Update: Open Enrollment 2016
When we last provided an update to the Board, Open Enrollment had recently
begun and early indicators suggested a stable experience for our members
Our next major milestone was automatically enrolling 2015 members into 2016
plans and, after extensive testing, auto-enrollment was completed at the beginning
of December to default into a 2016 plan those individuals who had yet to shop on
their own
Separately, we are seeing more than 16,000 new individuals enrolling for QHP
coverage effective January 1, 2016, with many more actively shopping and
preparing to pay by the December 23 deadline
Today we will provide you with some additional updates beyond the above related
to the customer experience for this year’s Open Enrollment period
2
More than one month into Open Enrollment, we continue to experience stable
operations and enrollment activity for both new and renewing members.
August September October November December January
9/16-10/5
First round of prod-like testing
12/7-12/11 Invoices
mailed for 1/1 renewals
(~135k)
12/23 Jan.
enrollment
deadline
Open Enrollment Timeline
11/20 – 11/25
Auto enrollment for
passive renewals
Renewals technical
release (6.5)
8/19-9/4
Preliminary notices
generated & mailed
(~120k)
10/7- 10/16 2016
Final Eligibility
1/31 March
enrollment deadline
(in OE)
1/23 Feb. enrollment
deadline
11/21-11/24
Carrier 834 files sent for
renewal population
8/24-9/16
“What to Expect”
for members
(~135k)
11/2
Mailing to Bronze members (~7k)
11/9-11/30
Eligible & unenrolled Open Enrollment reminder (~149k)
11/2-11/6
Message to shop (unsub) (~28k)
11/9-11/20
“Where to get help” (subsidized) (~120k) 1/1-1/15
OE is ending reminder (plan
in cart) (volume TBD)
10/5-11/2
DOR mailing to self-
reported uninsured
(~115k)
11/1-12/21
Paid Messaging Phase 1
1/1-1/22
Paid Messaging Phase 2
11/1-1/31
Call Center hours extended for Open Enrollment
11/2 Walk-in Centers launch (six sites)
11/1 Provider search go-live
1/1
Coverage effective for 2016
10/14-10/28
Renewal notices
generated & mailed
(~135k)
10/19-11/7
Second round of prod-like testing
10/19 Technical release (7.0) shopping improvements
10/26 7.0 post production release
Open Enrollment 2016
Renewals
Member Web Improvements
Operational Readiness
Outreach & Communications 3
12/2-12/16
Shopping information
(unsub) (~28k)
Auto Renewals
Prior to launching the auto-enrollment process, approximately 8,300 renewing individuals
actively selected a new plan for 2016 and thus were not part of the auto-enrollment batches
Excluding those that had already shopped or were otherwise not eligible for auto-enrollment,
approximately 129,000 applications were passively renewed in this process (representing
approximately 160,000 members eligible for auto-renewal)
Those members that actively select a different plan after auto-enrollment was processed will
be enrolled in their newly selected plan instead of the one that they were passively renewed
into so long as they make their first premium payment
We sent invoices to renewing members between December 4th through 8th; as such, we
expect to see additional shopping activity for our renewing population over the next few
weeks leading up to the deadline
5
While members will still be able to switch plans at any time during Open
Enrollment, members who did not actively switch their plan in November
were “auto-enrolled” into their pre-determined 2016 plan.
These figures are very early indicators of Open
Enrollment activity this year; we expect them to
increase as we near closer to the December 23
deadline
“New” members are those that were not enrolled
in MassHealth for 2015, and either obtained a
program determination in 2015 but never
enrolled or have never been with us before (in
this new system)
Application and Enrollment
Reporting: Renewing and New
6
Half-way through Open Enrollment, more than 180,000 individuals are
enrolled in a QHP for January 1, 2016.
As we are currently in a period with a lot of member movement, these figures are early-
estimate approximations and will likely change as January 1 approaches
For example, individuals in ConnectorCare in 2015 who were re-determined into a different
program for 2016 could provide updated information in the month of December that
redetermines them back into ConnectorCare
Data through December 8, 2016.
