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Commentary: Looking Ahead to Obamacare's Day 2


By Bruce Caswell and Thomas Romeo MAXIMUS, Inc. September 26, 2013

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With only a few days remaining until Oct. 1 -- the first major deadline of President Obama’s Affordable Care Act  -- federal and state agencies are busy orchestrating a complex series of tasks needed to launch online insurance exchanges and marketplaces. The to-do list is as dynamic as the community of contractors, insurance companies, grassroots organizations, social workers and other groups nationwide supporting the launch. Yet, in the rush to meet this important milestone, it can be easy to forget that Oct. 1 is merely the starting point in what will be a long journey to successful and sustainable health care in the United States.

As government and industry work together to enroll and extend health insurance coverage to millions of Americans, it will be extremely important to ensure the sustainability of exchanges well beyond Day 1, enabling access to affordable, appropriate and effective health care for every citizen who needs it.

Targeted, ongoing, straightforward communication

Empowering people with the knowledge to make an informed health insurance decision is one thing; motivating them to do so is an entirely different proposition. This is especially true for key groups such as the “young invincibles,” whose participation is critical to the calculus of keeping insurance rates affordable for everyone. Effective communication lies at the core of both educating and motivating the public.

More information does not necessarily translate to better communication. Americans have been bombarded for the past two years with thousands of news stories on health care reform efforts, and some may have hit a state of consumer fatigue that could be harmful to future enrollment numbers. In addition, a general sense of confusion around the ACA and online insurance exchanges continues to be a pervasive issue. In March, a Kaiser Health Tracking Poll found that the public’s knowledge of the ACA’s provisions had not increased since 2010, when media attention was at its peak, following the law’s passage.

To combat this fatigue, the government and its industry partners will need to execute a clear and succinct communication strategy, identify the appropriate frequency of outreach to avoid oversaturating the audience, and carefully select the right platform for reaching audiences with information that is relevant to them.

In addition, the importance of health literacy -- the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions -- cannot be overstated. It is estimated that more than a third of adults in the United States have below-basic health literacy. Communicating complex insurance terminology in plain language will be critical for helping consumers make informed decisions about their health plans and ensuring they can effectively navigate the system on and after Oct. 1. It will also be extremely important for people to understand their options should a request for services be denied, including how to issue an appeal through an independent review process and get the answers they urgently need.

Intuitive, user-friendly technology

The self-service and integrated eligibility and enrollment components of the new online exchanges create another tool for interacting with government and applying for public benefits. Ensuring these systems are functional, user-friendly and easy to navigate will be essential to their sustainability. In order to meet the Oct. 1 deadline, many states have delayed features such as mobile apps, doctor comparisons and customer support via Web chat, but as they move toward other maturity milestones, these tools will be become increasingly important to attaining the familiar “Travelocity experience” that consumers expect and that were envisioned for online exchanges.

The systems will also need feedback mechanisms to monitor performance, understand consumer application behavior and respond to issues as they arise. This will enable government officials to track customer satisfaction and collect key metrics to monitor quality. Enrollment and usage data will be essential to the ongoing success of the online exchanges as well. Analyzing the demographics of enrollees by age, ethnicity, geography and other qualifiers will help identify which messages and outreach strategies are effective and present opportunities for strategic course correction in communities where they are not having the desired impact.

Well-trained, informed citizen services

Continuously collecting citizen feedback will be fundamental to the sustained success of insurance exchanges -- not just where technology is concerned, but with services as well. Consumers must be able to communicate with the people who can help them through the process, such as the customer contact center staff, navigators, in-person assisters, certified application counselors and others serving citizen needs on the frontline. Establishing a network that people can turn to for help will be an important responsibility that goes on long past October, and the teams staffing the call centers will need to stay in constant touch with in-the-field assisters in order to ensure a seamless handoff of consumers at various stages of enrolling into insurance plans.

Anticipating the federal-to-state transition

Most states have initially selected a Federally Facilitated Marketplace model, yet in the coming years they will need to take the reins of their exchanges. Fully funded federal establishment grants are being awarded  until Jan. 1, 2015, but the outlook beyond that date is unclear, so states have an incentive to accelerate their plans to migrate to a State-Based Exchange sooner than later. States that will move to the SBE model for 2015 have a narrow timeline to prepare for the migration; officials overseeing the transition should already be addressing how to make this eventual transition as smooth as possible. They need to take stock of the people, processes and technology required to make this transition, and establish a detailed plan to take their own health insurance exchanges in-state.

The Affordable Care Act is one of the most sweeping changes to our nation’s public benefits system since the creation of Medicare. While the focus on establishing robust insurance exchanges is critical, it is important to remember that a positive citizen experience is the key to their success. Incredible progress has been made to prepare for open enrollment on Oct. 1, yet there is still much to do: Oct. 2 presents new challenges and opportunities around citizen education, technology, staffing, strategic planning and more, and key planning decisions in the near future will have a major impact on our government’s ability to deliver a successful program. Paying attention to these key issues now and throughout the implementation, federal, state and local agencies will have the opportunity to engage, support and serve citizens well into the future.

Bruce Caswell is president and general manager of health services for MAXIMUS, Inc. Thomas Romeo is president of MAXIMUS Federal Services.

Bruce Caswell

Bruce Caswell is president and general manager of health services for MAXIMUS, Inc..

Thomas Romeo

Thomas Romeo is president of MAXIMUS Federal Services.


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