Enrollment challenge

Organizers last week kicked off a privately run campaign to promote the rollout of insurance and Medicaid expansion under the healthcare reform law—a must since a divided Congress has refused to appropriate funds to conduct a broad education and outreach effort.

While some politicians are still seeking to undermine that effort—HHS Secretary Kathleen Sebelius was called to Capitol Hill to explain why she placed calls to companies her department regulates to donate to Enroll America—a behind-the-scenes effort is quietly taking shape among some of the organizations that will benefit the most from adding an estimated 25 million healthcare consumers to the insurance rolls over the next decade: the health insurance industry and healthcare providers.

Indeed, some healthcare officials are already spending time in places such as churches, laundromats and on Facebook to reach out and educate consumers about their newly available options. But like the rollout of the reform law itself, this shadow campaign is proceeding in fits and starts, hampered by uneven political support for coverage expansion in many parts of the nation and, in some cases, resource and legal limitations on their ability to join the effort.

“The public education and publicity challenge is an enormous one,” said Sabrina Corlette, research professor and project director at the Health Policy Institute at Georgetown University. In a report funded by the Robert Wood Johnson Foundation, Corlette and several other Georgetown colleagues last week drew comparisons between the current launch of the Patient Protection and Affordable Care Act and the Medicare Part D prescription drug expansion in 2005.

“Some of the polling data that we have in our report illustrates that even in a few short months before the launch of both programs, there is a lack of basic information in understanding the program,” Corlette said. “I think what the Part D experience shows is that an investment in education and outreach does pay off.”

Promoting the purchase of health insurance to a population that's never had it before was never going to be an easy task. It took more than a decade for Medicaid to reach all 50 states. The rollout of the prescription drug benefit for seniors, a group that already had coverage, generated confusion for nearly a year before advancing relatively smoothly.

A campaign among some providers to avoid similar confusion is already underway in California, the state with the largest uninsured population in the nation. Long Beach-based Molina Healthcare, which operates government-sponsored healthcare programs for low income families and individuals, has begun reaching out to the public through local groups and partnering with community organizations to inform people about their options under healthcare reform.

“You gotta have someone you trust,” said Dr. J. Mario Molina, president and CEO of Molina Healthcare. “A lot of people have experience with these not-for-profit organizations. They've developed a reputation, and people will go to them for help. This whole healthcare thing is complicated. You need someone you can talk to.”

Molina last year held a three-day event in San Bernardino, Calif., where Molina Healthcare, Molina Medical and Buddhist Tzu Chi Medical Foundation provided free medical, dental and vision screenings. More than 2,400 people, 80% of whom were uninsured, attended. At this year's event, held this past weekend, they pushed the insurance expansion.

“What we tend to see is that when they come in for free medical care, the community-based organizations end up finding out they're eligible for Medicare or Medicaid,” Molina said. “We think it's that word-of-mouth and grassroots connections that are going to have the greatest impact on how people choose.”

Many insurers are still figuring out how they plan to promote their new offerings on the insurance exchanges. Cigna Corp. surveyed some 7,000 people to understand their concerns regarding the new exchanges and discovered most felt they needed help making informed choices about their plans and even assistance in simply selecting a family physician.

“It's a very complex dynamic,” said Joe Mondy, a spokesman for the Bloomfield, Conn.-based insurer. “These exchanges really open up access to health plans for a lot of people who may have never had a health plan and may have never had a family doctor.” Based on the findings, Cigna plans to offer a year-round phone line for customers as they sign up for products, as well as continue to answer questions for them once they have registered.

WellPoint has also enacted several initiatives to inform consumers, including providing educational websites for brokers and employer groups, webinars, face-to-face trainings, e-mail communications, and an updated portion of its site that offers shopping guides and checklists for health plan customers.

The nation's Hispanic communities will be major targets for local outreach campaigns, including collaborative efforts with local media and retailers that cater to Hispanics, since recent immigrants represent a disproportionate share of the uninsured.

