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Outreach and Enrollment: The Path to New Opportunities in Coverage. 2013 Annual Conference & Clinical Summit, “Aiming for Excellence” - “ Inreach , Outreach & Enrollment” Presenters: Sophie Stern and Dayanne Leal. SECTION 1. Who we are What we do What is the enrollment opportunity. - PowerPoint PPT Presentation
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Outreach and Enrollment: The Path to New Opportunities in Coverage
2013 Annual Conference & Clinical Summit, “Aiming for Excellence” - “Inreach, Outreach & Enrollment”
Presenters: Sophie Stern and Dayanne Leal
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SECTION 1
• Who we are• What we do• What is the enrollment opportunity
Enroll America
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Our MissionMaximize the number of uninsured Americans who enroll in health coverage made available by the Affordable Care Act
Two-fold Strategy
Promoting Enrollment Best Practices
National Enrollment Campaign Using Cutting Edge Engagement Strategies
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2
Sampling of Our Partners
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How the Campaign Fits In
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1. Educate and Engage 2. Mobilize to Enroll 3. Work with Partners to Ensure System works
Enroll America will execute a national education and enrollment campaign
Successful implementation of ACA requires all-out effort by government, not-for-profits, insurers, hospitals, community health centers, health providers, and others
Campaign Strategies and Tactics
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Strategic Partners
Community Engagement
Data & Results Driven
Earned Media
Digital & Social Media
Paid Media
Surrogates
The 2014 Enrollment Opportunity
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Series10
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10
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Source: May 2013 CBO estimates
Mill
ions
Enroll at least 16 million people in new coverage options
} 7 million in Exchange (“Marketplace”) coverage
9 million in Medicaid or CHIP}Source: May 2013 CBO estimates
Pennsylvania's Enrollment Opportunity
• <138% FPL in Medicaid or CHIP
• 138%-400% FPL in Exchange (“Marketplace”) coverage
Source: Centers for Medicare and Medicaid Services (CMS) analysis of the 2011 American Community Survey (ACS)
Non-elderly unins...0.0
500,000.0
1,000,000.0 400% FPL and up
Between 138-400% FPL
<138% FPL
1.24 million PA residents
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SECTION 2
• Public Awareness of New Coverage• Research and Messaging• Eligibility, Benefits and Timeline
Public Awareness of the New Coverage?
What percentage of uninsured people do you think know about
the new coverage options coming this fall?
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Increasing Awareness…
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…but many of the uninsured still don’t know
Source: Enroll America *Source: Kaiser Family Foundation
November 2012 June 2013* August 2013*0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
22%45% 57%
Perc
ent o
f uni
nsur
eD A
war
e
Past Experiences Seeking Coverage
have shopped for insurance outside their job
44%have been uninsured for 2 years or more
67%
Source: Enroll America, November 2012
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Key Findings Across Segments
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Almost all (91%) believe health insurance is necessary or very important.
Cost and affordability are the biggest barriers.
Financial & health security are the biggest motivators.
Deep skepticism & confusion among consumers.
Sample Premiums Seem Unaffordable…
14Source: Enroll America, November 2012
16%
12%
…but focusing on yearly savings can help.
51%Percentage who found the same premium affordable when expressed in terms of annual savings compared to current premiums.
Reaction to a sample premium for a family of four, 250% FPL
All insurance plans will have to cover doctor visits,
hospitalizations, mental health and substance use
disorder services and prescriptions.
You might be able to get financial help to pay for a
health insurance plan.
If you have a pre-existing condition, insurance plans cannot deny you coverage.
All insurance plans will have to show the costs and what is covered in simple
language with no fine print.
4 Key Facts Reach Most Uninsured
One of these = top message
for 89% of population
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New Coverage Options in 2014
M’place w/out
Tax Credits
States that Don’t Expand Medicaid
Medicaid0-138% of poverty
Marketplace with Tax Credits139-400% of poverty
Marketplace with Tax Credits100-400% of poverty
Marketplace without Tax
Credits>400% of poverty
Medicaid*
Marketplace without Tax
Credits>400% of poverty
138% of poverty
400% of poverty
100% of poverty
400% of poverty
Medicaid cutoff
*Medicaid eligibility levels vary by state and population. Marketplace coverage without tax credits is available for individuals ineligible for Medicaid with income <100% of poverty.
