Why State Exchanges Are Under Immense Pressure and What They'll Do About It

September 8, 2015 Ray Catudal

Exchanges have been under immense pressure to offer better consumer experiences after several public missteps. Well this year is supposed to be the year that the state exchanges get it right. With open enrollment for individuals fast approaching, we are hearing more and more about how public exchanges are getting ready and using new methods to reach the consumer and better engage with them.

For example, the Maryland Health Connection will transfer consumer calls from a call center directly to a broker, who will then enroll the consumer. The Colorado Exchange, Connect for Health Colorado, will be offering people on hold the option to be put in contact with a broker via text. HealthSource of Rhode Island will be giving consumers on hold the option for in person assistance with United Way. It’s great to see that some exchanges are realizing that they need to do more to than rely on call centers to provide a better experience to consumers.

A mix of improving consumer experience, new decision support tools, and partnerships with brokers and navigators will go a long way in resolving a lot of the issues that the exchanges have run into previously. Additionally, these initiatives will make brokers very happy. After all, since the creation of exchanges, brokers have been voicing how little the exchanges and government have been leveraging their expertise. Brokers have been enrolling individuals for years before the government exchanges came along. Many exchanges initially did not realize how valuable brokers could be and did not leverage them much. The experience of two open enrollments, a lack of funding and the uncertainty around exchange sustainability have forced these exchanges to reconsider their use of brokers as experts and partners. Brokers are a good economic option considering the long telephone wait times consumers have been faced with and other ‘technical glitches’ that have occurred.

Two public exchanges that have been quite successful in the past, Access Health Connecticut and Connect for Health Colorado, have used virtual assistants to help reduce the number of calls coming into their call centers. The success that Connect for Health Colorado has seen as a result of their avatar Kyla, has them expanding her presence on the site just in time for open enrollment. By expanding Kyla to the Subsidy Eligibility System the avatar will be able to answer questions, help people determine if they are eligible for subsidies, and walk them through the enrollment process. 

Seeing upwards of nine times higher conversion rates, Access Health CT has become a popular adviser for other exchanges. More and more insurance carriers are also recognizing the value that avatars can provide to help consumers re-enroll into last year’s plan or cross walk them into new and/or better plans based on last year’s utilization.

Hopefully many of you will have already planned for this and are thinking ahead… post enrollment. Virtual assistants can help consumers on the status of their enrollment, their id cards, plan details, preventative services, HSA account set up. It’s not too late to talk to looking into implementing a virtual assistant to help with pre or post enrollment customer self-service.

Thanks for reading.

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About the Author

Ray Catudal

As Director of Healthcare Consulting, Ray is focused on CodeBaby’s healthcare specific customers and delivering on CodeBaby’s mission of customer centricity. With over 20 years of experience in medical devices, healthcare and technology, specifically: ehealth, health insurance, and software, Ray is a subject matter expert who contributes to industry articles, and speaks at trade shows and events.

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