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Health Connector Prepares for 2016 Open Enrollment

Health Connector Prepares for 2016 Open Enrollment

August 13, 2015

Connector 2015 open enrollment timeline

Today, the Health Connector met to:

  • approve readiness and outreach plans for this fall's Open Enrollment; and
  • approve the decommissioning of Dell 2.0 Financial Management System.

Materials from the meeting are posted on the Connector's board meetings page. Our full report takes just a click.

Executive Director’s Report

Health Connector Executive Director Louis Gutierrez began his report by acknowledging the progress being made in anticipation of the Fall 2016 Open Enrollment Period.  He stressed the importance of the upcoming updates and changes moving toward the Connector’s overall readiness for this year’s enrollment. Gutierrez reported that total medical enrollment totals just over 167,000 members, and over 42,800 members are enrolled in dental coverage. ConnectorCare enrollment has grown to over 120,000 members in August. 

Open Enrollment 2016 Readiness and Outreach Activities

Customer Experience Update

The discussion on Open Enrollment Activities began with the presentation of a timeline of milestones the Connector intends to reach before Open Enrollment ends at the end of January.  Open Enrollment allows individuals and families to enroll in non-group coverage or switch existing coverage for any reason, without needing a qualifying event. Some of the key dates were that all redetermination letters will be mailed on September 1st and all renewal letters will be mailed by November 1st

The Call Center continues to mostly perform well, the Connector reported, and now focuses on maintaining gains while improving the quality of interactions. The volume of calls is now at a low of about 70,000 in July, which they predict will pick up as Open Enrollment draws nearer. The Connector plans to focus on improving information provided on billing/payment related calls by providing call center staff with a refresher training. Issue resolution satisfaction is steady but the number of times consumers must call to have an issue resolved has increased; the Connector is working to investigate the problem and aims to decrease repeat calls.  Most important, the long-anticipated Assister Line is scheduled to go live on August 24th. The Assister Line aims to provide service to Navigators and Certified Application Counselors (CACs) who call requesting assistance with their clients. Ten agents will be trained to operate the special line during service hours, with five back up agents for high volume times. 

System Update Report

The System Update report included information about the implementation of new functionality in the hCentive system in preparation for the Open Enrollment period. Release 6.5, due out on August 14th, focuses on the renewals process, as individuals will be able to edit their own 2015 and 2016 applications, removing the burden of having to call customer service in order to make updates or changes. Release 7.0, 7.1 and 7.2 are the last improvements before the enrollment period begins, each scheduled for gradual release from September to early February. 

Redetermination and Renewals

A goal for Open Enrollment is to ensure that consumers who are happy with their plan and have no updates continue to get the same coverage.  However, the Connector’s overall message to the market is to encourage people to update their applications with the most current information and to browse their plan options. This is the first year that the Connector will   be conducting renewals in the hCentive system, and they are pursuing a Massachusetts-specific approach to redeterminations and renewals that has been approved by the federal Centers for Medicare and Medicaid Services (CMS). 

The Connector will only be notifying and renewing individuals who are actively enrolled in a 2015 Qualified Health Plan (QHP) or Qualified Dental Plan (QDP).  The Connector will use income provided in each member’s 2015 application, updated with the latest Federal Poverty Level (FPL) tables, rather than use more outdated Tax Year 2014 data. Members can remain in their same plan for 2016, if that plan is available, but if not, then members will be mapped into a similar plan.  Unless a member checks out with a new plan, they will be auto-renewed into their mapped plan in late November.  Members can always shop for a new plan until the end of Open Enrollment (until 12/23 for coverage starting 1/1, 1/23 for 2/1, and 1/31 for 3/1).