States that Expand Medicaid
Requirements for ALL States
A Single, Streamlined Application
• One application for all health coverage programs• Available in online, phone, and paper
Use Modified Adjusted Gross Income/No Income Disregards
Eliminate Asset Tests
Eliminate In-Person Interview Requirements
Use Electronic Verification to the Greatest Extent Possible
Regardless of exchange type
or Medicaid expansion!
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Marketplace Eligibility
1. Eligible for the Marketplace?
2. Eligible for Tax Credits?
3. Eligible for Cost Sharing Subsidies?
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Eligibility for the Marketplace
US Citizen or legal immigrant
• Undocumented immigrants are not eligible to buy a plan through the marketplace
Not incarcerated
• Incarcerated individuals are not eligible to buy a plan through the marketplace
Eligibility for Tax Credits
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Eligible for the Marketplace
• Consumers with affordable, adequate offers of job-based coverage cannot get tax credits
No affordable, adequate offer of job-based coverage
• Medicaid expansion state: tax credits between 138-400% FPL• Non-Medicaid expansion state: tax credits between 100-400% FPL• 400% of poverty = $44,680 for a single adult, $92,200 for a family of four
Not eligible for Medicaid, CHIP, Medicare, etc.
Income <400% of poverty
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Eligible for Cost Sharing Subsidies?
Eligible for Marketplace
• About $28,000/year for a single adult• About $58,000/year for a family of four
Income <250% of poverty
Must purchase “silver” level plan from marketplace
Essential Health Benefits
1. Ambulatory patient services2. Emergency services3. Hospitalization4. Maternity and newborn care5. Mental health and substance use disorder services, including
behavioral health treatment6. Prescription drugs7. Rehabilitative and habilitative services and devices8. Laboratory services9. Preventive and wellness services and chronic disease
management10. Pediatric services, including oral and vision care
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What is the timeline for getting health coverage?
• Open enrollment starts October 1, 2013, coverage starts January 1, 2014
• Regardless of your income… there will be a plan for you!
• Financial assistance available depending on income
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Marketplace Open Oct 1 to Mar 31
Sign up and select coverage
Coverage starts Jan 1*
*Must enroll by December 15th for coverage to start January 1st.
SECTION 3
• Enrollment process • Public Perception• Who will provide help
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Enrollment isn’t a snap
Program Percent of Eligible People Enrolled
Children’s Medicaid/CHIP, national average, 2009 84.8%
Medicare low-income subsidy, 2009* 40%
Unemployment benefits 72-83%
Earned income tax credit 80-86%
SNAP (food stamps) 54-71%
* Does not include populations automatically enrolled in the low-income subsidy.
Take-up in optional public benefit programs
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Single, Streamlined Application
Consumers can connect to whichever program they are eligible for, no matter where they start.
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Complete single application Determine eligibility
Enrolled in correct program!
Medicaid
CHIPIn-Person Assistance
Exchange
Single Application
Public Perceptions
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Three out of four of the newly eligible want in-person assistance to learn about and enroll in coverage.
Confused
Overwhelmed
Worried
Helpless
Secure
Confident
Reassured
Help gets them from here… …to here.
Source: Enroll America, November 2012
Value of In Person Assistance
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• What is and isn’t covered• Out of pocket costsKnowledge
• In-person beats online/self-service experienceSecurity
• Have provided all necessary paperwork• Have completed application correctlyConfidence• Know when their insurance will start• Know what to do if they need health services
before they get their cardReassurance
Source: Enroll America, Forthcoming
Who Will Provide Help?
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Certified Application Counselors
Navigators
*In-Person Assistance Programs not available in federally facilitated exchange states.
Consumer Assistance Programs
Medicaid eligibility workers
Insurance Agents, Brokers
Community Based
Groups
Community Health Centers
Where do you fit in this mix?
Help, I Need Somebody!
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What Kind?
From Whom?
How?
Where?
