By Cyril Tuohy
Kevin Counihan, the Connecticut official picked by the Obama administration to run HealthCare.gov, knows a thing or two about signing up the uninsured.
When it comes to health care exchanges, he thinks the nation is better off building a simple, robust site rather than a feature-heavy, whiz-bang destination.
“I know in our state ‘less is more’ was a clear mantra,” said Counihan, chief executive officer of Access Health CT, the state exchange of which he was in charge.
“We ended up scaling back 30 percent of our desired functionality in January of 2013, thinking that we were better of building a Ford Focus than a Maserati. And we also, to be frank, had to draw a line with some of the rules and regulations that kept changing,” Counihan said.
Access Health CT, which enrolled nearly 80,000 people, is considered a model for other states, even if running HealthCare.gov is a much bigger and more complicated proposition.
Counihan, who delivered his comments last month on a panel of experts gathered by the Kaiser Commission on Medicaid and the Uninsured, shed light on some of the challenges he faced in Connecticut.
The panelists explored which strategies worked and discussed how to best approach health care sign-ups with the approach of the second enrollment period on Nov. 15.
Counihan said it was critical to have a stable technology platform. He also said it was critical to fix problems as quickly as possible. At Access Health CT, he brought in an independent consultant to audit the system, fix holes and bugs, and issue patches.
“Our goal is to make sure that the system remains stable, workable, easy and simple as possible for the enrollees,” he said.
The Affordable Care Act (ACA) requires that most people be insured and that insurance exchanges offer subsidized private coverage to people who don’t have workplace health plans.
HealthCare.gov is used by 36 states to sell insurance under the ACA, but not every state has embraced the exchanges.
When HealthCare.gov opened for business last October, millions of applicants were kicked off the site and glitches from overwhelmed servers froze the application process. The delays prompted the Obama administration to prolong the enrollment period last spring.
In the end, more than 8 million people found insurance through the exchanges and the initiative was billed a success.
In Connecticut, which has a large Portuguese-speaking immigrant population and where 15 percent of the nonelderly were uninsured in 2011-2012, as many as 79,192 individuals selected a plan through the state’s program and another 120,000 residents gained coverage through Medicaid, the Kaiser researchers found.
Counihan said Access Health CT also developed a mobile app because the research showed that after 7 p.m. about 25 percent of enrollees signed up through smartphones and tablets. Of those, he said, 87 percent were under the age of 40.
Enrolling and retaining the young is seen as a key element to the success of the government exchanges by expanding the health care risk pool. Younger, healthier enrollees help to keep premiums affordable because that group uses health services less, which balances out the more expensive care provided to older enrollees who tend to require more care.
Counihan, who promoted health exchange enrollment at music concerts, said that outreach initiatives were key to getting people to enroll. The initiatives included developing customized materials and resources; reaching groups though marketing materials, media events and mobile efforts; establishing walk-in enrollment sites, and engaging health providers in outreach and enrollment.
The “number one influencer” for enrollees in the Connecticut exchange, he said, was word-of-mouth, references and recommendations by friends or colleagues.
Counihan also said the lesson from Connecticut is that enrolling people requires time and education, recruiting “assisters” with ties to local communities, developing relationships between assisters and brokers, coordinating help through a regional hub-and-spoke model, and expanding call center capacity to offer tiered assistance levels.
Counihan’s new job will be to keep those who are insured through state and federal health exchanges satisfied, and to reach out to millions of Americans eligible for coverage but not yet insured.
At a Hartford, Conn., news conference, Counihan said Connecticut’s health exchange “showed that government can work.”
"It can take on a highly complex social program and succeed," he said in comments published in a story appearing on the Kaiser Health News website.
"People understand intuitively that having people uninsured is not right for them or right for the country," he said. "Now, how we go about doing it — people can debate and there can be solid policy differences. But I'm fundamentally very optimistic that, even though there are some big, ideological schisms, that those can be bridged."
Cyril Tuohy is a writer based in Pennsylvania. He has covered the financial services industry for more than 15 years. Cyril may be reached at [email protected].
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