State exchange leaders: 4 secrets to HIX success

More than 100 days into open enrollment, state-based exchanges continue to outperform their federal counterpart. Their road to success wasn't easy, leaders at four state exchanges said this morning at a press briefing hosted by the Robert Wood Johnson Foundation.

Check out these four secrets to HIX success that participants, from exchanges in Kentucky, Rhode Island, California and Washington, D.C., shared with the audience.

1. Experience

Part of Kentucky's "secret sauce" to exchange implemenation was putting its state exchange, Kynect, under the Cabinet for Health & Family Services, which also includes Medicaid and other health policy departments. Having all of those programs in the same cabinet removed structural barriers, said Audrey Haynes, secretary of the Kentucky Cabinet for Health and Family Services.

Moreover, the proximity of the Medicaid department meant the exchange also had an experienced IT department to support it. "We had a lot of experience within the cabinet at bringing up very large IT structures," Haynes said.

That experience certainly has helped enrollment: As of this morning, the state has more than 195,500 enrollees, with about 76.1 of the overall enrollment qualifying for Medicaid.

2. Customer service

Open enrollment has shown marketplaces need to focus on better customer service. "Customer service is essential, and it is real private-sector-kind of customer service we need to provide," Christine Ferguson, director of the Rhode Island Health Benefits Exchange, told reporters.

Looking to boost customer service performance, Covered California has hired hundreds of new customer service workers, many of whom will be bilingual, Executive Director Peter Lee said. The California exchange also will add self-service tools for consumers, conduct email tests and follow up with consumers who have started the enrollment process.

Meanwhile, Kentucky relies on more than 2,000 certified exchange insurance agents, as well as navigators to help individuals and small businesses enroll in coverage, Haynes noted.

3. Marketing

Exchanges and participating insurers need to address marketing--they need to rethink their investments and redouble their efforts, according to Ferguson, who noted that the rocky federal exchange rollout scared away many early adopters. "We have to acknowledge that there was some damage done in the context of the marketing and outreach," she said.

State-based exchanges have an advantage in marketing resources. "California has been investing substantially in TV, radio, digital, social outreach," Lee told reporters.

The health exchange in California has taken the top spot for enrollment numbers, but those figures largely exclude Latinos, so CoveredCalifornia has adjusted some of its marketing strategies, particularly around Spanish-language and Latino communities, Lee added. It also is shifting the marketing message to include more details about why exchange coverage is affordable and what benefits are available.

Marketing also played a big role in the success of the exchange in D.C., where the largest percent of the uninsured population is younger than 40 years old. For that reason, the DC Health Benefit Exchange Authority has been focusing creative outreach initiatives on young consumers, including a youth enrollment leadership advisory council, events at dance clubs and bars, and even reaching out to young people lined up outside stores to buy Air Jordan sneakers, said Mila Kofman, executive director of the exhcange.

The results of the targeted outreach efforts: The highest group of enrollees by age for the D.C. exchange is 26-34 year olds.

4. Small business buy-in

The small business market is central to the future of the new insurance marketplaces, especially as more states move toward full-employee choice--a change will happen by reducing uninsured numbers, as well as by managing costs and looking at outcomes, Ferguson said.

"We really need to understand what [small businesses] want and how to provide the kind of data that their employees need to make decisions," Ferguson said.

Similarly, the Washington, D.C., exchange recognized it couldn't focus only on the individuals and ignore small-business clients. So it has ensured full functionality for the Small Business Health Options Program (SHOP) marketplace. "Now small businesses have the purchasing of large employers and can offer their employees the types of choices that were only available to large employers in the past," Kofman said. So far, the D.C. exchange has enrolled 11,977 small businesses in the SHOP.