Health exchange needs army of navigators to aid customers

By Katie Kerwin McCrimmon

Colorados 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, Colorados 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.

Thats a lot of navigators. Where are they going to come from? Riesberg said. Thats a major marketing functionand the largest sales force to be created in a short period of time that any Colorado company has done.

Colorados exchange board also voted last summer to allow health insurance brokers to participate in the states 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, its unclear how customers will know theyre 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.

Theres going to be a lot of work for anyone from call centers to technology to our navigators and brokers. Its going to have to be all hands on deck, Fontneau said.

While managers try to figure out how to run Colorados 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 Colorados 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 dont understand insurance. Its very confusing and pretty daunting. They want to be able to understand the kind of help thats 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 Mondays meeting. From left to right, Steve ErkenBrack, Gretchen Hammer, Patty Fontneau, Richard Betts and Arnold Salazar.

With respect to navigators, the consumer groups said its critical that Colorados 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 peoples 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 theyll need adequate funding and training.

To see more survey information or infographics outlining the results, click here.