Habits of Highly Effective Assisters: Post-Enrollment Strategies

© 2016 Enroll America | StateOfEnrollment.org

Good morning!There should be two notecards on your chair.

Please include your name on the front. We’ll collect these as part of today’s discussion. Thank you!

Before we get started…

On one, please write one “tried and true” tip that has helped you be moreeffective at providing post-enrollment assistance.

On the other, please write one challenge you face that you hope to learn new ways to address today.


Kristen Isaac, Jeff Parmelee, Kevin Simpson, Elizabeth Colvin, Lida Galindo | 05.12.2016

Habits of Highly Effective Assisters:Post-Enrollment Strategies


Notice of Benefit and Payment Parameters for 2017:

“… post enrollment and other assistance includes assisting consumers with applying for exemptions from the individual shared responsibility payment that are granted through the Exchange, with understanding the process of filing Exchange appeals, and with understanding basic concepts and rights related to health coverage and how to use it.”

Definition of post-enrollment assistance


1. Leave the room with at least one new tip, idea, or strategy to try to better provide post-enrollment assistance.

2. Meet at least one new person who can help you as you do this.

TIP: Share not only what but how.Be descriptive!

Goals for today


I. Brief introductions and opening remarksfrom panelists (35 minutes)

II. Break into groups (30 minutes)• We’ll use your notecards to shape the breakout group

topics!

III. Reconvene and Share (20 minutes)

Session format




topics!


Session format


Rachel Linstead Goldsmith (moderator)Enroll America

Follow-up calls to enrolleesKristen Isaac, Westside Family Healthcare (DE)

Partnering with providers on post-enrollmentJeff Parmelee, Sacramento Covered (CA)

Documents to include for appealsKevin Simpson, Marketplace Appeals Group

Carrier/Marketplace communications with enrolleesElizabeth Colvin, Insure Central Texas/Foundation Communities

Post-enrollment focus groupsLida Galindo, Servicios de la Raza (CO)

Workshop speakers


FOLLOW-UP CALLS TO ENROLLEES

Kristen Isaac, MPH, Outreach CoordinatorWestside Family Healthcare

© 2016 Enroll America | StateOfEnrollment.org 9

Enrollee follow-up calls = Identifying issues requiring assistance

Meet with your staff: Walk through draft materials for input and training

Think about who you’ve helped: What kind of situations did you encounter during OE3? What kind of post-enrollment issues would you have?

Pilot the materials: Make an initial round of calls to a subset of enrollees and re-assess your process and materials

Be calculated: Think about strategic messaging to include (i.e. OE4 dates, tax fraud, etc.)

Create your materials: Enrollee call list, call script, data collection method


Enrollee Call Script Excerpt


PARTNERING WITH PROVIDERS ON POST-ENROLLMENT

Jeff Parmelee, Project ManagerSacramento Covered


• Health Net recognized the increase of people insured due to ACA, but also an increase in emergency dept. visits

• Insured people were still using the E.D. for primary care

Health insurance ≠ Health Access

• We partnered with local hospitals to change the trend via:• Emergency Dept. Navigators (establish PCP, follow-up care)• Pediatric Health Navigators (establish PCP, follow-up care)• Referrals from hospitals (Kaiser, Dignity, U.C. Davis)

Partner with providers & hospitals to reach new enrollees

Receive

referrals from hospit

al person

nel

Contact &

educate

patients

Determine health insura

nce needs

Assist w/

enrollment

(if neede

d)

Assist w/

healthcare

navigation and

usage



ASSISTING CONSUMERS WITH MARKETPLACE ELIGIBILITY APPEALS

Kevin Simpson, DirectorMarketplace Appeals Group, Centers for Medicare and Medicaid Services


1. Make sure the issue is appealable.Common invalid appeals include complaints about the accuracy of tax forms (1095A), issues related to disenrollment/reinstatement related to non-payment of premiums, issues not yet decided by the Marketplace.

For the Quickest Resolution of a Problem


2. Provide relevant documentation.Currently, the most time-consuming element of the appeal process is obtaining appeal documentation from consumers.For example, documentation of income is essential in cases involving the award/reinstatement of APTC. Other documents may relate to reasons for exemptions, citizenship/immigration status, or loss of other coverage for SEP cases.

For the Quickest Resolution of a Problem


MARKETPLACE/CARRIER COMMUNICATIONS

Elizabeth Colvin Insure Central Texas/Foundation Communities


Post enrollment includes assisting consumers with rights related to coverage


Triage on data matching issues

Is there missing income that would have been reported to IRS?


SELF-EMPLOYMENT LEDGER NAME: _______________________________________________________

TYPE OF BUSINESS: _____________________________________________

DATES COVERED: ______________________________________________

GROSS INCOME: ______________________________________________

TOTAL EXPENSES: ______________________________________________

ADJUSTED INCOME: ____________________________________________

INCOME (money received) EXPENSES (costs) Date

received

Type of Income Amount

Received

Date

Paid

Type of Expense Amount Paid

TOTAL

Verification of 2016 Income for Application # _______________ How I earn my money: Example: I am a full-time musician and my income varies month to month. Why my income in 2016 is different from past years: Example: I quit my full-time job in 2014 to become a full-time musician so my income in 2016 will be much lower than in previous years. My estimated income for 2016: (needs to match the amount on the current Marketplace application): Example: My estimated income for 2016 is based on my income from the past two months. Average income of $1,112 per month = $1,112/month x 12 months= $13,344 The attached documents support my estimated income for 2016: (only include documents that clearly support the estimated income): I have attached my self-employment ledger showing my income and expenses for the past 2 months: November profit = $500 December profit = $1,225 Monthly average income (profit) = $1,112 Estimated income for 2016 = $1,112 x 12 = $13,344 I attest that the income information I am submitting is true and accurate. Signature Printed Name & Date

Income verification


POST-ENROLLMENT FOCUS GROUPS

Lida GalindoServicios de La Raza


Special populations need special care: Using focus groups to engage enrollees

Focus Groups

Partnership Identification

Objective

Recruitment

Strategy

Implementation

Findings


Sample material: Adelante Con La Salud


• Make enrollee follow-up calls to identify consumer issues requiring assistance

• Partner with providers and hospitals on post-enrollment

• Make sure appeals are the right course of action and include the correct documents

• Post enrollment assistance includes assisting consumers with rights related to coverage – such as carrier/Marketplace communications

• Post-enrollment focus groups allow you to design materials that will best reach your consumer base

Key takeaways




topics!


Session format


1. Introductions (name, role, organization, state)

2. Describe the nature of the challenge.

3. What things have people tried in order to solvethe problem (or work around it)?

4. What needs to happen for progress to be madeon this issue for OE4?

5. Are there tools or resources that would make iteasier?

Discussion




topics!


Session format