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As Enrollment Deadline Nears, Exchange Tweaks Strategy

As Enrollment Deadline Nears, Exchange Tweaks Strategy

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The final big push is on as less than six weeks of open enrollment remain for individuals seeking insurance through Covered California, the state’s health insurance marketplace.

The looming March 31 deadline gives ongoing urgency to the efforts of Covered California and its community partners to refine and improve their strategies for reaching groups, such as Latinos and African Americans, whose enrollment numbers have so far lagged.

“It requires us to do something that government isn’t always that good at, and that is to be active listeners, quick learners, and then very prompt actors and responders,” Kim Belshé, a Covered California board member, told an audience of health care leaders at a recent conference hosted in Sacramento by the Insure the Uninsured Project (ITUP).

Covered California has enrolled 828,638 people in one of the plans offered by the exchange’s 11 participating insurers. When Medicaid enrollees are added to the mix, the state has added more than 1.6 million people to the ranks of the insured.

Those numbers may sound impressive, but it’s been no secret that the state exchange has struggled to reach Latinos. According to exchange officials, about 46% of the Californians eligible for premium subsidies are Latino. Covered California reports that from October through January, Latinos accounted for about 21% of enrollees, with Spanish speakers accounting for about 7% of enrollees.

For the month of January, Latinos made up 28% of Covered California enrollees – an improvement over previous months, but still an underrepresented showing.

Peter Lee, Covered California’s executive director, acknowledged to the ITUP audience that “we have not been doing as well as we want in the Latino community, Spanish speakers in particular.”

He added: “When we look at marketing, we haven’t said, ‘OK, we got a good strategy, we’re done.’ We [asked]: ‘How do we alter our strategy partway through open enrollment to double down in some areas, to change our marketing and change some of our strategies to be more anchored in supporting in-person enrollment?’”

Covered California’s early website glitches have largely been fixed, and that includes improvements to the Spanish-language application.

“We have a Spanish-language full application that was not as good as the English on day one,” Lee said. “And that’s bad, shame on us. It’s a lot better now.”

Mid-February, Covered California added 250 workers to a call center in Fresno in an attempt to further bring down caller wait times. An early goal of fielding 80 percent of calls within 30 seconds proved unrealistic. “With added staff, we hope to bring it down by many, many minutes,” Lee said. “We will not bring it down to 30 seconds.”

Well-oiled websites and call centers are obviously important, but one of the emerging lessons confirmed by a number of outreach leaders at the ITUP conference is the importance of in-person enrollment.

“We are seeing that direct one-on-one contact really makes a difference,” Anne Filipic, president of Enroll America told conference goers. “And that the higher the number of times we’ve engaged with someone, the more likely they are to enroll in coverage.”

When it comes to recruitment, Filipic added that her organization has found online tools such as a calculator that estimates your potential premium to be more effective than ads that depict individual’s stories. “We are finding much greater success in terms of the tools,” she said.

Covered California is increasingly banking on in-person enrollers. “We now have over 25,000 people across the state in communities ready to help people enroll, Lee said. “One thousand of them speak Spanish. So our pivot in these last two months of open enrollment now is to get people to those people, to support in person enrollment, which we believe is going to be crucial going forward.”

As an example, David Panush, director of external affairs for Covered California, said that about 100 enrollment agents were slated to attend a naturalization event in Los Angeles last week where an estimated 10,000 people were to be sworn-in as citizens. Outreach workers would make the pitch to enroll in coverage to the newly minted Americans and their families.

Maria Lemus, executive director of Vision y Compromiso, an organization of community health workers, stressed the importance of cultural understanding when targeting minority groups.

“The nuances of outreaching to the Salvadoran community in Los Angeles could be very different than outreaching to an indigenous community in Fresno,” Lemus told conference attendees.

Her fellow panelist Brenda Darcel Lee, executive director of the California Black Health Network, agreed. “We’re not a monolithic group of people,” Lee said. “Approaching African Americans in different African American communities requires different kind of strategies.”

For example, Lee said her organization has “begun to work with more with the pastors in our communities because the church is still the hub of the African American community. So much information is disseminated from that pulpit every single week.”

Other successful enrollment strategies have included block parties in Oakland and mini-plays dramatizing the need for health insurance in Los Angeles, she explained.

The notion of “trusted communicators” is getting a lot of play recently: The idea is that familiar figures such as mom, a girlfriend or a pastor are more likely to succeed in getting people to sign-up then a website or call-center worker.

Kim Belshé, addressing the group of panelists, said, “I think it’s interesting that you all concluded the best way … of potentially better reaching young uninsured men is to first reach young uninsured women,” Belshé said. “Women are decision makers and enforcers, and they do a lot more research and homework.”

Whether it’s a girlfriend or an enrollment counselor, all agreed that it often takes repeated conversations to get someone to the point where they’re ready to enroll for Covered California – or Medicaid, which has no open enrollment season.

“For my money, I’m counting on our ground program,” Covered California’s Panush said. “The truth is we have a lot to do in this area, but everyone tells us – and we all believe that this is true – having that trusted communication is key to this.”

EDITOR'S NOTE: Ryan will blog this week from the 2014 California Endowment Health Journalism Fellowship, which will include a closeup field trip looking at the promise -- and challenge -- of Obamacare in California.  You can follow his posts here.

Image by edenpictures via Flickr

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