The state of enrollment: Lessons learned in connecting Americans to coverage

Enroll America issued a 92 page report on the lessons learned and best practices from the initial open enrollment on the new Affordable Care Act (ACA) Exchanges. According to the report, 8 million people enrolled in the new qualified health plans (QHPs) and an additional 4.8 million people enrolled in Medicaid and CHIP. The report was followed by a conference featuring analysis by health policy leaders and reports from Navigators and Assisters who were on the front lines during the open enrollment. The report highlighted many findings including:

• Repeated contact is needed for hard to reach populations.  African Americans, Latinos and young people were twice as likely to enroll after the third contact.
• People were twice as likely to enroll when helped by in-person assisters.  87 percent of partners surveyed by Enroll America reported that help from an assister was the top factor that led to a successful enrollment.
• Affordability has been the biggest barrier to insurance coverage. Informing people that financial assistance was available was the biggest motivator to enroll. Combined digital messages and email messages emphasizing affordability and access to personalized tools, such as calculators greatly increased uptake.

What will this November look like? See expected changes below.

• Enrollees need to be educated on payment of premiums and the need to re-enroll.
• 2015 outreach will target Latinos who have a low level of literacy and low enrollment levels.
• Messaging on financial assistance and examples with data are critical.
• Mobile matters since 85 percent of the target population have cell phones and one-half are smart phones.
• Personalizing the message is critical and testimonials where real individuals share real experiences are effective outreach efforts.
• Messaging about penalties is more effective when combined with the benefits of insurance.
• While data driven outreach helped drive successful campaigns in 2013-14, the effort in 2014-15 will be expanded to include predictive modeling and updating models and data to adjust for the newly insured.

The lack of insurance and health coverage literacy in the target population is very high, e.g. 50 percent did not know what an exchange was; 40 percent did not understand a deductible; and there was a poor understanding of the Medicaid expansion or availability of subsidies. HHS through the “Coverage to Care” Campaign, Exchanges and partners will continue outreach and education leading up to and during the second open enrollment.

The new campaign “From Coverage to Care” (C2C) is a national initiative to help new QHP enrollees and Medicaid and CHIP enrollees use their new health care coverage.  The program includes an 8-step roadmap which describes coverage basics such as steps to accessing care, benefits of coverage, and define terms, e.g. in and out of network coverage.  Topics covered in the roadmap include: Understanding Your Coverage, Using Prevention to Stay Healthy, Understanding Primary vs. Emergency Care, How to Select a Provider, Preparing for and Follow-Up After Appointments.  A diagram of the roadmap and videos are available here.  A marketplace 800 number is available 24/7 (800-318-2596) or consumers can contact their insurer or Medicaid or state CHIP agency. The C2C program is an ongoing program.  Separate resources are available for partners and providers to help their patients’ access covered care.

Healthcare.gov will be better for next open enrollment period given the short time frame between April and November and will include improved back-end functions, a small business portal and a simplified application that can be used by applicants with uncomplicated financial situations.

Resources

The launch of the Health Insurance Exchanges is the most challenging implementation in our industry’s history with a patchwork of eligibility, new systems and numerous regulations. GHG can help, find out how >>