Posts Tagged ‘Consumers’

KATCH-ing the Uninsured: Lessons from Kansas’ Out-stationed Eligibility Workers

January 23, 2012

To increase their capacity to reach uninsured individuals, many states utilize out-stationed eligibility workers to help enroll individuals into Medicaid. “Out-stationed” at community-based organizations (e.g. health centers, clinics, hospitals, schools, community centers), these workers enable individuals to apply for public assistance benefits at locations other than the typical Medicaid or social services offices; optimally in locations that are more geographically accessible to potential consumers than state or county offices might be.

Through support from the SHAP grant, the Kansas Access to Comprehensive Health Project (KATCH) hired, trained, and placed 12 out-stationed eligibility workers in communities throughout the state (target populations include Hispanics, Native Americans, and pregnant women).  Often tasked with a breadth of responsibilities, workers primarily assist individuals and families determine eligibility and enroll in Medicaid coverage options.  These workers often split their time between 2-3 offices at various community hubs while also spending time throughout their designated community to spread information and awareness at local events, such as health fairs, and to build relationships with key leaders at local elementary and high schools. When necessary, some workers also conduct home visits for hard to reach, often elderly, individuals.

Kansas’ out-stationed eligibility workers have largely been successful in the enrollment of eligible populations, processing approximately 5,000 applications to enroll nearly 7,000 individuals since the program began.  One key success of the program has been the ability of workers to conduct outreach efforts while also establishing connections with community stakeholders. Clinics and health centers have been especially receptive to this program, as workers have served to not only connect patients with coverage, but also to develop relationships, build education, and improve health care access among patients.  For instance, in the case of one tribe served by an eligibility worker, it was discovered that most health care needs of the tribal members were absorbed by the tribal health center, prompting many members to only apply for coverage when they needed specialty care outside of the tribal center. After placement of the eligibility worker in that health center, staff noted the positive impact of having someone available to build trust and share information with tribal members so that, in turn, tribal members would be more likely to apply for available programs before they were in need of specialty services. (Click here,  here, or here for some additional resources detailing enrollment strategies across states.)

Kansas continues to evolve the work of its out-stationed program, leveraging lessons from a recent audience analysis to enhance outreach practices, as well as researching better ways to track enrollment and disenrollment information through the eligibility process. Kansas has also learned many valuable lessons from the project about the unique needs and challenges of various populations in navigating current state eligibility processes. For example, the hiring of bilingual out-stationed workers greatly benefited one region of the state with a large concentration of Mexican-Americans.  For communities with large Native American populations, cultural competency was a huge barrier to enrollment, and workers who had an understanding of the traditions and unique needs of local tribes were most successful. Such lessons will be used to enhance the capacity of the state’s new eligibility enforcement system—which will provide consumers with self-service options to inquire about potential eligibility for social service programs—to work for diverse populations within the state.

Thanks to Jenifer Telshaw and Russell Nittler from the Kansas Department of Health and Environment for their input on this blog. For more information about the work of Kansas or any other SHAP state to increase enrollment, please be sure to check out some of our previous blogs, or you can contact a member of our SHAP team directly.


All Consumers Want for X-changes is a User-Friendly Interface

December 19, 2011

The holiday season is upon us, though far from sugar plums, visions of insurance exchanges are dancing in the heads of state officials across the country (for a recap of current state progress on exchanges, be sure to check out this recent State Refor(u)m blog). Of the many exchange components states are currently working on, one that is particularly important for eventual exchange users is the development of the user-interface or in non tech terms the website or web portal. Specifically, through this interface, consumers should be able to apply for coverage programs, calculate expected tax credits and cost-sharing, and obtain standardized comparative information about available qualified health plans.

The look and “user-friendliness” of the web portal will be especially important in drawing consumers to an exchange and to make sure that they get the help they need to choose a plan, enroll, and stay covered. Among the many design considerations, states will need to be especially aware of keeping information at appropriate literacy levels for consumers as well as how best to display relevant data to consumers. To delve further into these design issues, 11 states (including SHAP grantees Colorado, Minnesota, New York, and Oregon) are participating in the Enroll User Experience 2014 (UX2014).

