Talking Coverage: SBMs Keep Lines of Communication Open with Consumers

Heading into the third week of open enrollment, early outlook has been positive for State-based marketplace (SBM) states. California recently wrapped up a 2,000-mile bus tour to “spotlight” the launch of open enrollment; Massachusetts and Vermont, which in prior years struggled with technical systems, report smooth enrollment via their enhanced systems; Minnesota is touting a new report that showcases the potential for savings for its marketplace consumers; and Maryland has more than doubled its enrollment traffic from this point last year. Where issues are arising, states are flexing their nimbleness to address concerns, such as Rhode Island’s recent steps to ramp up customer service supports and New York’s extension of enrollment deadlines for consumers impacted by the closure of the state’s Co-op.

Many of the improvements states have implemented in recent months, including updated marketing, enhanced purchasing tools, and increased access to assistance, have been in response to time spent over the past year speaking to and learning from consumers. SBMs have been reaching out to the uninsured in their states through the use of surveys, phone calls, and focus groups to learn more about barriers to enrollment. Open dialog between customers and the marketplaces, targeted data collection, and the agility of states to adjust and adapt based on this feedback, represents a unique and important opportunity for those states that have chosen to run their own SBMs.

Assessing Customer Satisfaction
In fielding consumer surveys, many SBMs found customers have high levels of satisfaction with both the enrollment systems available in their states and the coverage purchased. Surveys conducted in California, Colorado, Connecticut, and New York found that between 85 and 92 percent of their consumers reported they would recommend use of the SBM to friends and family.  In Vermont, 82 percent of customers reported that their 2014 selected plan either met their needs “somewhat well” or  “very well”.

Altering Outreach to Reach the Uninsured
Even with high levels of engagement and satisfaction from existing customers, there are still a significant number of uninsured in many states and an increased need to provide support to identify and enroll these individuals. In mid-2015, Maryland’s SBM conducted a series of focus groups with the uninsured to identify perceived barriers to obtaining coverage. Participants in these groups reported that the complexity of health insurance choices can be “immobilizing” and increased support is necessary to help make decisions.  In response, Maryland is expanding its in-person assistance offerings – with larger numbers of “ConnectNow!” enrollment events and the addition of 23 partnership organizations with application counselors (adding to the 35 existing partnerships in the state). 

Messaging to Improve Consumer Awareness
Reports from California, Maryland, and Vermont have found that a significant number of consumers remain unaware of the availability of federal subsidies to improve affordability of coverage purchased through the marketplaces. This knowledge gap is coupled with the results of multiple surveys that found affordability to be the biggest driver of consumer enrollment and plan selection.

Based on these survey findings, messaging becomes an important strategy for the marketplaces to not only ensure that consumers are aware of the opportunity to purchase coverage but that they also know about the tax credits to support affordability. Wanting to improve their efficiency, states have been thoughtful in strategizing where to best allocate resources to maximize reach to desired consumers. A Connecticut survey found that an increased number of consumers engaged with the SBM after receiving brochures and pamphlets in the mail. In response, the state is planning on modifying marketing materials this open enrollment to ensure they are engaging and informative.

Supporting Consumer Education and Insurance Literacy
Surveys from several SBM states found that consumers are seeking more support in selecting the right plan for their families and, despite considerable gains over the past three years, require refreshers on important health insurance literacy topics.  For example, an independent survey conducted in Colorado recommended that the state develop materials to support increased consumer health insurance literacy, including a simple and accessible glossary of important health insurance terms. The state responded by creating a comprehensive list of terms and definitions, which includes a search function and is available directly on the Connect for Health Colorado website.

Boosting Call Center Performance
Call centers continue to be an important tool for consumer engagement and satisfaction, often representing the SBM’s most public face. In many states, call center utilization grew during last year’s open enrollment period. Despite these increased numbers, most consumers still reported receiving useful information and support from call center representatives. In Vermont, 66 percent of respondents indicated that they were satisfied with the amount of information received. In Connecticut, 65 percent of those who enrolled in a self-purchased, qualified health plan indicated that they were either “very satisfied” or “extremely satisfied” with the call center service.

Some customers, however, have reported long wait times and unanswered questions.  In response, states are implementing new strategies to relieve call center back log. In response to feedback from customers, Vermont has placed an increased focus on call center training in 2015. This has already significantly reduced the number of cases that need to be escalated, resulting in customers having answers during their first call to the contact center.

Looking Forward
Following this open enrollment period, several SBMs have plans to roll out additional consumer surveying, which will allow them to engage with their customers and implement changes to improve the enrollment experience. The District of Columbia is planning to issue a comprehensive survey, including questions that focus on moving consumers from coverage to care, to be completed by July 2016. In releasing its updated proposed strategic plan, Washington State identified consumer surveying as a key tool in 2016 for measuring transparency, engagement and affordability.

NASHP will be tracking the work being done by the SBMs and the federally-facilitated marketplace, as well as the experience of enrollees around the country, and will report on the best practices and lessons learned as we move through this latest enrollment period.