Building Upon Enroll America’s Success in OE1: Enroll America Acts on Evaluation Results

By Jennifer Sullivan and Sophie Stern

As we laid out in our report last month, State of Enrollment: Lessons Learned from Connecting America to Coverage, 2013-2014, measurement and program evaluation are at the core of all we do here at Enroll America. We want to learn what works, what doesn’t, and why so that we can ensure we’re maximizing every opportunity we have to connect consumers to health coverage.

Because we are committed to continually improving what we do, we were eager to participate in an independent evaluation of our work conducted this summer by Mathematica Policy Research. We are also committed to sharing what we learn with partners around the country — at our first annual conference, through our #StateOfEnrollment blog series, our training opportunities, and so much more.

We are proud to report that many of the strategies we used during the initial open enrollment period (OE1) were underscored as strengths in Mathematica’s evaluation. Mathematica found that “Enroll America pioneered an innovative outreach approach that uses data-driven, campaign-style methods to increase enrollment under the ACA…The Enroll America approach prioritized efficiency and evidence in ways more commonly associated with the private sector…This model included real-time tactical support conducted at a level of scope, rigor, and sophistication never seen, to our knowledge, in a public coverage program outreach effort.” We’ve highlighted a few of the strategies that were found most effective in depth below:

  • Activating, coordinating, and expanding capacity of partner organizations. Coordinating efforts with national and local stakeholders creates a drumbeat so that consumers can hear consistent messages repeated in multiple contexts about how they can get covered — making it more likely that they will follow through with enrollment. Very early on, Enroll America enlisted many different voices in all 50 states and Washington, D.C., and provided resources through our Best Practices Institute on a variety of topics to help stakeholders maximize enrollment.

Moving into the next open enrollment period (OE2), Enroll America will continue to play this role, particularly as the broader enrollment community prepares for a host of new enrollment issues: re-determinations, renewals, and reconciliation. And, we will continue to act as a convener to help connect the remaining uninsured to coverage. 

  • Data-driven, campaign-style outreach. Enroll America’s “big data” approach to health coverage enrollment is the first of its kind, according to Mathematica. There are two key ways Enroll America uses data to improve outreach: the uninsured model and the national database, called Get Covered Data (or GCD):
    • The uninsured model is the foundation on which our outreach strategy was built. The model makes outreach more efficient by identifying consumers who are most likely to be uninsured so we (and our partners) can engage more people for each dollar we spend and each hour volunteers are on the job. The model was just updated for OE2, which will help us as we work to engage the remaining uninsured. 
    • GCD is a secure, online database that enables grassroots staff and volunteers to implement outreach according to the uninsured model to make sure consumers have the information they need about their new coverage options, that they know where to get help, and that they are aware of any upcoming enrollment deadlines. The database also allows staff to record whether individuals reported enrolling in coverage and why they ultimately did or did not take action so we can tailor our outreach to these individuals in the future. Moving into OE2 we are promoting the use of GCD among partners, and are working with stakeholders across the country, including Colorado’s marketplace (Connect for Health) and The California Endowment, to make sure health coverage outreach continues to be as precise as possible.
  • Prioritizing efficiency and evidence. When collecting consumers’ contact information for targeted outreach, we define success as building the richest list possible (collecting names, phone numbers, emails, and addresses) as efficiently as possible, bearing in mind that time and money are limited.
    • One such example comes from OE1, when we found that our initial digital strategy yielded acquisition costs of more than $100 per email address. We found that using internal data to guide the paid media plan instead was a far more affordable approach that positioned the campaign to engage a broader community in the discussion about getting covered, allowing interested uninsured individuals and families to opt into our consumer-facing Get Covered America (GCA) program. The results were significant: The cost of email acquisitions dropped to under $5 per email address, a reduction of more than 95 percent. 

Importantly, the evaluation also makes a number of recommendations. And while many of the recommendations are already core elements of our program for OE2 or are among assessments we made in our State of Enrollment report last month, we think there are ways Enroll America and partners can get even more mileage out of these suggestions. Let’s take a look:

Recommendation: Expand the pool of Certified Application Counselors (CACs).

  • What we’re doing: Every state has Navigators and community health centers that receive funding to provide enrollment help, but there are often not enough assisters to meet consumer demand. In order to build the pool of CACs, we are recruiting a wide variety of organizations to become CAC organizations, including hospitals, health-related student associations and academic programs, churches, and outreach groups. We are also working with these groups to create opportunities for their volunteers to become CACs, and are also recruiting volunteers of our own, through the Get Covered America Fall Fellows program, to work as CACs.