35%
36%
37%
45%
Health insurance…
Doctor or nurse
Family member
State employee…
Source: Enroll America, November 2012
Navigator Duties: Make Things EASIER
E Expertise (Medicaid, CHIP, QHPs)
A Accessibility (cultural, linguistic, people w/disabilities)
S Selecting a plan (facilitating)
I Impartiality
E Education
R Referrals
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Certified Application Counselors
• Integral part of ensuring adequate assistance, especially in states with fewer federal resourceso Important role for CBOs, providers, hospital staff, health centers, etc.
• Training provided by the exchange • Funding
o No federal funding for CACs, but Medicaid administrative match available for Medicaid CACs (23 states fund now, but Nevada does not)
o Flexibility for private funding
• Must disclose conflicts, but fewer prohibitions than navigators, IPAso Agree to “act in best interest of the applicant”
• Must make info accessible to people with disabilities• No obligation to do outreach
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New CAC Option for Organizations
• Organizations may certify staff/volunteers to become CACs
• Eligible organizations must:o (1) have processes in place to screen
staff/vols to ensure that they protect personally identifiable information
o (2) engage in services that position them to help those they serve with health coverage issues, and
o (3) have experience providing social services to the community.
• Orgs must enter into agreement with exchange and are responsible for their CACs following federal rules
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Differences Between Assister Types
Navigators/In-Person Assisters CACs
Conduct outreach X
Culturally/linguistically accessible services XServices for people with disabilities X XSubject to state training/certification rules (where they exist) X X
Funded through government dollars XMust be free from conflicts of interest XPermitted to have conflicts of interest, as long as disclose these to the exchange and to the consumer, and agree to act in best interest of applicant
X
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SECTION 4
• Who is the uninsured• What role do you play• Inreach, Outreach and Enrollment Best
Practices
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Five Clusters of Targets
Uninsured, Unnecessary & Uninterested
Reluctant but Reachable
Desperate and Believing
Connected, Low-income Women
Insured but At-Risk
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Uninsured, Unnecessary & Uninterested
• 71% uninsured, most >2 years• Only 22% consider health insurance necessary• Skeptical that they could find affordable coverage
in 2014• Good news: this group is moveable
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Best messengers• Family• Friends• Doctor
Top motivators • Financial security• Finding a plan to fit budget• Individual mandate$$$
Reluctant but Reachable
• 64% uninsured, most have tried to find coverage
• Young, low-income, least educated, many have young children in Medicaid/CHIP
• Majority (71%) consider health coverage necessary
• “Soft” believers, can be moved when told more about new options
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Best messengers• Doctor• Someone like
them who has tried it
• Someone from health agency
Top motivators • Reliable coverage• Financial security• Finding a plan to fit budget
Desperate & Believing
• Poorest, sickest, least educated• 1/3 receive SNAP benefits• Strongest interest, least skepticism in new
coverage options• Not aware of new options, but instantly
interested when told
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Best messengers• Medicaid office• Federal/state
government official
• Doctor
Top motivators• Financial security• Finding a plan that fits their
budget• Mandate
Connected, Low-Income Women
• Well-connected to Medicaid (themselves or their children)
• Nearly half (48%) receive SNAP benefits
• Many in fair/poor health, have chronic health conditions
• Interested in new coverage options, but skeptical about costs
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Best messengers• Someone like
them who has tried it
• Medicaid office• Federal/state
government agency
Top motivators • Plan will be there for them when they
need it• Financial security• Find a plan that fits their budget
Insured, but At Risk
• Young, low-income (<250% FPL)• 63% covered now, but risk losing coverage: aging off parent’s
plan, losing Medicaid, low-wage worker getting coverage through job
• Weak interest in new options, very skeptical
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Best messengers• Family member
(mom, spouse)• Doctor• Someone like them
who has tried it
Top motivators • Financial security• Plan will be there
for them when they need it
• Find a plan that fits their budget
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Relationships with the uninsured
Insured patients = better long term health outcomes
Medicaid Primary Care Rates IncreasePart
of C
ore
Mis
sion
People trust
providers
Enroll the Whole Family
Why Health Centers, Rural Health Clinics and other like-mission providers?
Outreach and Enrollment Opportunities
• What role will your organization play?
• What is your organization currently doing?
• What tools exist?• What tools does your
organization need?
