Takeaways from AHIP Exchange Conference: More to Exchanges Than Technology

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February 03, 2014

Technology is only part of the equation to a positive insurance exchange consumer experience.

I was recently invited to present at the AHIP Exchange Conference, which brought together federal and state health leaders, health insurance carriers, and other key stakeholders to discuss the progress of open enrollment in the health insurance exchanges— a topic that has remained in sharp focus since October 2013.

The big takeaway from the conference was that, despite getting off to a bumpy start, health reform is moving forward. The key in advancing the rollout of the Affordable Care Act (ACA) is to build off of the successes and obstacles experienced.

So, what were the lessons learned?

Perhaps the biggest lesson discussed at the conference was the importance of the consumer experience. That also happened to be the topic of my presentation at AHIP: why a deep understanding of health insurance consumers is essential to the success of exchanges.

Operating exchange contact centers for a number of states has given MAXIMUS a unique seat at the table. If you’re in one of the states we’re supporting, when you have a question about your health coverage, what you qualify for, or need help navigating the exchange website, your call will be answered by one of our employees.

But, before we arrived at this point, we embarked on several years of upfront planning and research and surveyed our existing enrollment projects – as well as studied broader consumer demographic projections - in order to understand the populations we would potentially be serving under the ACA. That included everything from anticipating the amount of time an average consumer would need to spend with a customer service rep on the phone, to population demographics (e.g., culture, language, education, and income) and how they might impact the consumer experience when reaching an exchange contact center.

Even still, great customer service is not always an exact science. For what you cannot predict, you need to be flexible and agile enough to rapidly respond to evolving customer needs. This is especially true under health reform, which represents one of the most complex and comprehensive changes to our health care system since the introduction of Medicare.

Across the states we’re serving, we’ve often had to respond to significant ebbs and flows in consumer demand; in some cases, by scaling our operations by hundreds of call center representatives. Health insurance coverage is inherently complex for consumers, and it’s certainly something that cannot be addressed by technology alone.  Our view from experience to date is that even with the continued improvement in exchange web portals and back-end systems, many consumers will continue to rely on trained and knowledgeable customer service representatives to confidently complete the eligibility and enrollment process.

Consider three “customers” seeking insurance through an online insurance exchange:

When you hear about people using online insurance exchanges, it’s often assumed that this population is comprised of millions of individuals seeking coverage. In reality, families make up a large portion of the uninsured. This adds a great degree of complexity to the equation. We’re frequently helping parents who are not only enrolling into coverage for themselves, but also for their children—with different family members qualifying for different plans. Even in the best performing insurance exchanges, we’ve found that these parents prefer—and often rely upon—phone support to sort through the decision-making process.

Language and health literacy have also presented customer service challenges. In states like New York, for example, it was estimated that roughly one-third of exchange consumers would speak a primarily language other than English. Research has also estimated that roughly half of all uninsured Americans have below average health literacy—the ability to understand and make informed decisions based on basic health information.

Both of these factors have influenced how people interact with insurance exchanges, and have certainly had an impact on both the volume and types of calls that we receive. Today, many of our call centers have representatives able to serve consumers in more than a dozen languages. In addition, our Center for Health Literacy has played a significant role in everything from the training of our call center representatives to the design and extensive field testing of informational materials for insurance consumers – all to ensure that people are empowered to make informed decisions about their health.

While the technology behind exchanges continues to be closely watched, there are many other factors that influence consumer experience, including the diversity of people shopping for insurance for the first time. The importance of understanding how all the pieces fit together cannot be underestimated.