We are also helping in-person assisters combine forces to connect more consumers to help through the Get Covered Connector. The Connector will be an online, nationwide tool for consumers to schedule appointments with in-person assisters. By signing up as Get Covered Connector partners, assister organizations will be able to team up and offer one place for consumers to go to make appointments for local enrollment help. And then partners will be able to use the tool to manage assisters’ schedules and track information about appointments.

  • What partner organizations can do: Partners can consider becoming a CAC organization or building and maintaining relationships with CAC organizations. Partnering and sharing information with CAC organizations can also help make sure consumers are receiving coordinated, consistent messages about how to get connected to coverage and stay enrolled.

Recommendation: Reconsider the allocation of resources for the field campaign, especially in geographically dispersed states.

  • What we’re doing: Moving into OE1, we hired field staff in states where there were the highest number of eligible uninsured and fewest federal resources to conduct outreach. Now that over 15 million individuals have enrolled in coverage, we are re-evaluating our strategy to engage the remaining uninsured so that we can continue to reach consumers as effectively and efficiently as possible. And in states where we do not have a field campaign, our regional managers are prioritizing states and focusing on training models to help stakeholders learn about and implement best practices.
  • What partner organizations can do:Re-evaluate the allocation of resources. Take time to learn what worked well during OE1 and evaluate the new landscape. Make sure the strategies used during OE1 still apply or whether they need to be adapted for OE2. Consider activity surrounding renewals and reconciliation and what this means for programmatic activity, as well as the demographics of the remaining uninsured.

Recommendation: Enhance the earned media strategy.

  • What we’re doing: Local news media proved to be one of the main sources of information on the Affordable Care Act (ACA) for consumers who were uninsured. Among those who were uninsured and got insurance, 17 percent cited local news as a source of information on the ACA. Enroll America launched an earned media effort in June 2013 alongside the consumer-branded GCA campaign. From that point forward, Enroll America attracted earned media attention, resulting in more than one billion impressions, but we can do even better. Lessons learned from OE1 show the importance of engaging specialty media and other trusted sources of information to motivate uninsured consumers to action. Moving into OE2 we plan to increase strategic partnerships with Latino media outlets, expand our Communicators Program to get more trusted voices trained on enrollment messages, and continue to highlight the availability of financial help through media events.   
  • What partner organizations can do:Take a look at your organization’s outreach plan and make sure earned media is well integrated into it. How do you plan to amplify your outreach through the local news? If you’re not sure where to start, check out our training and resources on the topic.

Recommendation: Ramp up volunteer recruitment.

  • What we’re doing: By the end of OE1, more than 31,800 volunteers had committed time to the GCA campaign. Mathematica found that “top performing states” had the highest number of active volunteers per 10,000 uninsured people. By recruiting volunteers and providing them with training and ongoing support, GCA increased its rate of consumer engagement and was ultimately able to have more than 670,000 conversations with people who were looking for health insurance. To ramp up volunteer recruitment we used our “Summer Fellows” program to recruit and train over 350 people across our 11 field states on how to do community organizing, and we’ve hosted multiple trainings across our field states to provide opportunities for both partners and volunteers to learn more about how to help increase enrollment and health insurance literacy in their communities; through these efforts, we have added thousands of new volunteers this summer.
  • What partner organizations can do: Look closely at programmatic goals for OE2 and identify how volunteers can help increase capacity. Some organizations may want to consider launching a volunteer program (it’s important to begin this process as early as possible), whereas others may be able to tap into existing volunteer programs at partner organizations for help during OE2. Organizations with established volunteer programs will want to look for ways to maximize efficiency and strengths of volunteers. Building on volunteers’ strengths and giving volunteers skills-building opportunities can help increase retention.

Recommendation: Continue to place a high priority on seeking partnerships, especially with groups connected to key uninsured constituencies.

  • What we’re doing: We worked especially hard during OE1 to mobilize women, Latinos, African Americans, and young adults to enroll. We continue to convene partner organizations around these key constituencies. In response to our partners’ interest in working closer with one another and an increase in the sheer number of partners, we will be restructuring how we convene our national partners in order to maximize groups’ strengths and capacity and allow for more strategic coordination.

We also continue to work with partners in communities in all 50 states in a variety of ways, such as an intensive outreach planning and technical assistance program, online training resources, and a health insurance literacy listserv and resource hub. 

  • What partner organizations can do: Remain active participants in the health coverage enrollment network in your community. Consider assessing each partnership and make recommendations on how to improve communications. Begin to think about developing a shared enrollment outreach and event calendar for OE2 and identify venues for shared activities.
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