By Gene Lewit, Stanford University’s Center for Health Policy/Center for Primary Care and Outcomes Research
President Obama, in conjunction with many states, nonprofit organizations, insurance brokers and others, is set to embark on an outreach campaign designed to motivate almost 30 million Americans to enroll in health coverage made available through the Affordable Care Act (ACA). In order to facilitate enrollment, many states will offer online enrollment systems intended to provide high-quality customer experiences while maximizing online use and self-service for people applying for Medicaid, CHIP or exchange coverage. Some components of the outreach campaign will undoubtedly direct people to the online systems to enroll in coverage.
In two previous blogs posts on the site, I wrote about findings from Mathematica Policy Research’s evaluation of Health-e-Application Public Access (HeA PA) – a fully automated, web-based application that was originally designed for enrolling low-income children and pregnant women in California’s CHIP program (Healthy Families) or screening them for its Medicaid program (Medi-Cal). The first brief from the evaluation provided encouraging information about the positive impact HeA PA made on families’ ability to enroll their eligible children in public coverage programs. The second brief described the characteristics of HeA PA applicants and their experience with the self-service tool. The most recent brief, Outreach to Low-Income Families During the First Year of HeA PA, looks at the impact of the seven-month outreach campaign intended to boost enrollment in Medi-Cal and Healthy Families, and encourage use of the new online enrollment tool. Based on nearly 15,000 surveys completed by applicants in 2011 after they submitted applications, this brief offers insights for those designing outreach campaigns for the ACA.
Outreach for HeA PA began slowly. During the first six months that HeA PA was in operation, the state promoted it through existing communication channels, principally a link to the HeA PA website (www.healtheapp.net) on the Healthy Families Program landing page. But beginning in July 2011, the state launched a more aggressive campaign consisting primarily of paid online advertising in English and Spanish as well posters and flyers and a limited number of Spanish-language print ads in La Opinión and El Mensajero, newspapers with wide circulations in the Los Angeles and San Francisco areas.
The online ad campaign, described more fully in brief with examples of the ads themselves, aimed to convey four key messages: (1) affordable health care for children is available; (2) families can apply online for children’s health insurance; (3) HeA PA is a legitimate application route for Healthy Families, a trusted public program; and (4) the online application is user friendly and convenient. The online ads featured active links to the HeA PA website providing an immediate measure of audience response and allowing the components of the campaign to be adjusted over time to improve response rates.
The good news is that the online campaign was associated with a substantial increase in the number of unique visitors to the HeA PA website as compared to the number of visitors in the period before and after the campaign. And although the evaluator cannot tell with certainty whether the campaign lead more families to submit applications or choose HeA PA over other application methods, there is evidence that the campaign bolstered the use of HeA PA when it was active. Another piece of good news is that the campaign did not seem to disproportionately increase applications from ineligible families.
Interestingly, although the HeA PA outreach campaign drove traffic to the HeA PA website, simply featuring HeA PA on the main Healthy Families website and modifying existing communication channels to incorporate the website link also generated substantial use of HeA PA even before the campaign began. Oklahoma had a similar experience after launching an online application for Medicaid and CHIP in 2010. Accordingly, the brief’s author cautions that states considering new online self-service tools alone or in conjunction with expanded Medicaid eligibility should be prepared for high utilization even before an outreach campaign is in place.
It also appears advisable for states and the federal government to build into their online systems the capacity to capture data about the pathways through which applicants connect to these tools. Doing so could yield significant insights about the ad types and placements that are most effective in attracting eligible individuals and families.
Gene Lewit recently joined the Stanford University’s Center for Health Policy/Center for Primary Care and Outcomes Research; more information about Mathematica’s evaluation of HeA PA is available at http://www.mathematica-mpr.com/Health/health-e-aap.asp.