UX2014 is a project charged with “developing a first-class user experience design for health insurance exchanges.” Distinct from other exchange development efforts, UX2014 is philanthropically funded and centers on the philosophy of what makes a good user experience in any context. I recently had the opportunity to interview Jim Jones, Senior Consultant, Sellers Dorsey, about his work with UX2014. He shared some early lessons from the project:

  • Be wary of the written word. In writing text for the exchange, developers should use clear and direct language written at an appropriate literacy level so that it can be easily read and understood by consumers. Developers should also be aware of potential intonations and nuances that may impact consumer reaction to the exchange or skew responses needed for accurate eligibility determinations. For example, instead of asking, “List your earned income” it is more appropriate for an exchange to ask, “What do you get paid from your job?”
  • Design for a varied audience. Exchange consumers will vary in the level of assistance or independence and the amount of detail they will desire or need as they navigate the web portal. Designs should account for the variability of consumers and empower consumers to self-navigate through the enrollment process while also providing ample mechanisms for consumers to get assistance or explanations about available coverage options.
  • Build environments that foster consumer trust. Consumers will be expected to share personal data with the exchange, and so exchanges must be designed in a way to build trust with consumers. While serving different functions than the exchange, developers may want to look to popular websites for examples of successful personal data gathering, including banking websites, tax preparation websites (e.g. TurboTax®), travel sites (e.g.®) and dating websites (e.g.®).
  • Gauge consumer expectations on data sharing. Data sharing capabilities between federal and state hubs and the exchange will facilitate the process of data verification and eligibility determinations for consumers applying through the exchange. However, Mr. Jones noted that users have conflicting reactions to these data capabilities. Where some will be frustrated by sharing information they believe the government should already have access to, others will be deterred if an exchange seems to know too much. Developers should be sure to gauge the attitudes of intended audience so that they can build compromises to optimize data collection. In addition, the user interface will need to account for situations where the data sources aren’t available for that person at that time or contain dated information that no longer reflects the current status of the family (composition, income, etc.).
  • Consider the needs of navigators. While consumers looking to obtain information about health insurance and subsidy options will be the primary users of the exchange, it is also important that exchanges work for the various entities designated to assist these consumers through the navigator program. Designers should consider embedding tools into the exchange portal so that these assistors can be more successful including account management capabilities.
  • “You only have one right foot, and you need to get off on it.” Although, states face fast approaching deadlines to implement exchanges, it is important that states build-in adequate time to conduct testing and work out any programmatic kinks. It will also be important to manage public and political expectations at the launch of the exchange. According to Mr. Jones, “nothing is perfect at the beginning,” yet early design flaws may put the exchange at risk of building a negative reputation that will deter future users. “Consumers will only embrace the system [once] it is proven to work for them.”

Free resources from UX2014, including a variety of deliverables and design guidance, will be publicly available to states in 2012. For more information about the design principles of UX2014, as well updates about the project, be sure to check out their website: For more information about state specific activity related to creating a user-friendly exchange, be sure to check out resources posted on State Refor(u)m.

How to Succeed in Business (With Health Insurance Buying): Formulating a Health Insurance Outreach Strategy to Engage Small Businesses

July 20, 2011

Much attention has been paid lately to the role of small businesses in advancing health insurance coverage, right down to last Tuesday’s choice to release the new Health Insurance Exchange Regulation at a local DC hardware store.  Such small businesses employ over 42 million Americans, yet because of their small scale and the escalating costs of health insurance coverage, many struggle to purchase or maintain coverage for their employees.  As a result, nearly 23 million small business owners, employees, and dependents are uninsured.

New opportunities offered by the ACA, including the Small Business Health Care Tax Credit, better position these employers to offer coverage.  States must strategize about how they may wish to engage small businesses in the health insurance market to take advantage of these opportunities.  To glean some important outreach lessons for states, I recently spoke with Terry Gardiner, Vice President of Policy and Strategy, and Jessica Stone, Outreach Manager, of the Small Business Majority, who shared the following valuable lessons:

1)      Small businesses are not your typical consumer

Small business owners are busy individuals whose primary interest is to ensure that their businesses stay afloat.  Messages tailored to small businesses need to be clear, concise, and should focus on how health insurance might improve a business’s bottom line.  Outreach workers should prepare an elevator speech that can quickly engage employers by mentioning such positive benefits like the Health Care Tax Credit.  These workers should also be prepared to offer support options for employers who lack administrative personnel to assist in the procurement and administration of health insurance.

2)      There is not one “silver bullet” approach to reaching small businesses

The U.S.’s 5.8 million small businesses range greatly in everything from industry (agriculture, retail, construction, etc) to location (rural, urban, suburban).  Owners may spend most of their time at a desk, out in the field, or even working out of their car, while employees may be full-time, part-time, seasonal or salaried.  States should closely examine their small employer industries and develop multiple outreach strategies that account for this variability through creativity and targeted messaging.

3)      Network! Network! Network!