Application and Enrollment
Reporting: Renewals
7
Renewing members are generally staying in similar coverage for 2016. It is
still early yet, though; our experience suggests that most member movement
will occur on or about the December 23 deadline.
*Data as of December 7, 2015.
Total 2016 Enrollment, by Metallic Tier*
Catastrophic Bronze Silver Gold Platinum Connector
Care
Shopping/ Not
Yet Re-
enrolled
20
15
En
rollm
en
t
Catastrophic 76% 12% 0% 0% 0% 2% 9%
Bronze 0% 84% 2% 1% 0% 3% 10%
Silver 0% 0% 86% 1% 0% 1% 11%
Gold 0% 0% 5% 84% 0% 1% 10%
Platinum 0% 0% 1% 7% 82% 1% 9%
To encourage shopping for members that might be experiencing significant rate or benefit
changes, we have launched an email campaign designed to encourage close attention to key
considerations for shopping
Phase I Phase II Phase III Phase IV**
“What are limited /
smaller networks?”
“Cost sharing: What
does it all mean?”
“What is a Metallic
Tier?”
“There’s still time to
switch! Are your
benefits right for you?”
**To be sent in January to 2015 Bronze plan members that didn’t switch.
Service Center Performance
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Nov-15 Dec-15 Jan-16
Ca
lls
Calls Offered
Jan 2015 – Nov 2015 = Actual Dec 2015 – Jan 2016 = Forecasted
OP
EN
EN
RO
LLM
EN
T *
* Updated forecast
1,153
1,669
1,281
149 81 28 12 32 27 20 8
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15
Se
co
nd
s
Average Speed to Answer (ASA), in Seconds
32.2%
40.3%
35.6%
5.6% 3.2%
0.9% 0.4% 1.0% 0.3% 0.7% 0.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15
Abandonment Rate
9
Service Center Performance:
Open Enrollment Month One
TOP CALL DRIVERS
Application /
Eligibility
36%
Enrollment
27%
Billing/
Payments
16%
Account
Change
9%
Other 1%
0
1,000
2,000
3,000
4,000
5,000
6,000
11/1 11/8 11/15 11/22 11/29
Calls Handled
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
11/1 11/8 11/15 11/22 11/29
% Calls Answered
0%
1%
2%
3%
4%
5%
11/1 11/8 11/15 11/22 11/29
% Abandoned
0
5
10
15
20
25
11/1 11/8 11/15 11/22 11/29
Speed of Answer (Seconds)
General
Questions
11%
10
Consumer, Partner, and Media Feedback
“The online portion of applying for insurance is very confusing,
But the staff today were excellent, knowledgeable, and friendly.”
-- November 4, 2015 walk-in
“Everything is going very well here. Your staff are doing
excellent.” -- November 24, 2015 Brockton Neighborhood
Health Center staff
“MassHealth, Health Connector walk-in center in
Springfield offers enrollment help”
-- December 3, 2015 Springfield Republican
Walk-In Center Performance
1,319
736
302 317 224
760
0
200
400
600
800
1,000
1,200
1,400
Boston Brockton Fall River Lowell Springfield Worcester
Walk-Ins by Location
Billing &
Payments
5%
Account
Changes
6%
Application &
Eligibility
26%
Document
Processing &
Verification
7% Enrollment
13%
General
Questions
43%
Reasons for Walk-In
0% 0% 2% 7%
91%
0%
20%
40%
60%
80%
100%
Overall Satisfaction – November 2015
Very Dissatisfied Dissatisfied
Neither Satisfied nor dissatisfied Satisfied
* On a scale of 1 to 5, with 1 being very dissatisfied and 5 being very satisfied, how satisfied are you with the overall service provided to you by the Health Connector today?
