From The Field N O V E M B E R 1 7 , 2 0 1 4 What We Learned from the First Open Enrollment Period, and What to Expect from the Second DAVID ADLER LORI K. GRUBSTEIN Program Officer, Robert Wood Johnson Foundation Program Officer, Robert Wood Johnson Foundation I t seems like just yesterday we were celebrating the victories many groups in the field by surprise. Going forward, it is from the first open enrollment period under the Affordable imperative that assisters and navigator organizations anticipate Care Act. More than 8 million consumers signed up for and prepare for a surge in demand around the end of the open coverage through state and federal marketplaces, and millions enrollment period. Groups should also do what they can to more enrolled in Medicaid. As the spring of success gave way head off or minimize procrastination. For example, they might to the summer of planning, we are once again in the autumn get the word out to the eligible but unenrolled that if they wait of enrollment. As work gets rolling for the second open enroll- too long, they might face longer wait times. ment period, it is an opportune time to reflect on lessons learned from the first open enrollment period, especially since IT IS THE MESSENGER AS MUCH AS THE the second one is shorter and there are fewer navigator MESSAGE resources available from the federal government. One of our key assumptions in making grants to support out- reach, enrollment, and consumer assistance was that the best IT IS NOT JUST ONE (TOUCH) AND DONE way to reach people is to partner with groups that are trusted We learned that many consumers needed multiple contacts and credible sources of information within their communities and in-person help to get through the enrollment process. and that develop tailored, relevant, and engaging messages, According to Enroll America’s State of Enrollment report, materials, and approaches for the groups they are serving. “With each contact from an Enroll America volunteer or Ensuring that consumers are hearing from trusted messengers staffer, consumers became more likely to successfully enroll.” means working together. Across the country, we saw how They found this effect was particularly strong among African- successful enrollment efforts focused on collaboration among American and Latino consumers. Results from a survey navigators; assister organizations; local grassroots organiza- conducted by PerryUndem found that while 52 percent of tions; and national groups like Enroll America, Community consumers enrolled online on their own, 20 percent got help Catalyst, National Association for the Advancement of on the phone and 18 percent got help in person. It is also Colored People, National Council of La Raza, Families USA, important to note that Latinos were much more likely to rely the Asian Pacific Islander American Health Forum, and Young on in-person help. Among Latinos who enrolled, 34 percent Invincibles, to name just a few. Furthermore, faith-based orga- got in-person help (PerryUndem 2014a). Every foundation nizations, libraries, community colleges, sports teams, and will approach this work differently, but given the importance retail stores were key partners. In New Jersey, the New Jersey of multiple contacts with consumers, foundations may want to Health Initiatives program of the Robert Wood Johnson think about how to incorporate information about enrollment Foundation supported veterans who were trained as assisters. into multiple areas of work, so that they are consistently rein- We can go on in listing myriad types of groups, both expected forcing the message. and unexpected, that had a hand in contributing to the great success of the first open enrollment period; ultimately, the “NEVER PUT OFF UNTIL TOMORROW WHAT lesson is to have a diverse set of groups on board so that MAY BE DONE DAY AFTER TOMORROW JUST consumers can hear from trusted messengers. AS WELL.” – MARK TWAIN COORDINATE, DO NOT DUPLICATE All of us procrastinate. It is a natural tendency. Last year, we saw huge upticks in enrollment numbers during the final few Another important lesson is the critical role of a statewide weeks of enrollment. While this is not shocking, it did take coalition where enrollment activities are within the state, as well as with national groups. Through our Consumer Voices assisters this year will need to have an eye on enrollment, as for Coverage initiative, the Robert Wood Johnson well as on re-enrollment. New research from PerryUndem Foundation was able to support these coalitions in a dozen shows that many of the remaining uninsured may have looked states, and many other funders also contributed to these for insurance during the last open enrollment period but found statewide coordination efforts in these and other states. it was unaffordable (PerryUndem 2014c). Convincing the Having