Retail Enrollment Centers

With the ACA’s introduction of open enrollment periods for health coverage programs, the time was right for innovative outreach models to reach new populations. Retail enrollment centers (also called “pop-up retail shops”) were one outreach and enrollment tool developed by states that has shown early promising results. In the first two years of ACA open enrollment periods, at least three state-based exchange (SBE) states (Connecticut, Colorado, and Kentucky) created retail enrollment centers. State officials interviewed reported a number of positive impacts from enrollment center experience, including increased visibility, improved outreach impact, a greater than average effectuation rate due to motivated and prepared consumers getting the help they need in a one-stop shop, and ensuring an accessible, central, community-based location to support enrollment. In this chart, we’ve captured information from three states that successfully used pop-up retail shops to inform other states that may be considering them for future years.

The states featured in this chart have demonstrated how to quickly build effective retail enrollment centers. As SBMs, the Connecticut, Colorado, and Kentucky exchanges were uniquely situated to reach target populations and try dynamic, innovative outreach methods to increase enrollment. SBMs have more centralized control over multiple aspects of outreach and enrollment processes than other states because the responsibility and authority for outreach is housed within the SBM, allowing the SBM the ability to tailor communications to the unique enrollment and assistance landscape, opportunities and challenges facing that specific state.

NASHP gathered information to create this chart through key informant interviews, email queries to state officials, and research supported by the Robert Wood Johnson Foundation’s Enrollment 2014 project, a one year project in which NASHP interviewed state leaders and stakeholders in 10 states with early success in enrollment and supported engagement of FFM state officials in Medicaid, CHIP, and Insurance/Exchange agencies. Although the information below reflects the step-by-step considerations of building pop-up shops for outreach and enrollment into health coverage programs by SBE agencies, other state agencies may also use this model to develop retail enrollment centers for other programs. Has your state also used a retail enrollment center approach? Please let us know – we welcome information from other states with similar experience.

State State Exchange Structure Number/ Location of Stores; Hours of Operation; Selection Process Staffing Operational Costs & Expenses Physical Plant Number of People Enrolled at Stores; ROI Development Timeline
CO State Agency:
 Colorado Health Benefit ExchangeExchange Name: Connect for Health ColoradoStructure:Public non-profit established by state law
Number/ Location:
 1 store in Downtown Denver (Years 1 and 2) (1)
Operating Hours:
 M-F: 10am-6pm Sat: 12pm-6pm Closed Sunday (except on open enrollment deadline)Location Selection:

  • Identified high uninsured area with data from ACS & Year 1
  • Close to public transit and high population density to reach target population
  • Reviewed brokers’ and health insurance guides’ existing locations to determine areas of need
Positions:

  • Store manager and greeters
  • Customer service center reps
  • Brokers (not exchange employees
  • Health coverage guides (Navigators)
  • Medicaid program reps (back-end access to Medicaid eligibility system)
Employees/ Contractors:

  • FTEs: Co-located 3-5 existing staff
  • Brokers: 4-6 onsite
  • Medicaid rep: 3 days/wk.

Note:Usually 4-5 workers at store

Staff Shifts:

  • 2 opening shifts
  • 1 swing shift
  • 1 closing shift
Increased Staffing:

  • Peak Days (just before 15th of month): 2-3 more staff at the store to respond to on-site news media and to manage line/ direct customers; 2 more staff to manage line/direct consumers
  • Last Two Weeks of OEP2: Customer service center rep. at store full-time
Operational Costs:
 $16,000 rental$42,314 operational (furniture, wifi, signage, security, etc.)
Additional Expenses: 
Night security (amount not provided)
Machinery/ Technology:
 Repurposed staff laptops & work cell phones; no new equipment purchased
Retail Space:
 2,000 sq. ft. 4 month lease (Nov. 1-Feb. 28)
Process for Establishing:

  1. Site search: Worked with real estate agent to identify available spaces meeting selection criteria
  2. Site selection: negotiated contract, rental price with broker
  3. Interior space “clean up” of carpets and walls
  4. Site set-up: wi-fi, wiring, furniture rental; print/install signage- coordinated by existing marketing staff member
  5. Site break-down coordinated by staff member
Enrolled:
238 enrolled1,055 assisted (not including individuals who called or were assisted but didn’t want to be tracked)
ROI:
(2)$206.06 per enrollee$55 per customer assisted 2

Other Benefits:

  • Direct access to unique population
  • Increased community presence and visibility
  • Prime location for earned media and location for open-enrollment kick-off
Planning:
 Work-plan fully developed 3 months prior to launch
Physical Plant:
 Scouted physical locations 2 months prior to launch; finalized location 1 month before launch
Staffing:
1 month to plan; planning began 3 months prior to launch Identified sign-up tool to fill unique shifts by brokers, navigators, and staff
CT State Agency:
Connecticut Health Insurance Exchange
Exchange Name:Structure:
Quasi-public entity established bystate law
Number/ Location:
 2 stores: New Haven & Hartford (Year 1)
Operating Hours:
10am-8pm most days
Location Selection:

