean the same thing to every trainer — and tied every score to a next step. Together they form a training system that is designed, delivered, measured, and improved as one coherent structure.