this coordination function in place ensured that remaining uninsured of the benefits of insurance compared to enrollment materials, best practices, and data were being the penalty and risk of being uninsured may prove difficult. shared, and also worked to make sure that gaps were filled. It also provided an important feedback loop between on-the- FINAL THOUGHT ground groups and policymakers. Coordinating bodies were The Affordable Care Act presents a tremendous opportunity able to collect information on how enrollment was going in for the nation to move toward a society where everyone has their respective states and detect patterns of problems and access to affordable, stable insurance. At the Robert Wood then provide this information to policymakers to help resolve Johnson Foundation, this is a longstanding goal and a key fea- issues that were identified. They were also in a position to see ture of what it means to build a culture of health in the United where things seemed to be going smoothly and share that States. Last year we saw tremendous success in increasing the information. Finally, they were able to play the connector role number of people in this country with health care coverage. with national enrollment efforts, such as Enroll America. Armed with the lessons from last year, we know that the broad Community Catalyst’s report Connecting Consumers to enrollment community, including grantmakers, is up for what Coverage: Mobilizing for Enrollment (2014) provides examples may be a challenging second enrollment period. We look for- of how these coordinating tables operated in various states. ward to continuing to share lessons and information as we go States need to figure out what model will work best for them, through this next period of work. but the key is to have a coordinating table. “WHAT GETS MEASURED GETS MANAGED.” – PETER DRUCKER An important element of success was using data to target enrollment efforts and track results. In this case, many groups SOURCES found that the most effective messages focused on individual financial concerns. For example, Enroll America found that Community Catalyst. Connecting Consumers to Coverage: consumers were more likely to click on getcoveredamerica.org Mobilizing for Enrollment the promise of the Affordable Care Act. when they were presented digital tools like calculators that June 2014. http://www.communitycatalyst.org/resources/ helped them get individualized information about coverage publications/document/Connecting-Consumers-to- versus personal stories, and they found consumers who used Coverage.pdf. these tools were more likely to be motivated to enroll than Enroll America. State of Enrollment: Lessons Learned from consumers who saw other messages. This was important Connecting America to Coverage, 2013-2014. June 2014a. information for tailoring their work and helped them devote https://s3.amazonaws.com/assets.getcoveredamerica.org/201406 resources to the most effective tools and messages. Similarly, 13_SOEReportPDFlr.pdf. early research that PerryUndem conducted for the Robert Wood Johnson Foundation showed that the most effective PerryUndem. Checking in on Enrollment: Communicating to message was that financial help was available—a message that Uninsured Consumers Midway through Open Enrollment. January became very important for groups working on enrollment 14, 2014b. http://www.rwjf.org/en/research-publications/ (PerryUndem 2014b). The availability of financial help was find-rwjf-research/2014/01/checking-in-on-enrollment.html. the central theme of the Robert Wood Johnson Foundation’s digital advertising, which steered targeted consumers to their PerryUndem. Open Enrollment, Round 2: Insights from marketplaces at an unusually high rate for a digital campaign. Uninsured Individuals about Enrolling in Health Coverage Without the research and monitoring to find this out, many through the Health Insurance Marketplace. October 2014c. groups may have wasted time and energy on messages and http://www.rwjf.org/en/research-publications/find-rwjf- materials that were not very effective. research/2014/10/open-enrollment—round-2.html. PerryUndem. Why Did some People Enroll and Not Others? May EXPECT TOUGH CUSTOMERS IN 2015 21, 2014a. http://www.enrollamerica.org/resources/public- As this next open enrollment period begins, conventional education/why-did-some-people-enroll-and-not-others/. wisdom is that 2015 may be more challenging than 2014 in some key ways. Those who were highly motivated to get health insurance (i.e., the low-hanging fruit) probably got it Views from the Field is offered by GIH as a forum out of the gate in the first open enrollment period. Further, for health grantmakers to share insights and experiences. If you are interested in participating, please contact Osula Rushing at 202.452.8331 or orushing@gih.org.