Product Talk: Enhanced Direct Enrollment

Product Talk: Enhanced Direct Enrollment

Softheon’s private-label enrollment solution, Enhanced Direct Enrollment-as-a-Service (EDE) offers a unified enrollment experience and an updated, easy-to-use portal for Marketplace members. Now available to any health plan engaged in the ACA Marketplace once it informs CMS that it is partnering with Softheon as an EDE vendor, Softheon EDE uses a series of Centers for Medicare and Medicaid Services-based (CMS) application program interfaces (APIs) to process eligibility and changes behind the scenes. In this interview, we spoke with Min Kyu Han, one of EDE’s product owners. 

Softheon: Please introduce yourself and describe your role at Softheon.  

Min Kyu Han: Hello! My name is Min Kyu Han, and I am the product owner of Clarity here at Softheon. Clarity, I like to say, is the face of Softheon – providing front-end web applications that a wide variety of clients can use to access or provide service in the healthcare industry. I have been with Softheon for a little over three years now, after graduating from Stony Brook University with Bachelor’s degree in Applied Mathematics & Statistics and Economics, and with a Master in Business Administration. I have been part of multiple implementation projects at Softheon with payments, correspondence, and enrollment management teams, and am focusing on enhancing the consumer experience of our products! 

What did enrollment look like before EDE? 

If I was a member trying to enroll in an on-exchange plan in a federally-facilitated marketplace (FFM) state, I would have to start at an issuer’s website to pick out a health plan. But if I were wondering about my eligibility for subsidies, such as premium tax credits, I would be redirected to the federal government’s Healthcare.gov through a pop-up screen. But in order to complete the transaction, I would have to return to the issuer website. This back-and-forth between websites is known as “double redirect.” 

What are the implications of this enrollment experience? 

The current process creates two different user experiences, which can be confusing for the enrollee. The user interface and experience can look completely different down to the font and colors between the government and the issuer’s websites. The enrollees might’ve thought they were done once they reached Healthcare.gov, only to be redirected once again. This confusion has real-life ramifications, leading to drop-offs in enrollment and more questions to answer for the call center. From a technical standpoint, the transfer to and from Healthcare.gov makes it more challenging for us to troubleshoot for enrollees as it’s harder to pinpoint the location of an issue when an enrollee moves between sites. Today’s consumers expect an easy, quick transaction, and any barriers can prevent them from completing an enrollment.  

What is EDE and how does it improve the customer experience? 

EDE was created by CMS to allow brokers and members to enroll in coverage from application to renewal on a single web portal, significantly improving the user experience. This new method simplifies enrollment in health plans sold through Healthcare.gov.  

Using APIs, EDE gives the issuer the power of controlling the subsidies eligibility form which resides on Healthcare.gov. This means enrollees don’t have to be redirected to and from the Healthcare.gov site anymore; they can simply stay on the issuer website from start to finish, while still obtaining premium tax credits and other subsidies. With EDE, all issuers must do is include the verbiage of Healthcare.gov.  

How does EDE work with other Softheon products? 

EDE is now integrated into our complete member journey. We service a single-source marketplace, meaning we not only provide the shopping experience, which now includes EDE, but we also provide enrollment, payment, and account management. From picking out a health plan to setting up your autopayment, we have an end-to-end solution. So unlike other entities that have EDE, our solution doesn’t just stop at shopping.  

Any other exciting features you would like to mention?  

The EDE solution is white-label, meaning it’s completely customizable to any brand. Any issuer can take the solution and brand it to make it feel like their own product.  

EDE sounds complex. What was the process to get EDE up and running? 

The marketplace is highly regulated and simulating the role of Healthcare.gov requires stringent business and security audits, both of which we’ve successfully cleared. We’ve been in close contact with CMS for months, as we were invited to join the closed Direct Enrollment Partner Workgroup weekly meetings to coordinate closely with CMS on direct enrollment enhancements. Having cleared the audits, we implemented EDE Phase 3, which means 100% of enrollment scenarios, even the most complex ones, like married applicants not filing jointly, or dependents that are not children, can be handled within Softheon EDE. Our issuers have peace of mind knowing they can service the full span of consumer scenarios.  

The views and opinions expressed by the authors on this blog website and those providing comments are theirs alone, and do not reflect the opinions of Softheon. Please direct any questions or comments to research@softheon.com 

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