Operational Readiness

As a result of lessons learned in Open Enrollment 2015, where the Health Connector experienced unprecedented call volume, the goal for 2016 is to increase access to timely, quality customer service for individuals and families across the Commonwealth.  The Connector has undertaken several different methods of enhancing the customer experience, including but not limited to:

  • Quality and training program re-assessment;
  • Refining staffing levels and assessing staffing needs at different call volumes; and
  • Increasing efficiency through real-time handle time monitoring and a refined call-back process.

The Health Connector has been working with its business operations vendor, Dell, to develop a comprehensive operations forecast to better estimate their future needs, without exceeding the budget of $1.4 million.  The Connector plans to extend operation hours at the call center during Open Enrollment beyond what was offered last year, and supplement current locations in Boston and Worcester with additional in-person customer service center areas. The Monday-Friday hours during Open Enrollment will be 8AM to 9PM and Saturday and Sunday hours are 9AM to 5PM.  There are also contingency plans in place to involve extra staffing in the event that there are shortages during peak times, but the overall funding for this initiative will not exceed $900,000. 

The Connector also plans to implement a “Distributed Service Model” whereby individuals looking to apply for coverage or are currently enrolled will have the opportunity to seek in-person support closer to their home.  The budget for this project will be no more than $2.26 million. Customer Service Interaction Centers (CICs) will operate in areas with the largest concentration of members and uninsured individuals, including:

  • A year-round location in Springfield, MA   
  • Three temporary “pop-up” sites in Northeastern and Southeastern MA

More about the CICs can be found at: http://wwlp.com/2015/08/12/mass-health-connector-looks-to-add-walk-in-centers/.

Outreach Strategy 

The outreach strategy for the Open Enrollment period is three-fold:

  • Target the Remaining Uninsured
  • Support Redetermination and Renewals
  • Increase Awareness and Understanding through community engagement and context development

Although Massachusetts has reached a low of 3% uninsured, the Connector aims to lower this rate further by employing a mixture of targeted and broad-based strategies like direct-to-consumer contact, community awareness, and media/public education campaigns. There was some discussion among the Board members about the cost-effectiveness of each of the outreach efforts and whether they can, in fact, engage the remaining 3% uninsured using current strategies. Nevertheless, the Connector has conducted research into reaching the remaining uninsured and is partnering with other agencies, such as the Department of Revenue (DOR) and the Department of Unemployment Assistance, as well as using social media, direct mail, and the new CICs to meet their goal. Specifically with the DOR, the Connector is sending letters to tax filers who, based on previous tax filings, do not carry health insurance that meets Minimum Creditable Coverage standards, which is estimated to be approximately 180,000 individuals as of the most recent year. In future years, the Connector hopes to work with the DOR to amend state tax forms to allow individuals to self-select to receive mailing with assistance for obtaining insurance if they report that they are uninsured. 

Notably, the Connector announced the recipients of this year’s Navigator grant awards to outreach and enrollment assisters that will support renewals and redeterminations for existing members as well as the remaining uninsured. The Navigator program is an ACA required, state-funded method of providing customers with culturally and linguistically appropriate assistance in areas such as direct outreach, application and enrollment guidance, and post-enrollment needs. There are 14 organizations for the 2016-2017 year; of which 12 are returning Navigators and 2 are new organizations. We are happy to announce that Health Care For All and Tapestry Health are both the new additions to the Navigator program.   

Decommissioning Dell 2.0 Financial Management System

Lastly, the Board voted to authorize a work order for the maintenance and disposition of the Dell 2.0 Financial Management System (FMS) for a cost of no more than $1.2 million.  Dell implemented the FMS 2.0 infrastructure during the original Health Insurance Exchange/Integrated Eligibility System project, which continues to support premium invoicing, collections and enrollment processes.  The work order provides for ongoing maintenance of and eventual retirement of FMS 2.0 in favor of new FMS 3.0 infrastructure to support implementation of the Health Insurance Exchange powered by hCentive.   

The next Connector Board meeting is scheduled for Thursday, September 10th at 9:00am, 1 Ashburton Place, 21st floor, Boston.

     - Michelle Savuto