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Medicaid and Marketplace experts came together to discuss methods to retain enrollees and navigate the end of the Public Health Emergency (PHE). Softheon and USofCare, a nonpartisan organization committed to ensuring every American has access to quality care, co-host “Measuring our Progress on Enrollment,” a virtual event following the conclusion of Open Enrollment 2022. USofCare’s Chief Program Officer, Kristin Wikelius, guides panelists through questions regarding boosting and sustaining record-high enrollment in health coverage.

Industry experts on the panel included Nevada Medicaid Administrator Suzanne Bierman, Kevin Deutsch, General Manager and Senior Vice President of Health Plan Solutions at Softheon, and Terry Burke, Senior Advisor in the ACA Exchange Market at Oliver Wyman and Interim President of the Individual Exchange Business Segment at Amerihealth Caritas.

With record-breaking enrollment numbers exceeding 14 million, health plans on the Marketplace must make efforts to retain this inflex of members. Additionally, the surge of Medicaid members following the PHE presents a unique challenge to the Marketplace and Medicaid platforms. The end of the Medicaid reassessment grace period will result in vast numbers of now ineligible Medicaid members rapidly transitioning to the Marketplace.

With personalized health coverage and collaboration at the forefront of health insurance innovation, featured experts discussed methods to either maintain enrollees or seamlessly transition them to another form of coverage.

Table of Contents

  1. Examining the Coverage Lapse Model’s Performance
  2. Identifying Final Predictors
  3. Conducting Additional Testing and Recommendations
  4. Softheon’s APTC Data Analysis and Visualization
  5. Appendix: Key Terms Used to Describe the Model’s Data

Addressing Marketplace Plan Saturation

The ongoing boom in the ACA Marketplace encourages health plans of all sizes to either enter the Marketplace or expand their plan offerings; however, this expansion results in unforeseen consequences.

Open Enrollment 2022 saw a “mass tidal wave of product choices and company choices; people are confused. They are still enrolling in record numbers, but they are not always sure what they are enrolling in” explains Burke.

Oversaturation of the Marketplace results in a reduction of health literacy as potential members have little hope of fully comprehending all their options. An overabundance of plan options also presents administrative burdens for health plans.

Deutsch goes on to explain, during Open Enrollment “there was a number of plans that exited the marketplace early because of challenges with sustainability.”

The myriad of offerings proves to be unsustainable despite health plans continuing to further push beyond their limits, “now as [health plans] get back into the marketplace, we see several new plan options that are available to the consumer.”

In today’s market, even small, regional health plans will offer an extraordinary number of plans in an effort to give more choices to the members and shift towards a retail-centric model. After discussing the risk of this approach, our panelists provide ways to effectively attract and retain members without increasing administrative burden.

Meeting the Member in Their Moment

Health plans can still transition to a retail-centric approach without reducing coverage transparency. Focusing on consumer outreach and education allows health plans to make the most of the resources they already possess.

Burke describes this foundational approach as being “brilliant at the basics.”

Customize Member Communication

Automating and improving the day-to-day user experience in a non-intrusive way allows health plans to scale their operations continually and effortlessly. For example, constantly communicating to members through a variety of interfaces – including mail, email, text, and phone – creates a sense of human connection and increases member retention.

Members are primarily looking for a personalized approach to health care, and health plans can supply that by expanding the ways they can interact with them. Sending welcome kits and notices throughout grace periods is just one way to provide custom support for your members.

Messaging matters as people float between Medicaid and Marketplace. Meeting the member in their moment involves tailoring communication.

Partner with Trusted Representatives

Burke suggests health plans take steps to mimic Medicaid behavior in the Marketplace, specifically regarding community outreach. Partnering with trusted community representatives can potentially increase health literacy in areas with high termination rates. Larger health plans have begun entering communities and finding an advocate to guide members and increase retention rates with little administrative overhaul.

Targeting and enhancing the broker toolset ensures that an entire subsection of your membership receives personalized guidance. Brokers should be treated as an essential resource for health plans with a user interface designed to scale with demand.

Deutsch shared examples of health plans implementing the retail model in non-traditional ways. Initiating payer integrated payment solutions with retail outlets grants increased accessibility for members with unusual circumstances. Members bring their invoices to partnered retail providers and pay their premium while in the store. Unique payment methods target populations without access to technology or traditional banking systems.

Health plans do not need to reinvent the wheel and add obscure plans to appeal to members. Panelists stress that a successful plan does the most with the assets they already have, and simply meeting the member in their now leads to an increase in retention rates.

Breaking Down Data Silos

All panelists agree that health plans and agencies need to scale operations and accommodate changing regulations through advancements such as automation, artificial intelligence (AI), and machine learning.

Nevada experienced a 35% increase in Medicaid enrollment since the start of the PHE. A “majority of these enrollees would still qualify for either Medicaid or Marketplace coverage [following the end of the Medicaid reassessment grace period], so we are trying to strengthen this transition of care and coverage and promote continuity,” explains Bierman.

Ensure that member data transfers between Medicaid platforms and the Marketplace will increase continuous coverage for members during this transitional period. Nevada mandates Medicaid managed care organizations (MCOs) to participate on the Marketplace in efforts to break down the data silos that occur in healthcare. MCOs serve 75% of the Nevada population, dramatically reducing the amount of enrollee data migration required during the Medicaid to Marketplace transition.

Themes of communication and integration across different entities continue to be an underlying theme across all discussion topics. Deutsch noted that a successful Medicaid unwinding period requires a “cross-section between Medicaid and Marketplace. Each of the constituents in the industry, whether it be the Medicaid organizations, MCOs, participating Marketplace plans, or technology partners, must make every effort to get in contact with these specific individuals to facilitate that successful transition between Medicaid into a Marketplace plan.”

Targeting At-Risk Members with Predictive Analytics

Softheon shares the success of their predictive model that identifies at-risk members before they even enter a grace period. Cycling back to the discussion of AI and machine learning ushering the next advancement in member retention, Softheon utilizes member enrollment and payment history to identify specific behaviors indicative of future termination.

Informative findings regarding the correlation between member behavior and termination risk include:

  • Members utilizing auto payments terminate at a much lower rate than those using a manual
    payment method.
  • Silver plans termination less often compared to bronze and gold due to an increase in subsidies.
  • Family plans lapse at a lower rate compared to individual plans.

Softheon’s model predicts terminations with 80% or greater accuracy across multiple testing scenarios. The model identifies individuals who would terminate coverage throughout the remainder of the year at the third month of their membership, based on several factors identified in enrollment and their payment history.

Identifying risk factors allows health plans to focus on the 20% of the population that contributes to 70% of terminations. Focusing efforts solely on at-risk individuals could enable ROI on retention while minimizing operational and administrative spending.

“The administrative piece of health insurance has to be as simple as possible, the least touch to make sure that they have access to their care they don’t have to worry about it,” Deutsch concluded.

Interested in getting a head start on Open Enrollment 2023? Learn more about scale operation to seamlessly enter the ACA Marketplace with Softheon’s Whitepaper.