The Be Covered campaign of Health Care Service Corp., which operates Blues plans in Texas, Illinois, New Mexico and Oklahoma, is “a grassroots campaign that introduces the uninsured to new health insurance options under the ACA,” said David Sandor, HCSC vice president of public affairs and corporate communications.

“We call this social marketing,” Sandor said. “We're trying to achieve a social good instead of sell a product or a service. We want to get people engaged.”

Through Be Covered, HCSC is currently partnering with more than 120 groups across the four states, including civic organizations, schools, religious institutions and physician practices, in order to provide information to uninsured people through events, print and digital content, texting and e-mail campaigns, and Spanish language newspaper inserts.

Reaching out to the uninsured won't be new for many hospitals, including 694-bed Hackensack (N.J.) University Medical Center. That hospital has already trained its financial counselors to inform patients about the new options. The state already reimburses hospitals for patients without private insurance who don't otherwise qualify for federal assistance. “I think patients and people in general are very aware of the fact that New Jersey is a charity care state,” said Anne Goodwill Pritchett, vice president of patient financial services for Hackensack.

Some systems are planning direct outreach efforts in the community, including hosting social media information sessions. Officials at CHE Trinity, the newly formed system consisting of Trinity Health and Catholic Healthcare East, plan to use computer kiosks stationed at the system's ambulatory offices and hospitals to ensure those without home or mobile Internet access stay informed and can electronically register. They've used similar kiosks to help patients manage chronic conditions, including diabetes. Livonia, Mich.-based CHE Trinity, which is on the advisory council for Enroll America, has also deployed volunteers with laptops who could register clients at places including laundromats and churches.

But some legal officials caution there are limits on what hospitals and healthcare systems can do to promote insurance expansion. The federal anti-kickback law could impose penalties on hospitals if they use insurance promotion as a tool to steer potential patients toward their facilities. “If there's such a thing as sending a registration van around to pick up patients and sending them to a hospital, that would be problematic,” said Elizabeth Mills, a health attorney lawyer in the Chicago office of Proskauer Rose.

Government won't be totally hands-off in the campaign—at least in those states with political administrations that are actively backing both their local exchanges and offering expanded Medicaid coverage. Some are laying plans for a major outreach effort.

Jim Stevenson, chief communications officer at the Washington State Health Care Authority, said they are “on the verge of a campaign to educate consumers and prospective consumers about the exchange and the opportunities it holds to shop in a new marketplace.”

The state's campaign will kick off in mid-July with an enrollment summit where they plan to talk to advocates and stakeholders and partner with associations that have an interest in healthcare reform. “This is a state where our legislature and the Medicaid program have been very active in enrollment,” Stevenson said.

One reason such campaigns have operated below the radar to date is that officials don't see much benefit from engaging in mass advertising or outreach until exchanges are up and running. Timing is “everything,” Stevenson said, adding “It's been difficult to promote the Medicaid expansion when coverage isn't effective until Jan. 1.”

Corlette and the Georgetown researchers discovered the same effect in their study of the promotion of Medicare Part D, which, unlike the Affordable Care Act, received substantial financial support from the government for promotion. “One interesting thing we found was that they actually launched publicity campaigns much earlier, in the spring of 2005,” Corlette said. “They're waiting until later in the year because apparently one lesson learned from Part D is that it was almost too soon to start educating people. They almost needed to give people a place to go and something to obtain. There's nothing they can actually do right now.”

Consumers shouldn't expect to see much active outreach until the weeks before Oct. 1, which now looms as only the kickoff date for the push to get people enrolled. “That is just the first day to sign up,” Molina said. “I think if you push too hard, you'll end up with a backlash … Like a lot of new products, there are some people who jump on the bandwagon, but most people wait to see how it works out and wait till the bugs are worked out.”

Follow Rachel Landen on Twitter: @MHrlanden