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An Action Plan for Health Centers
1. Develop a plan
2. Invest in staff
3. Make your data work for you
4. Utilize technology
5. Hold on to what you’ve got
6. Recognize everyone’s role in outreach
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Outreach Planning…
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Outreach Best Practices
I. Identify your strengths
II. Identify and understand your target
III. Build an outreach plan
IV. Identify essential skills
for staff
V. Utilize consumer
tested messages
VI. Follow up, monitor, evaluate
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I. Identify Your Strengths
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Who does your organization currently reach?
• Recognize your stakeholders such as staff, patients, community members and partners
What programs and resources currently exist?
• Build strong relationships and trust with community leaders. They can refer patients to you
I. Identify Your Strengths (cont.)
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How can services be coordinated and integrated?
• Map patient entry points• Institutionalize process at each point to educate and potentially assist
eligible patients• Focus on consistency across the organization
What is the outreach program’s goal?
• Reach specific ethnicity?• Geographic region? • Age?• Demographic?
II. Who is Your Target Audience?
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53%47%
Race/Ethnicity Percent of Uninsured
Uninsured Rate
White (non-Hispanic) 45% 13%
Black (non-Hispanic) 15% 21%
Hispanic 32% 32%
Asian/Pacific Islander 5% 18%
American Indian/Alaska Native 1% 27%
Two or More Races 2% 15%
62%Live in Families
with at least One Full Time Worker Under
100%100-138%
139-250%
251-399%
400%+
38%
13%
25%
13%10%
Federal Poverty Level
Source: Kaiser Commission on Medicaid and the Uninsured, October 2012
Tips for Targeting
External
Utilize peer to peer outreach
Promote word of mouth
Develop referral networks with partners
Use data to identify uninsured
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III. How to Create an Outreach Plan
Choose your target
Set a goal (metrics)
Identify who your support will be (who’s
your champion?)
Create your message to target
your audience
Create timeline of events + activities
+ outcomes
Evaluate your work
Follow up, follow up, follow up
IV. Essential Skills for Staff
Flexibility Sense of humor
Understanding of target
population
Readiness to try new tactics
Outgoing personality
Willing to work nights and weekends
Understands importance of
follow-up
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V. Consumer-tested materials
• Know your audience• Use plain language• Find the right translator• Monitor the translation• Get an independent review• Use a clear and consistent
design• Always conduct consumer
testing
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VI. Follow up, monitor, evaluate
Plan
Do
Check
Act
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Incorporating Best Practices in Your Work
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Before the appointment
During the appointment
Post appointment
Incorporating Best Practices in Your Work
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Before the appointment
During the appointment
Post appointment
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Before the appointment
• Develop a referral network with organizations who provide application assistance • Help consumer make an appointment • Give them a reminder (text or call) the day before• Make sure they have transportation to the appointment
During the appointment
Post appointment
Incorporating Best Practices in Your Work
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Before the appointment
During the appointment
• Build trust• Answer questions• Go slowly• Provide the consumer with a next steps document for after the appointment
Post appointment
Incorporating Best Practices in Your Work
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Before the appointment
During the appointment
Post appointment
• Follow up to make sure they’ve paid their premium • Help them set up a primary care physician• Follow up occasionally to:
• Confirm/update contact information• Seeing if they’ve seen their primary care provider• Reminding them about the upcoming open enrollment period
Incorporating Best Practices in Your Work
In-reach and Outreach ideas and tools
In-Reach
Text (and/or voice) messaging
Newsletter
Website
Social media
Direct mail
Appointment cards
On-site promotion
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Ways Providers Can Help
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Train staff on four key messages
• Clinicians and outreach, administrative staff
Consider getting staff trained as Certified Application Counselors
• Partner with a local organization and develop referral relationships• Offer space in your office for assisters to meet with patients
Identify Navigators and other assisters who can help
• Include information about healthcare.gov and the hotline on your voicemail, on-hold message, and website• Hang posters in waiting room
Spread the word!
Thank You!
Visit Us For More Information On:• Best practices in outreach & enrollment• Messaging research• Mapping tools• Outreach toolkits• News and events• …and more!
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Questions?
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Dayanne Leal National Outreach Specialist
Sophie SternSenior Policy Analyst