July 28, 2014; Kaiser Family Foundation

We only came across this very interesting transcript recently, but it is important enough to mention in the NPQ Newswire. Despite all the befuddlement and chaos that accompanied the launch of the Affordable Care Act last fall, particularly with the federal HealthCare.gov website, there were some states that did reasonably well with ACA insurance enrollment. Earlier in July, the Kaiser Family Foundation issued a report on what worked in the enrollment efforts of Colorado, Connecticut, Washington, and Kentucky and then convened a discussion with representatives of the four states.

One of the Kaiser authors, Samantha Artiga, highlighted some of the findings of the report. Noting that the successes in these states could be attributed to a combination of strategies, she highlighted particularly significant practices and strategies:

“One real key element of success for these states was that they branded the coverage expansions for both Marketplace and Medicaid coverage as state initiatives. As a result, many consumers in these states really identified the coverage as a state approach rather than something specific with the Affordable Care Act.”

In addition to branding, Artiga said that direct community level outreach was critically important. The states “used every avenue that was available to connect with consumers where they live, work, play, and pray,” she said. (One state did outreach by traveling the state in a branded RV; others established walk-in enrollment places in heavily trafficked areas, set up operations at state fairs, and created their own enrollment events.) She also acknowledged the importance of consumer “assisters” to help people navigate the options on the state exchanges—and resources for the assisters to make their help more effective. We presume that those “assisters” include the networks of navigators that NPQ has frequently lauded for their outreach efforts in many states.

Artiga concluded her review of the Kaiser study findings by mentioning the importance of systems and operations. In each of the four states in the study, the enrollment systems worked “relatively well,” but they did so because the states “employed a number of strategies to overcome system problems…For example, they each had data and feedback loops in place to help them quickly identify system problems and then deploy workarounds or make incremental fixes to address those problems as they were identified.” She also mentioned the importance of close coordination among key agencies, particularly between the exchange staff members, Medicaid program staff, and the states’ insurance departments. In addition, Artiga notes that the states all solicited community stakeholders early and often and responded to the feedback they got.

In addition to these overall strategies, the states are still working on improvements, tactics, and special efforts to make the next enrollment period work even better. Access Connecticut’s Kevin Counihan mentioned the development of a new mobile app plus, on the website, a pop-up avatar that restates consumers’ questions and provides common answers. Health Colorado’s Taylor Roddy added that, like Connecticut’s development of health avatars, the Colorado exchange is adding more help text to the website. Lisa Lee from Kentucky Department of Medicaid Services and Rudy Vasquez of the Sea Mar Community Health Centers of Washington both highlighted their states’ plans to use data from the exchange systems and other stakeholders—for example, checking with hospital emergency rooms to identify individuals who might be frequent users of ERs for non-emergency medical treatments that might make them good candidates for new ACA health insurance.

The Kaiser report and the dialogue with representatives of the four states reveal much that other states and the federal government could have and should have done to make the rollout of the Affordable Care Act even more successful. What is striking about their conclusions about branding, marketing, outreach, and systems is that nearly everything in the Kaiser report is what smart nonprofits know about how to deploy their resources to reach people in need. If the states are really smart about improving their exchanges, they should be reaching out to the nonprofit stakeholders in health insurance reform—navigators, community health centers, health insurance cooperatives, and health advocacy organizations—for feedback, considering their observations seriously, and putting their recommendations into action.—Rick Cohen