June 13, 2014 | Rosemarie Day

Top 4 Lessons Learned: First Open Enrollment

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It’s been 2 months since the end of health reform’s first open enrollment period in the individual marketplace, but there’s no time for the dust to settle.  There are only 5 months until the second open enrollment begins on November 15.  Given the short timeframe, it’s critical to review the lessons learned to ensure future success.


Exchange directors reflected on lessons learned at the National Health Insurance Exchange Summit in Washington, DC last month.  Here are some highlights – they resonate with what we learned in launching Massachusetts’ first exchange:

1. PACE YOURSELF:  “It’s a marathon, not a sprint,” was the consensus of several of the exchange directors. The reality of the amount of work that remains can be daunting, and exchange “sustainability” means more than just financial viability – it has to include what’s feasible for staff to do.  Launching a start-up organization is exhausting, and doing so in a giant public spotlight is especially tough.  Exchanges have to find ways to sustain their staff.

2. PRIORITIZE (RUTHLESSLY!):   Several exchanges failed to launch successfully.  Those that did learned to prioritize, ruthlessly, often making gut-wrenching decisions about what they’d have to give up.  This will continue to be the case as the public exchanges move forward.  The best ones will do this well.

3. COLLABORATE:   Exchange directors spoke about viewing their insurers as partners.  It’s essential for effective outreach and education of consumers, and also for ensuring the best array of products for consumers to choose from.  Connecticut and Rhode Island meet regularly with their carriers to discuss and resolve issues – Connecticut even has a “Carrier Council.”  Exchanges also need to collaborate with state Medicaid agencies, given the large number of members who will move between the programs.

4. OUTREACH, OUTREACH, OUTREACH:  Exchange directors have repeatedly touted the importance of their outreach programs.  But what specifically worked?

    • Messaging early and often:  Successful exchanges raised awareness prior to open enrollment, and followed up with a “call to action” when the website was ready for enrollments.  They weren’t afraid to saturate the marketplace.
    • Informed partners:  Exchanges need multiple partners, and they need to be well-informed.  It’s great to work with providers, but the doctors and intake workers need to be trained on the details of health reform (who’s eligible, how to enroll, etc.).
    • Target the audience:  Covered California saw a near-doubling in Latino enrollments during the last phase of open enrollment, once they enhanced their outreach and messaging to Latinos.  Potential customers need images of “people like me” in outreach materials.  They also need strong community-based assistance.


Health insurers who participated in exchange marketplaces learned many of the same lessons, even if their failures were less public.  But there have been many successes:  Wellpoint’s CEO, Joseph Swedish, stated that they are “pleased with the progress they have seen in the exchanges” (Wellpoint is expected to add over 600,000 members in public exchanges).  In a common theme for successful organizations, he noted that they had an intense focus on execution.

Insurers are also putting an intense focus on analytics, including exchange pricing and evaluating their products and network designs.  Much of the information they have about their new customers is very preliminary, so they are unlikely to make major changes in offerings until 2016.  That said, there was some mispricing, and we can expect to see course corrections in that area.


The next open enrollment period will bring some significant challenges, which makes learning the lessons from the first one all the more important.  Specifically, there will be more to do in a shorter time period:

  • TIME CRUNCH:  There will only be 3 months instead of 6 months in the second open enrollment.  And 6 of those 12 weeks fall squarely in the holiday period.
  • RENEWALS:  Marketplaces and carriers will have a whole new function to perform – they have to run their first-ever renewal process, with the goal of retaining as many customers as possible.  At the same time, they will have to recruit new members if they hope to make their enrollment targets.  They will certainly benefit from first year lessons here.