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.
Consumer representatives urged Colorado health exchange board members to adequately fund and train navigators around the state. From left to right, Debra Judy and Adam Fox of the Colorado Consumer Health Initiative and Lisa Ritland of CoPIRG.
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.
Health exchange board members at Monday’s meeting. From left to right, Steve ErkenBrack, Gretchen Hammer, Patty Fontneau, Richard Betts and Arnold Salazar.
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.
All states have licensed, expericensed brokers ( many who have been enrolling people in health plans for years) Who can easly handle the tasK..many of these people are members of http://www.nahu.org easy to reach….However why do we want to re-invent the wheel and hire people off the street and try to train them to enroll people in a complex product…..not an easy task..Also who are going to service the people after they enroll?…There is more work in servicing the people then enrolling them..the navitagors?….If there is a promblem or issue people will be back to the people who enrolled them..Are you prepared for that?…Would you trust YOUR health insurance plan to an newbie navigator who has been on the job for a few months?……..
I agree with MKing. To preface my remarks I need to point out that we’ve known this problem was coming for over 60 years 37 of which I have worked in the industry. It has always been very clear that something needed to be done or the system would run beyond its capability to support itself. Like most things with Americans however nothing is addressed until it becomes a crisis. While I agree in principle with much that this law encompasses it is ill-conceived and the bureaucracy that is growing around it is atrocious. I am sure that Colorado, like most states, has thousands of highly qualified agents. Medicare enrollment is currently handled by qualified agents who have gone through the training. They did not have to find an entire new stable of people with no background. Colorado is warming up for a disaster of monumental proportions if they do not include the qualified people they have now. Their problem is finding people who are qualified, can do the work, and are willing to do it for free. There must be a problem in there somewhere. If I sound a little terse with my response it is because I grow very weary of the lunacy and stupidity that surrounds this law. I welcome responses and would be willing to debate or discuss this with any industry interested individual or group.
I would like to put forth a simple proposal that if implemented will solve the problem of having brokers be navigators without any conflict of interest. This solution should be acceptable to all the parties involved, the states, the exchanges, the federal government, health insurers, brokers and, most importantly, the insureds. It is a win-win solution for everyone:
Allow health insurance brokers to become navigators but not be paid commissions by the insurance companies. Instead, health insurers would pass on to the exchange the acquisition cost that is normally built-in to health insurance premiums and the exchange can compensate broker-navigators as a fee-for-service. This acquisition cost must be uniform across all insurers to avoid giving broker-navigators a financial incentive to favor some insurers over others. If the exchange wants to reduce the insureds’ premiums even more, broker-navigator compensation can be funded from the monies provided to the exchange by the federal government.
In the health insurance industry brokers currently receive a residual income in the form of annual renewal commissions. This is the incentive that brokers receive to continue providing service to insureds after the initial sale and installation of a policy. In order to assure that broker-navigators continue to provide on-going service to their insureds, the exchange should pay broker-navigators a flat renewal fee which, again, can come out of the insurer’s built-in acquisition cost.
Because the enrollment goes to the insurer from the exchange, health insurers don’t have to know which broker-navigators are directing insureds to their products. This will prevent any type of conflict of interest in the form of additional compensation to broker-navigators from health insurers, such as paid conventions or other perks.
In all probability this solution will not require additional legislation by congress to amend the Affordable Care Act, since the states have enough autonomy under the law regarding how to establish the operation of their exchanges.
Good Article. I echo most of the concerns expressed by the people who have already commented.
However, what has yet to be addressed is the issue of whether Navigators are going to be licensed or not. If not, they shouldn’t ba allowed to take applications and do enrollments. Are they going to spreadsheet the alternatives and make recommendations? The task of setting up a call center, getting staff licensed and trained is daunting. Combine this with the fact that most call centers in the Medicare World hire people on a season basis, then lay them off and rehire a new batch every year. It costs a fortune to keep staff on past the annual enrollment period. But, the training effort is huge.
The average call center employee is paid $11 to $14 an hour.m
It appears Exchange staff see the brokerage community as the enemy. No matter what they say in public, they are trying to figure out how to dis-intermediate the health insurance distribution channels and capture broker commissions so as to fund the exchange. They have no other source of funding within easy reach.
Are insurance brokers and consultants destined to go the way of travel agents? If so, then the computer systems need to be much better architected than the Colorado Benefits Management System which cost $300 million dollars and is still a disaster zone.
The same large insurance carriers who sit on the Exchange Board are engaging in polite civility by day and waging war by night using the light of the moon. The big insurors are encouraging the staff to venture forth into a minefield, all the while, positioning their companies to launch private exchanges. United Healthcare has purchased Connextions through its Optum subsidiary and Kaiser is building a 500 person IT facility in Lone Tree. Blue Cross has purchased Bloom out of Minneapolis. Even AFLAC is building an exchange. The list goes on. Every major carrier has a covert operation underway to launch private exchanges. They expect the state government run exchanges to fail and will shed crocodile tears when it happens. And, don’t overlook the fact that the major big box retailers like Walmart have skunk-works development efforts underway to enter the health insurance industry. Any economic sector that channels 20% of the GDP is sure to attract sharks once there is blood in the water. If you think Walmart doesn’t have the muscle to do the job, remember who brought us $4 prescriptions.
The common thread running through all these efforts is the use of internet and call center technology to eliminate the need for insurance brokers and consultants. Nowhere on the blueprints is any mention of brokers. They are expected to disappear like the dinosaurs and the woolly mammoths.
All of this suggests a complete bull-dozing of the insurance landscape. Accountable Care Organizations are taking on risks and hospitals and doctors are conspiring to vertically integrate and set prices. Even a few years ago the Insurance Commissioner would have insisted that these risk bearing groups obtain a Certificate to operate. No longer.
And, state law expressly forbids cooperatives from engaging in insurance. Yet, the feds have funded the startup of a cooperative and its application to operate is pending subnmittal and approval.
The feds demanded and the feds got, in return for all the funding, a tacit agreement to embrace an Essential Benefits Plan that eclipses state legislated mandates over a twenty year period.
The Colorado State Legislature and the Division of Insurance appear willing to surrender state sovereignty in the insurance area without a shot being fired. From the creation of the Exchange, the Cooperative, ACOs and EBP’s, there has been no voice of opposition. All of this comes on the heels of years of failed attempts to reform health care. From the reign of Governor Richard Lamm through the Colorado 208 Commission there has been failure. Now it appears that failure has put the federal government in charge. R.I.P.