Health systems have gained a lot of experience during the first three health insurance exchange open-enrollment periods. Lessons learned so far:

  1. Start early. By autumn 2015, Harpreet Cheema, vice president of product development at Trinity Health, was already planning for the 2017 enrollment period. “Planning early is very important,” he says. “Our payer partners file their products starting April or May each year. So, for anybody that we are working with or actively pursuing a partnership with, we must plan ahead.”
  2. Use data to develop a strategy. Christus Health uses research findings about uninsured individuals published by Enroll America and Robert Wood Johnson Foundation to inform its annual plans for outreach. For example, national research showed that, after the second open-enrollment period, 65 percent of the people still uninsured work in businesses with 50 or fewer employees. That prompted Christus to target small businesses that do not offer health benefits during the third open-enrollment period. Christus also makes use of its internal data. It knows where its uninsured patients live and how they use health care services. Abby Lowe McNeil, system director of communication and public affairs, and her colleagues use that information to plan enrollment events and direct mail campaigns. “We know who those uninsured patients are and we are in contact with them regularly,” she says. “Health plans do not have that kind of data, so it’s really helpful for us on the provider side to be able to reach out to those people and try to assist them in getting coverage.”
  3. Work to understand the consumers you want to reach. Providing facts about penalties, tax credits and benefit designs is not the same as understanding what makes an individual tick. Trinity Health used focus groups to understand the priorities and motivations of various types of consumers. They found, for example, that some consumers only want catastrophic coverage while others are most concerned about primary and preventive care. “First of all, segment them in different buckets because different groups are distinct from each other, and determine what communication tactics will help convert them from being uninsured to insured,” Cheema says.
  4. Experiment with enrollment activities.During the most recent enrollment period, Carolinas Health System made space available for brokers at its main campus in Charlotte. “Everyone in Charlotte knows where that is, so people could come in and sit down with a broker,” says Greg Gombar, the system’s chief financial officer. “That was not us doing the enrolling — we handed them off to the broker so they enrolled in whatever plan the broker and the patient thought was appropriate.”
  5. Hire specialists to answer consumers’ HIX questions. During the first two open-enrollment periods, CHS trained its call center employees to field calls from consumers looking for information about their insurance options and how to enroll. “We have learned that those conversations get pretty complex pretty quickly,” says Marcey Stone, the system’s director of market communication. “In some cases, our team was not able to provide the level of information the caller needed.” In the most recent open-enrollment period, CHS hired licensed insurance brokers to staff a call center and respond to HIX calls. “They have a level of expertise and they can answer some of those complex questions,” Stone says. “We’ve really found that that’s made a tremendous difference for our patients and consumers.”
  6. Educate newly insured patients.“A lot of these people are still not familiar with what the term ‘deductible’ means or what ‘co-pay’ means,” Cheema says. “How do you calculate co-insurance? What is out-of-pocket maximum?” Trinity Health offered educational seminars to HIX enrollees after the first open-enrollment period. More recently, it added “Insurance Coverage 101” information to hospital websites to help patients understand their benefits. After the first open-enrollment period, Christus found that many patients did not connect promptly with a primary care physician. The health system worked with insurers to create an onboarding process, using direct mail, email and, if needed, outbound calls to educate newly insured patients about how to use their benefits wisely. “We talk about how to budget for health care expenses, how to choose a primary care doctor, what’s covered in an annual wellness visit, what screenings are covered in your visits,” Stone says.