By Katie Kerwin McCrimmon
Colorado’s health insurance exchange has morphed from a Travelocity-style self-service website to an online interface with in-person navigators slated to help hundreds of thousands of customers choose from an array of complex health plans.
The most vexing questions now are if there will be enough navigators and who will pay them to avoid conflicts of interest.
New surveys of potential health exchange clients released Monday found customers want simple TurboTax-style guidance, help from people in their communities whom they trust and side-by-side comparisons of complex health plans.
Doubts are surfacing, however, about how exchange managers will be able create this system by Oct. 1 and how they can avoid having navigators or health insurance brokers steer clients to plans that financially benefit the workers or health systems they represent.
Jim Riesberg, Colorado’s commissioner of insurance, said during an exchange board meeting Monday that building such a large customer service force will be a massive task.
Riesberg calculated that in order to enroll the anticipated number of clients, the state will need enough navigators to enroll 800 people a day, 24/7 for at least six months.
“That’s a lot of navigators. Where are they going to come from?” Riesberg said. “That’s a major marketing function…and the largest sales force to be created in a short period of time that any Colorado company has done.”
Colorado’s exchange board also voted last summer to allow health insurance brokers to participate in the state’s health exchange. Brokers traditionally get paid through commissions from health insurance companies. But federal regulations prohibit any kinds of commissions for navigators. Health exchange managers are considering using grant funds to pay navigators. But if they do that, it’s unclear how customers will know they’re getting unbiased advice about health plans.
Exchange Executive Director and CEO Patty Fontneau said Monday that having enough customer service workers will require help from multiple sources.
“There’s going to be a lot of work for anyone — from call centers to technology to our navigators and brokers. It’s going to have to be all hands on deck,” Fontneau said.
While managers try to figure out how to run Colorado’s health exchange, outreach workers from the Colorado Consumer Health Initiative, the Colorado Center of Law and Policy and the CoPIRG Foundation have been surveying health workers and potential clients to learn their thoughts on navigators and how the exchange can effectively serve customers. The groups held 20 meetings across the state with a total of 414 consumers and health workers. They also surveyed 109 community organizations and received responses from people in 32 of Colorado’s 64 counties.
The groups recommended:
- Creating a comprehensive, integrated system of support including call centers and navigators.
- Using multiple technologies including in-person, mobile vans, telephone, online and mobile platforms to educate and enroll exchange clients.
- Offering customer service that is culturally and linguistically accessible from trusted sources.
“This is a big task,” said Elisabeth Arenales, director of health care programs for the Colorado Center on Law and Policy. “People want a high-quality experience. They want to be treated with respect. They want to know how to use the exchange. Many don’t understand insurance. It’s very confusing and pretty daunting. They want to be able to understand the kind of help that’s available to them.
“The bottom line is we need to be creative and reach people where they are,” Arenales said.
With respect to navigators, the consumer groups said it’s critical that Colorado’s health exchange managers:
- Ensure sufficient funding to support the navigator program;
- Develop a comprehensive training program;
- Create quality improvement measures to ensure a positive experience for consumers.
“The exchange will only fulfill its mission of increasing affordability, access and choice around health insurance if it works for all Coloradans,” said Danny Katz of CoPIRG. “By talking with hundreds of them across the state, we know it will be critical for the exchange to offer face-to-face assistance to navigate the complicated world of insurance as well as an online step-by-step website that includes a cost calculator, consumer reviews, plan ratings and other tools that increase people’s health care literacy so they can find the best plans for them.”
Dede de Percin, executive director of the Colorado Consumer Health Initiative, a coalition of groups that represent over a half-million Colorado consumers, said many organizations are interested in providing navigators to help the exchange. But they’ll need adequate funding and training.
To see more survey information or infographics outlining the results, click here.