Special Open Enrollment Checklist – Is Your State Ready?

The 14 state based Marketplace platforms must ensure customers can enroll during the Special Open Enrollment Period April 1st – April 30th (for Connecticut residents). The Feds will be doing the same preparation supporting 37 states (1).

 

Your organization likely has already taken many of the steps below.  However, we all know what they say about ‘assumptions…’ It’s best to double check and validate your organization is truly prepared.

 

Below is a good checklist with questions to ask your leaders, validating your open enrollment approach is stable.

 

Checklist for Special Open Enrollment (SEP)

1. Security – if there is a security breach or violation, what is the escalation approach? If you ask two random staff members are they clear on the procedure, or are only a few people briefed?

 

2. Business Validation – how is business validation being conducted and when does that occur? Which mock business scenarios are being executed to ensure critical functionality works as planned?

  • Business Health Check– how are business process changes communicated internally and through the call center to ensure reps are communicating consistently?
  • Technical Health Check – is there a playbook for a morning system health check including ETL, databases, application servers, HTTP servers, shared services/ Federal Data Services Hub, batch, rules and notice generation? Do we have a process to generate hourly exception reports highlighting issues with the Federal Data Services Hub before our customers notify us?

 

3. Training and Education – is the field staff trained and clear on the conditions of who can enroll during this special period? What training have in-person assisters, brokers, internal staff, call center staff and operations had to prepare?

  • Health Insurance Terminology – where do members of your organization go for the answer to ‘what does this mean?’
  • Enrollment Paths – are folks clear on when to use which path to enroll customers? For example, APTC quick flow, leveraging the call center or when to lead a customer towards in-person assistance at a store or benefit center?
  • Coverage Dates – does the staff know what date and time you must have enrolled by to have May 1st effective healthcare coverage? When do insurance plans expire for customers?

 

4. Reporting Enrollment Numbers – how are we doing to report numbers to CMS/CCIIO? What is the frequency and who’s on point (2)?

  • Expectations of Analytics – have you communicated to CMS/CCIIO what enrollment numbers will be communicated, when?

 

5. Issue Communication – when there are issues, and there will be issues, how does the team communicate? An escalation bridge? Command center calls or just a flurry of emails? The approach should be consistence and have a cadence for communication frequency. How are new issues logged and triaged? If a team member is made aware of an issue-now what? How do vendors report issues? What is the chain-of-command to ensure those issues are presented, logged and addressed?

  • System Change Requests – how are system changes requests handled? How do we loop back to the requestor with new information when made available?
  • Carriers – what is the communication process to carriers? Is it the same as normal? What is normal anyways? How are carriers communicating issues regarding reconciliation and member enrollment?

 

6. Identify Hard Stops – have you identified where the hard stops are in your application flow? For example if the FDSH identify proofing service goes down, can customers use a secondary service or are they stopped dead? If the income services from FDSH times out, now what? The effectiveness of your decisions are primarily based on the quality and timeliness of the information from which you’re making decisions. Establish a clear plan to move information quickly to the resource making decisions.

 

7. Media Strategy – when and how does information go to the media to ensure the state is proactive with positive information and gets ahead of challenges as they arise?

 

8. Ancillary Products – for dental and vision etc. has a business and system process been setup to support this open enrollment period? Who do customers call? How do escalations occur? I’ll take liberty and bucket SHOP in here as well. How are employers notified? What communication is going to newly enrolled employees?

 

Lastly what type of website and IVR messaging is being setup to help funnel customers down the right path? Are you adding a banner to the website, changing the initial IVR message?

 

Although there were not excessive system changes required for this Special Open Enrollment Period, setting up a daily command center call, is a good idea to ensure leaders have equal awareness of new challenges.

 

 

References:

 

  1. Centers for Medicare & Medicaid Services. (2015). Getting 2015 coverage with a Special Enrollment Period. Retrieved from https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/

  2. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. (2015). Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report (pp. 1–73). Retrieved from http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Mar2015/ib_2015mar_enrollment.pdf

  3. DRUMMOND, K. (2012). Image Source. Retrieved from http://www.prevention.com/health/health-concerns/new-checklist-help-early-ovarian-cancer-diagnosis

 

Previous articleAgile: The History Never Read
Next articleTaught to Succeed – Not How to Fail
Peter is a healthcare business and technology executive, recognized for Digital Innovation by CIO 100, MIT Sloan, Computerworld, and the Project Management Institute. As Managing Director at OROCA Innovations, Peter leads the CXO advisory services practice driving digital strategies. Peter was honored as an MIT Sloan CIO Leadership Award Finalist in 2015 and is a regular contributor to CIO.com on innovation. As Head of Information Technology, Peter was responsible for Connecticut’s Health Insurance Exchange’s (HIX) industry-leading digital platform transforming consumerism and retail oriented services for the health insurance industry. Peter championed the Connecticut marketplace digital implementation with a transformational cloud-based SaaS platform and mobile application recognized as a 2014 PMI Project of the Year Award finalist, CIO 100, and awards for best digital services, API, and platform. He also received a lifetime achievement award for leadership and digital transformation, honored as a 2016 Computerworld Premier 100 IT Leader. Peter is the author of Learning Intelligence: Expand Thinking. Absorb Alternative. Unlock Possibilities (2017), which Marshall Goldsmith, author of the New York Times No. 1 bestseller Triggers, calls "a must-read for any leader wanting to compete in the innovation-powered landscape of today." Peter also authored The Power of Blockchain for Healthcare: How Blockchain Will Ignite The Future of Healthcare (2017), the first book to explore the vast opportunities for blockchain to transform the patient experience. Peter has a B.S. in C.I.S from Bentley University and an MBA from Quinnipiac University, where he graduated Summa Cum Laude. He earned his PMP® in 2001 and is a certified Six Sigma Master Black Belt, Masters in Business Relationship Management (MBRM) and Certified Scrum Master. As a Commercial Rated Aviation Pilot and Master Scuba Diver, Peter understands first hand, how to anticipate change and lead boldly.