“Looking for the new health insurance marketplace, set to open in this state in two months, is like searching for a unicorn.” –Robert Pear, New York Times, 2013
Nationally, 12.7 million consumers enrolled in health insurance through the Marketplace and in Missouri 290,201 people gained coverage. These numbers not only represent success, but also the real lives that have been improved through increased access to health care. As a third open enrollment period in the insurance Marketplace came to a close, Hawthorne President, Cynthia McCafferty sat down with Nancy Kelley, Program Director for Expanding Coverage, of Missouri Foundation for Health, to discuss the hard work and dedication that made this year a success.
Cynthia McCafferty: Cover Missouri, the public education effort run by Foundation, has had one of the most successful open enrollment periods for three years in a row, what do you think were the keys to success?
Nancy Kelley: Despite the relatively inhospitable environment for the Marketplace in Missouri, the state has seen significant enrollment in health coverage which has increased with each open enrollment period (approximately 150,000 in OE1, 250,000 in OE2 and 290,000 in OE3).
The Cover Missouri Coalition was formed out of a need within the state for leadership and structure to coordinate efforts to help consumers get, keep and use health insurance.
From its start in 2013, the Coalition has fulfilled a critical role as both convener and communicator. Cover Missouri has continued to evolve in response to changing needs within its membership and within the environment. The structure has facilitated coordination of outreach and enrollment efforts, training and information-sharing at both the state and regional levels. Members of the Coalition actively commit to shared learning as well as maintaining an inclusive environment where all are welcome and encouraged to participate.
Through Cover Missouri, the Missouri Foundation for Health has assured that critical expertise has been available to Coalition members and the body as a whole. Contracted partners are in place to support and guide Cover Missouri’s awareness campaign, technical assistance activities, facilitation of the Coalition, health insurance literacy efforts and evaluation.
Perhaps most importantly, Missouri’s enrollment success is due to the development of a wide network of well-informed, well-prepared assisters (navigators, Certified Application Counselors, agents and brokers) available to provide in-person assistance to consumers across the state.
Cynthia McCafferty: What were some of the most challenging audiences to reach? How did you reach them?
Nancy Kelley: Across all three open enrollment periods, several groups proved to be challenging to reach. Those groups have been African-Americans, Latinos, LGBT, people living in rural settings and young adults under age 35.
Cover Missouri has found that the content of the messaging is not substantially different for any one group, but the delivery method may need to be adapted. For example, in some Latino communities in Missouri, the Spanish-language radio station was the best way to reach a broad audience and have credibility within those communities.
With people living in rural settings – often farmers who are a distinct set of independent business owners – it was helpful to underscore the bottom line of how coverage may benefit them financially as opposed to the penalty hurting them. In addition, timing proved to be important for outreach to farmers. They sent the message loud and clear that when it is harvest time, they are in the field and health insurance will not be their priority.
Cover Missouri invested more heavily in digital media during the third open enrollment period and yielded significant results. This effort was aimed mainly at the young adult group. Overall impressions, engagement with Cover Missouri social media channels and visits to our website substantially increased in response to digital advertising.
For all the groups to which Cover Missouri reached out, word-of-mouth was far and away the most common way for outreach to take place. No matter what the demographic of the group, having that trusted messenger to inform and influence was a major key to successful enrollment. Within both the African-American and LGBT communities, this was especially noted by our partners doing outreach as an effective way to build credibility and connection with the intended audiences.
Cynthia McCafferty: Looking back, is there something you would do differently?
Nancy Kelley: One tactic that has generally not been as productive as hoped has been hosting stand-alone outreach events. Planning such events is labor intensive and frequently did not result in large attendance numbers.
In response, Cover Missouri partners shifted whenever possible to pairing their outreach and enrollment events with existing activities already planned in the community. Examples of such activities range from health fairs to back-to-school nights, parenting classes to livestock auctions, street festivals and more. This revised tactic proved to be more effective in reaching consumers since people were already going to attend those events and it did not demand that they take extra steps.
Cynthia McCafferty: Of all the tactics you employed, which one was most successful and surprising?
Nancy Kelley: We continually marvel at the growth of the Cover Missouri Coalition. In April 2013, in response to the recognition that no other entity was well-positioned in Missouri to coordinate enrollment and outreach efforts, a 30 member steering committee was called together by the Missouri Foundation for Health. By the end of that year – just eight months later – membership had grown tenfold to 300. Clearly, the Coalition was meeting a need and continues to do so with current membership at just over 900.
It’s important to note that only a small fraction (33) of the 300 organizations belonging to the Coalition receive any level of funding from the Foundation. What do the others get out of it? It seems there are a number of aspects of the Coalition that are vital to its success:
- The Cover Missouri serves a critical role as a source of current, accurate news and information. The environment of shared learning seems to serve the Coalition members well.
- In addition, the structure has been inclusive from the start – if an individual or organization is interested, they are welcome.
- Finally, Cover Missouri has aimed to solicit frequent feedback from members and be responsive to their evolving needs.
Cynthia McCafferty: What advice do you have for others looking to educate people about complex issues?
Nancy Kelley: First, expect and plan for repeated delivery of the information in multiple ways. For example, someone may need to hear a message on the radio, then read a handout and then have a couple conversations about an issue before they decide to take action.
Second, assure that you are using the right messenger for the person or group you are aiming to reach. All the best information can be lost if the messenger is not a trusted influencer for the audience.
Third, strive to deliver all messages using the plainest language possible. This means for both written and verbal communication, lead with the main point followed by just a few details and end with a specific call to action. In conversation, it’s always a good idea to invite the listener to repeat back what they heard you say to be sure they understood the key points as you intended.