Enrollment in the Federally Facilitated Marketplace reached eight million at the end of the first enrollment period on March 31, 2014.
As of early January 2015, since the latest open enrollment period began on November 15, 2014, In the Loop that nearly 6.6 million consumers selected a plan or were automatically re-enrolled in the marketplace, with numbers expected to rise as the period's deadline approaches.
Some of the enrollment success can likely be attributed to the work of federally qualified health centers (FQHCs). Through the Health Resources and Services Administration's (HRSA) Health Center Outreach and Enrollment Assistance, HRSA awarded approximately $150 million in early July 2013 to 1,159 health centers in support of outreach and enrollment activities nationwide.
While FQHCs can take pride in their successes to date, there is still a significant opportunity to facilitate enrollment of eligible health center patients and service area residents into the marketplace. To do so will require FQHCs to tackle some common challenges.
Many consumers experienced "glitches" on the Healthcare.gov website. Complicated eligibility rules added to the confusion, as did the circulating of significant misinformation about the marketplace and enrollment. Many FQHCs face challenges working with people in or near the "coverage gap" as well as educating individuals who never had health insurance before.
Here are six strategies FQHCs should consider following to help overcome these challenges and maximize future enrollment.
1. Obtain executive leadership support. Before beginning plans for an outreach and enrollment campaign, it is critical to obtain executive leadership support for such efforts. This will help ensure the campaign has access to the resources it will need to be successful, including those needed for staff training, development of educational materials and the gathering of data on prospective enrollees.
2. Establish internal committee. A robust campaign such have input from different individuals who will be involved in its implementation, both internally and externally. Members of the internal committee for an outreach and enrollment campaign can include directors of communication, marketing, strategic policy and member services (eligibility) and the practice administrator or operations director. It may be worthwhile to include other members depending upon what types of initiatives are in your campaign and the departments they impact.
3. Develop campaign proposal. For the campaign to be successful, you will want to develop a proposal that spells out your objectives and describes the manner in which you intend to achieve those objectives. Develop in-reach, outreach and enrollment assistance plans. Determine the messaging you will use to communicate objectives and the importance of marketplace enrollment with FQHC staff, community partners and patients/consumers. Gather internal data to identify current uninsured consumers and their location, and then assemble collateral and generate creative messaging to contact and connect with identified patients.
Once the proposal is complete, have the campaign committee and any executive sponsors review it. Solicit their feedback and request any suggestions for ideas to improve the proposal further. While you will want to follow the plan developed closely to stay on track, keep it as a living document. You may receive good suggestions worth incorporating as you roll out the different stages of the campaign.
4. Identify training and other requirements necessary to support outreach and enrollment activities. You will want to ensure all staff have taken the appropriate courses and understand all policies related to assisting consumers apply for coverage. It can be a worthwhile practice to put staff through mock scenarios to test their understanding of the policies and identify opportunities for improvement. These opportunities can include not only education on policies but also effective communication techniques.
Note: If you form a coalition, such as those that will be described below, it's a worthwhile practice to collaborate to standardize training material and then offer extra training sessions for all staff to ensure trainings are standardized as well.
5. Connect and coordinate with community and strategic partners for outreach and enrollment efforts. These can include national, regional, state and local partnerships.
National resources can include In the Loop, a project of Community Catalyst and the National Health Law Program, the Families USA Enrollment Assister Resource Center and weekly assister emails or webinars from CMS.
An example of a state-level resource is the Texas Association of Community Health Centers. This organization offered additional marketplace training and created an outreach distribution list for assisters to communicate with each other
On the local level, many FQHCs have formed coalitions with local healthcare districts, hospitals, other certified application counselor (CAC) and navigator groups, and organizations like Enroll America and their local primary care associations. For example, in Texas, the San Antonio, Houston, El Paso, Dallas and Austin areas all created and formalized coalitions to prevent duplication of services and outreach efforts. They created screening tools to prescreen individuals and an appointment system to maximize time for enrollment centers. As another example, an FQHC in Austin worked with a hospital system and placed CAC personnel in the inpatient setting. These individuals rounded on anyone identified by hospital as uninsured.
6. Take aggressive approach to outreach efforts. There are many different ways to reach prospective enrollees. Distributing materials and providing informational presentations in a variety of settings can prove effective, especially if you can partner with settings where these consumer are likely to go. This can include churches, public libraries, public schools, organizations hosting adult education programs, food pantries, and hospitals and other healthcare facilities. Consider offering "Health Insurance 101" classes at these locations for consumers to attend and learn about health insurance.
Work with the local media to promote these events. Use social media and, if your budget permits in, signs and banners in high traffic areas. Targeted mailings to specific businesses or groups can also prove effective. Consider asking staff for suggestions on ways to connect with prospective enrollees as they may be aware of good settings not on your list.
As you roll out outreach efforts, it is important to track the success rate of each initiative to determine the best use of your resources going forward. It is also worthwhile to keep data on the financial impact on the center of your efforts to grow enrollment.
It is important that the coalitions you form don't end with enrollment. Coordination and collaboration with community groups and hospitals on enrollment efforts should be seen as first step toward building collaborative population health management programming for the target population you have successfully enrolled. Keep the dialogue open and maintain the relationships that were formed through this effort as a way to move past enrollment into service delivery, even before the enrollee becomes a patient.
Maria Serafine is a consultant with and Joan Dentler is president and CEO of Avanza Healthcare Strategies, which provides hospitals and federally qualified health centers with strategic guidance, with a focus on outpatient services and population health management.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.