  • Identified areas with high uninsured rates
  • Temporary site
  • Nimble and cost-effective
Staff Positions:

  • Onsite store managers
  • Retail manager (oversaw operations from main office)
  • Outreach staff- navigators, assisters, brokers signed up for shifts
FTEs/ Contractors/ Other: **

Staff Shifts:

  • 5 people per store
Increased Staffing:

  • End of OEP, added staff to handle volume
Outfitting Stores:
 $136,000 for both stores
Operating Budget (Per Year):
 $140,000 (not including staff time)
Machinery/ Technology:
 20 laptops per store (only about 15 in use at a time)
Retail Space:
 2,200 sq. ft each; 1-year lease
Acquisition:
Real estate agent helped survey properties/select space

Process for Establishing:

  1. Real estate search
  2. Real estate selection
  3. Installation: contracted with firm that does trade show development -all components of store and signage fabricated before, put up quickly with no permanent work
  4. Technology/Machinery purchase
Enrolled:
7,639 enrolled15,191 assisted
ROI:
(3)$36 per enrollment$18 per individual assisted

Other Benefits:

  • 50% closure rate is roughly twice the insurance industry average of 20-25%
  • Individuals who came to the stores were more motivated and prepared to enroll
Planning: **Physical Plant:**Staffing: **
KY State Agency:Exchange Name: Structure: Number/ Location:
1 store in Fayette Mall, Lexington, KY (Year 2)
Operating Hours:
10am-9am (mall hours)
Location Selection:

  • Analyzed open enrollment from year 1
  • Identified areas for improvement
  • Considered population density/size of the city
  • Proximity to the main exchange office (30 mins. from main office)
Positions:

  • 2 Greeters
  • 1 store manager
  • 1 Medicaid case worker (not exchange employee)
  • 1 consumer rep. (to direct applicants to right assisters) (4)
  • 2 in-person assisters (min) 3-4 insurance agents (not exchange employees)
FTEs/ Contractors/ Other:

  • 2 FTE greeters (temps)
  • Co-located exchange staff
  • 3-4 Brokers onsite
  • 1 Medicaid caseworker
Staff Shifts:

  • Most staff: 2 rotating shifts (9 am – 3:30 pm; 3 pm – 9:30 pm; staffing hours had to align with mall hours)
  • Case workers and managers: 9:30 am – 5 pm
  • Medicaid case worker: 9 am – 6 pm
  • Insurance agents: 9:30 am -3 pm
Increased Staffing:

  • Mornings: increased insurance agents to handle higher volume
Outfitting Stores:
$60,000 (including reusable materials)
Operating Budget (Per Year):
Under $100,000
Machinery/ Technology:

    • 4 laptops
    • enrollment kiosk
    • mobile printer
    • paper shredder
    • 5 phones (4 for the state lines)

Note:connectors and agents used their own equipment.

Retail Space:

1540 sq. ft.; 4 mo. lease (Nov. – Feb.)

Acquisition:

Worked with a marketing firm and advertisements; approached the mall about a temporary lease.

Process for Establishing:

  1. Found location
  2. Rented space
  3. Marketing firm merchandised (painted/ designed space)
  4. IT stocked with cable lines, computers and est. direct access to the state system
  5. Exchange stocked all materials (brochures, etc.)
Enrolled:
 Over 5,900 enrolled7,600 visited the store
ROI:
$27 per enrollment$21 per assisted

Other Benefits:

  • Direct access to unique population
  • Physical presence in community/ visibility
  • Also used space for promotional events
Planning:
 2 months to plan; planning began 3 months prior to launch
Physical Plant:
 1 month to install fixtures and prepare physical plant (after the design/layout was finalized); began 1 month prior to launch
Staffing:
2 months of planning prior to launch; ongoing changes during first weeks of operation; by 6 weeks following launch the staffing plan was finalized

Notes:

(1) Connect for Health Colorado also worked with five other retail centers staffed by other organizations. This chart only tracks the center fully run and operated by state agency staff.
(2) ROI determined by dividing overall cost by number of people helped ($58,000/1,055=$55); however, this ROI does not reflect actual cost per person assisted given larger volume of individuals that were helped not tracked in the system.
(3) Estimated based on $276 total annual costs divided by number of individuals enrolled or assisted. Note that this does not take into account the staff time invested in developing and supporting the center.
(4) Added consumer representative role 1 month after launch, upon realizing consumers needed help at the beginning of the process to route them to the right assisters for help.