Only about half of small businesses belong to a formal business group such as a chamber of commerce.  So in addition to reaching out to those groups, states should look for local networks like community groups (e.g. Kiwanis Club) and trade associations (e.g. local alliance of realtors) through which outreach can be presented on a business owner’s “home turf.”  States may also research licensing databases for lists of licensed businesses by size and region.  Outreach efforts will work best when they strive to engage small business owners through a clear presentation of facts on access to health care and insurance opportunities relevant to the local community.

4)      Promote small businesses as “catalysts for change”

Increased participation and pooling of small employers in the health insurance market, especially with the development of the Small Business Health Options Program (SHOP Exchanges), will likely increase their influence over market behavior and practices.  States can work with small businesses to capitalize on this influence and promote innovative insurance design including health co-ops, integrated health plans, and plans with wellness programs.  This increased empowerment can also be leveraged as a selling point in messaging to small businesses, especially for those that have previously been reluctant to buy health insurance coverage.

Examples of approaches and materials developed with such valuable lessons in mind are available from several SHAP states including Maine, New York, Texas, and Washington, which have all strategized on ways to educate small employers about health insurance coverage opportunities. Many thanks to Mr. Gardiner and Ms. Stone for sharing their insights on this topic.  As always, if you would like any additional technical assistance on this or any other topic, please feel free to contact our SHAP team: Anne Gauthier, Kathy Witgert, Denise Osborn, Chris Cantrell, or Christina Miller.

The Role of Navigators and Brokers in State Run Health Benefit Exchanges

June 10, 2011

[Note: Information for this blog was developed from an April 20th NASHP webinar for state officials participating in its State Health Exchange Leadership Network, funded by the Nathan Cummings Foundation. The webinar, titled Navigating Brokers? Brokering Navigators?  What’s an Exchange to Do? included presentations from Jon Kingsdale, Wakely Consulting, Christine Barber, Community Catalyst, as well as from state officials considering the role of both navigators and brokers in achieving key policy goals of an Exchange.]

By 2019, it is estimated that nearly 29 million Americans will purchase their health insurance through the newly established Health Benefit Exchanges.  New insurance rules and opportunities, as well as the unique characteristics of the anticipated Exchange population, make for complex enrollment issues, and consumers will likely need assistance to steer them through Exchange plans.  To help address this need, Exchanges are required to establish a “Navigator Program” through which the Exchange will award grants to public or private entities to serve as navigators (ACA §1311(i)) that will:

  • Facilitate enrollment in Exchange plans;
  • Provide referrals to consumer assistance to enrollees who have grievances, complaints, or questions; and
  • Share culturally and linguistically appropriate information about qualified health plans, premium tax credits, and enrollment.

Navigators are also required to demonstrate that they have existing relationships or could readily establish relationships with employers, employees, the self-employed and consumers.  By design, they will need to showcase expertise in both understanding public and private insurance programs, as well as in understanding issues with income variation and premium subsidies.

As states design their navigator programs, many are considering the role that brokers will play in the context of Exchanges. Many states have a long history with brokers, who are certified or licensed private entities that connect consumers with insurers and appropriate insurance products.  Because of their typical client base (businesses), they often have a keen knowledge of laws regulating private insurance (ex. HIPAA, COBRA) and may serve as a human resource (HR) provider for those businesses that may not have appropriate HR personnel.

Licensed insurance agents and brokers are included in the ACA as an example of entities that may serve as navigators, with additional language stipulating that the HHS Secretary will establish procedures so that States can have brokers assist individuals and employers with enrollment in qualified health plans and applying for premium tax credits and cost-sharing reductions (ACA §1312(e)).  However, the ACA also stipulates that navigators cannot receive consideration from a health insurance issuer for enrolling individuals or employers in a plan—a common source of income for insurance brokers.

Many states have taken active steps in engaging both consumer and broker groups as they develop key policy goals for their Exchanges.  For example, Tennessee has established a Technical Advisory Group for Agents/Brokers to aid in resolving key issues in Exchange planning.  Meanwhile, they have also conducted open meetings with providers and advocates to discuss these issues.

Similarly, several SHAP states have worked to engage broker (ex. ME, TX, WA) and consumer groups (ex. CO, KS, NY) to increase enrollment in their SHAP coverage.  For instance, in Washington, brokers have been a critical component of enrollment in the Health Insurance Partnership, and state leaders continue to glean valuable lessons about the role of brokers in enrolling individuals in their state run product.  New York partners with community agencies and health plans to train facilitated enrollers who are authorized to assist applicants with every step of the complex application process, including initial outreach.

We invite you to share your work or questions about working with brokers or navigators with your peers via the comments section below or through  As always, if you would like any additional technical assistance on this or any other topic, please feel free to contact our SHAP team: Anne Gauthier, Kathy Witgert, Denise Osborn, Chris Cantrell, or Christina Miller.