Echoing a Call for More Enrollment Data

By Molly Warren

Having better data often helps us make better decisions. This certainly holds true when it comes to outreach and enrollment. Having more granular information about who is enrolling in and retaining health coverage allows the enrollment community to better understand trends in health coverage, to gauge consumers’ needs, and to identify systemic issues (and propose solutions). And in turn, this also helps us make more informed decisions on our outreach and enrollment efforts to ensure we realize our goal of maximizing the number of Americans who get covered and stay covered.

Last week, the Commonwealth Fund published a blog post analyzing the current availability of enrollment data and the potential learning opportunities that additional data would offer. To say the least, this post resonated with a lot of us here at Enroll America. One of our core values at Enroll America has always been a commitment to being data-driven; we are always looking to better understand who is — and, often more importantly, who is not — enrolling in and maintaining their coverage, so we can fine tune our strategies and work with partners to reach those who most need to hear about their health coverage options. Here are a few key points from the blog post, written by a trio of researchers from the Center on Health Insurance Reforms (CHIR) at Georgetown University:

  • The opportunity for learning is huge with more data. More detailed information can inform policy decisions moving forward and ensure marketplace consumers are being served as well as possible. Specifically, the authors call for disaggregated, plan-level enrollment data by rating area.
  • Data consistency is needed. State-based marketplaces (SBMs) and, on behalf of states using HealthCare.gov enrollment platform, the U.S. Department of Health and Human Services (HHS) all report similar high-level, summary enrollment numbers, but states vary widely when it comes to the specific parameters and timeframe that they report on. This makes comparisons between states difficult.
  • SBMs and HHS can learn from Colorado and Massachusetts. These two SBMs have been particularly transparent with their enrollment data. Both provide easily accessible and regularly updated dashboards that allow stakeholders to measure progress over time.
  • Enrollment by issuer or plan is ideal. Unlike a lot of SBMs, HHS does not release enrollment data by issuer or plan (on behalf of states using HealthCare.gov enrollment platform). Having these data would allow researchers to find and dig into patterns in consumer behavior — like understanding what motivates marketplace consumers to change plans and coverage levels.

In addition to the findings and recommendations from CHIR, there are some specific data points that would be especially helpful from Enroll America’s perspective. For example, having information about enrollees by both income level (as measured by the federal poverty level) and amount of financial help received (including both premium tax credit amount and level of cost-sharing reductions) would give us insight into how consumers at various income levels are taking advantage of financial help (a key driver of consumer engagement and enrollment). Since financial help varies considerably by income and the specific plan a consumer selects — particularly for cost-sharing reductions — small income differences or plan choices can dramatically change the out-of-pockets costs consumers face. Having more granular data about income and financial help can show where the gaps in uptake really are and whether consumers are forsaking large cost-sharing reductions or small ones, as well as help guide and target improvements for the affected population.

Other examples of data points that would be helpful include geographic, demographic, and income-level information about:

  • Consumers who did not effectuate enrollment. Having more specific information on these consumers, who selected a plan but did not pay their first premium, as well as those who completed the application but did not select a plan, would allow us to examine who is dropping off at these critical intersections, and to identify if certain groups need additional reminders and follow-up about paying premiums, or whether certain issuers had better (or worse) payment systems that are easing the payment process (or creating barriers) for consumers.
  • Consumers who enrolled via Special Enrollment Periods (SEP). Understanding who SEP enrollees are now can help guide outreach planning to people in similar circumstances who might not know about the marketplace and availability of financial help yet, and also identify areas where additional efforts are needed.
  • Consumers who updated their application during and outside of open enrollment. These data would allow us to gauge whether consumers are updating the application as income and life circumstances change, which is important so consumers receive the right amount of financial help. If consumers don’t update their information along with changes, they may end up owing money back when they pay their taxes at the end of the year.
  • Consumers who disenrolled, and why. Understanding transitions in the marketplace is critical to ensuring long-term enrollment gains. With better information about which populations are disenrolling, how long they’ve been covered in the marketplace, and, very importantly, why they’re disenrolling (e.g. gaining another form of coverage, eligibility change, failure to pay premium, etc.), the enrollment community can identify where and how to make improvements that lead to sustain retention over time.
  • Consumers who re-enrolled. Having more granular information on re-enrollees is also crucial to understanding their behavior and needs, and allows the enrollment community to better serve this population. For example, it would be helpful to understand the average length of time re-enrollees have been covered in the marketplace, which re-enrollees started actively re-enrolling but didn’t complete the process prior to auto-enrollment, and who, among re-enrollees who were initially auto-enrolled, took subsequent action and what the action was (e.g. after initial auto-enrollment, who updated their account information, changed plans, and changed to a lower premium plan).

HHS and SBMs have been progressively sharing more data, more regularly. This information has been increasingly helpful, but even more is needed to truly evaluate enrollment and retention across the country. We’re hopeful that the movement towards increased data transparency will continue, so that we can continue to work with our partners around the country help Americans get covered and stay covered.

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