In the future, will managers of HealthCare.gov spend enough on marketing and sales support to keep consumers going in through the digital, or brick-and-mortar, door?
Officials at the Centers for Medicare & Medicaid Services (CMS) talk a little about sales, marketing and consumer assistance support issues in a big new 2017 “parameters” document.
The document, which is on track to appear in the Federal Register on March 8, sets the rules for how many Patient Protection and Affordable Care Act (PPACA) programs and rules, including HealthCare.gov, will work in 2017.
The U.S. Department of Health and Human Services (HHS) set up HealthCare.gov to provide exchange enrollment and administration services in states that are unable or unwilling to handle those jobs themselves.
Starting in 2018, CMS, an arm of HHS, wants HealthCare.gov navigators, or nonprofit, grant-funded exchange ombudsmen programs, to offer enrollees post-enrollment assistance, as well as help them understand the enrollment process.
Last fall, when CMS published a draft of the 2017 parameters document, it suggested that states that thought of themselves as running state-based exchanges, but using HealthCare.gov to administer enrollment, should pay HealthCare.gov 3 percent of the premium revenue, to cover the cost of HealthCare.gov computers, call centers and other systems.
CMS suggested that the exchanges could keep 0.5 percent of the premium revenue for marketing, outreach and consumer support efforts.
Many exchange system players interpreted that proposal to mean that CMS managers think a typical exchange should have a sales, marketing and advertising budget equal to only about 0.5 percent of premium revenue.
Exchange managers and nonprofit exchange plan helpers seemed to react to that similarly to the way health insurance agents and brokers react to insurer announcements of producer commission cuts.
Mila Kofman, executive director of the District of Columbia Health Benefit Exchange Authority, wrote to encourage HealthCare.gov managers to budget enough to target hard-to-reach populations, such as uninsured people ages 26 to 34.
“Outreach at movie openings such as Hunger Games and Star Wars and cafe crawls in the late hours are aimed at educating and enrolling this age group,” Kofman says. “For [HealthCare.gov] to continue its strong success, sufficient budget focus on marketing is necessary.”
Representatives from Enroll America, a major HealthCare.gov enrollment coordination group, also objected to the idea that HealthCare.gov can spend just 0.5 percent of premium revenue on marketing and outreach, or that it can expand navigators’ post-enrollment duties without providing more financial support.
The exchange program may get less free publicity in the future, and surveys show that about 60 percent of the remaining uninsured consumers have either not heard of the PPACA premium tax credits or are not sure how the tax credits work, the Enroll America reps say.
“Commitment to outreach is both time- and resource-intensive,” the reps say.
In responses to HealthCare.gov comments, CMS officials say they will try to be flexible about how exchanges and navigators can use grant money, and the flexibility should ease some of the concerns about that money.
About marketing funding adequacy, officials said, “We will continue to assess the [HealthCare.gov] user fees… as it relates to the adequacy of funding for ongoing marketing and research.”
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