* Until Nov 28 * Until Nov 28
11
1 3 8
20
58
39
13
32 24
0
20
40
60
80
100
July August September October November December
Urgent Services and Ombudsman Inventory
Urgent Services Ombudsman
• Cases resolved, year-to-date = 3,817
• As of December 1, 2015, the online
ombudsman form has been re-designed to
direct members with general issues to the
appropriate self-service or customer service
channels
Urgent Services and Ombudsman
* Until Nov 30
Current Total Inventory : 198
Analysis of Ombudsman Service
355 423
538
381 310
350
266 249 229 171 191
152 167
Jan Feb March April May June July August Sept October MTD Nov
US Ombuds
Summary of Ombudsman Cases :
1. 46% routine requests; members did not
attempt to call customer service first
2. 5% general feedback/suggestions from
members
3. 49% members who need assistance from
ombudsman team 12
Call Center Satisfaction Survey:
November Results
20% 17% 16% 23%
32% 40% 39%
51% 42% 39%
64% 22% 21%
18%
22%
22%
21% 23%
18% 31%
31%
13%
13%
7% 11%
15%
14%
15% 7%
11% 8% 12% 7%
11%
10% 15%
13%
11%
7% 10%
11% 7% 9% 6% 34%
44% 40%
27% 22% 18% 20%
8% 12% 10% 10%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov
Overall Satisfaction by Month
76% 85%
74%
8%
6%
11%
4%
4% 6% 3%
2% 3%
9% 4% 6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CSR Satisfaction CSR Friendliness CSR Knowledge
CSAT Score – November 2015
1 2 3
~7% increase in Overall Satisfaction compared to prior month
84% of respondents were satisfied or completely satisfied with Customer Service
Representatives (CSRs)
91% of respondents found CSRs friendly
85% of respondents found CSRs to be knowledgeable
13
2016 Open Enrollment: Year-over-
Year Comparison (first 30 days)
94
75
0
20
40
60
80
100
2014 2015
Calls Offered (Thousands)
20% Fewer Calls Received
Year-over-Year
14
843 819
0
200
400
600
800
1,000
2014 2015
Average Handle Time (AHT) (Seconds)
AHT 24 Seconds Reduced
Year-over-Year
7%
0%
0
2
4
6
8
2014 2015
Abandoned Calls (%)
Abandonment Rate Reduced YoY
2014: 7.8% II 2015: 0.2%
149
14
0
50
100
150
200
2014 2015
ASA (Seconds)
ASA 135 Seconds Reduced
Year-over-Year
Our year-over-
year comparison
to date illustrates
a much-improved
member
experience this
Open Enrollment.
Customer Feedback:
We are listening…
Yes I found the representative that I talked to very courteous very knowledgeable and very helpful so far this is been a very
pleasant experience. So thank you.
The customer services representative was very helpful and there was no long wait time to get a live person on the phone and
they seem to be very knowledgeable on the questions that I ask. Have a good day.
I'm very happy with the service today. I was picked up right away and the young lady that's helping very nice. Unfortunately I
don't remember her name but the service was good and I didn't [speak] with you since last year when the service was a little
aggravating but this time it's been a pleasure. Thank you. Bye.
The rep was patient and knowledge and was helpful and answered all the questions and made it an easy process so we are
more than satisfied. Thank you.
This is the fourth call I've made to mass health connection and I've been on the website and I was very confused and things are
getting crazy because I need to put in a premium payment by the 23rd. Anyway it's it was my fourth call. The three other calls I
spoke to people who could not find me in the system the claim that my husband was the head of the household and I couldn't
talk to me. But anyway today I got Steve and Steve it was wonderful. Steve found me in the system. He talked me through some
plans. We agreed on a plan he signed me up. Steve needs a raise. Thank you.
Today I wasn't somewhat satisfied with the customer service. I've been calling for a month and 1/2 now to straighten out my
health insurance and I just keep getting the run around. I've not received a health insurance card. My voided check is not been
applied to my account and overall I would say now so has way too much paper work and it's very complicated to deal with.
15