Thousands look, 226 buy during exchange debut

By Katie Kerwin McCrimmon

Colorados new health exchange has attracted thousands of visitors since its launch on Oct. 1, but only 226 pulled the trigger and bought insurance as Obamacare officially launched.

High traffic to the Connect for Health Colorado website caused technology glitches that prevented many people from being able to create accounts immediately after the exchange launched. Those problems continued through last week and prompted two unscheduled shutdowns to reboot the exchanges software, technology managers said.

Even so, as of Friday, about 28,000 people have created accounts and about 204,000 unique visitors have surfed the site that offers health plans to individuals and small businesses, managers said. They say the system overloads that prevented people from creating accounts are now largely resolved.

Thats not the case with the federal health exchange, which has been bombarded with high numbers of visitors, most of whom cant sign up or shop for health plans.

Colorado is one of 15 states that opted to build their own health exchanges, a decision that board members celebrated during a board meeting Monday.

There are a lot of misconceptions that were having a lot of the same issues (as the federal exchange), said Dr. Mike Fallon, an emergency physician who runs urgent care centers and sits on the Connect for Health Board. Colorado made the right choice in doing this on our own.

Still, Colorados exchange is grappling with some problems including:

  • Long call times at the exchanges Colorado Springs call center, some of which have lasted over an hour. The long calls tie up agents and underscore the complexity of helping people buy complicated insurance plans. Overall, managers say wait times to talk to an agent have decreased from over six minutes on Day 1 to about a minute as of Friday, and the average call time is about 13 minutes.
  • A rocky start working with brokers. Account set-up functions also worked poorly for brokers and customer service agents at the call center were not able to help them when client information failed to load properly. If theres room for great improvement, its with that group (brokers), said Patty Fontneau, CEO and executive director of Connect for Health.
  • Higher than expected numbers of chats that required a shifting of duties at the call center.
  • A backlog of emails that are only now being returned relatively quickly.
  • Some frustrations from customers who have not gotten real-time determinations about whether they qualify for Medicaid, and must wait in limbo before they can buy on the health exchange.

This is going to be fits and starts because its complicated, Fontneau said, The most important thing is that we need to give people what they need now. Then, with whats confusing to them, how do we make it easier for them to do this themselves?

Among the groups that Connect for Health Colorado is targeting in its new ads are restaurant workers and small business employees.

Fontneau said better training so call center agents can assist brokers will help the exchange reach its goal of enrolling about 136,000 people by the end of 2014.

If every broker sold one plan per day, we would hit our numbers, she said.

Overall, she said that the launch was going very well and that she was delighted by the traffic to the site.

Nonetheless, board member and technology expert Eric Grossman wanted to know how Fontneau and other managers plan to transform shoppers into buyers.

As you start to look at enrollments, were at about a 1 percent conversion of accounts created to enrollments. What are some of your thoughts on closing the gap? Grossman asked.

Thats the reason we didnt want to do enrollments, Fontneau said of the tally that 226 people had enrolled in plans. (Some of them are covering dependents, which brings the first-week number to 305 covered lives.) You cant look at the first few days. These are numbers that Im not surprised to see nor am I happy to see. Weve had tremendous interest. The fact that not that many people bought in the first week is not concerning to me.

Health insurance industry representative Marc Reece of the Colorado Association of Health Plans echoed Fontneaus comments after Mondays meeting. He said insurance companies didnt expect a flood of purchases immediately after the exchange opened.

Its going very well, Reece said. I think any of the hiccups we heard about were not unexpected. It hasnt hurt the shopping experience. The carriers have been pleased.

Unlike some states, Colorado chose to allow customers to anonymously shop for health insurance and to get estimates on how much they might qualify for in tax breaks from the federal government to make health insurance more affordable. That means that consumers have been able to poke around on the site even if they arent yet ready to buy or had trouble creating accounts.

Consumers cannot apply yet for tax credits online. For now, they have to go through the call center in Colorado Springs. Managers plan to launch the online tax subsidy portion of the site by Nov. 1.

After having some wrinkles testing online provider directories, exchange managers are planning to add the directories to the Connect for Health site this week. That would allow customers to enter the names of their providers and be guided immediately to plans that include their doctors.

Latinos are uninsured in high numbers in Colorado. The new health exchange is trying to entice them to buy through a Spanish language website and targeted ads.

For some consumers, the process of signing up has gone well, while others have struggled.

Karen Spink of the Health District of Northern Larimer County spoke to the Connect for Health board Monday about what she and fellow health coverage guides in the Fort Collins area have experienced on the ground.

She said her group deliberately did limited outreach to potential clients knowing that there could be challenges during the debut.

Overall, she said her group has served 37 clients so far. She said customers want to spend at least 60 to 90 minutes with health coverage guides and some of them want to come back for repeat visits.

This is a major life decision for them to make and it may take more than one visit, Spink said.

Some clients are very frustrated that they have to fill out the Medicaid application even if they know they wont qualify.

Some people are very frustratedand still have to go through it, she said.

Many end up in limbo when they dont get a definitive answer from Colorados Medicaid system, which is called PEAK.

They know they wont qualify and they want to move forward, she said.

She said shes seen the systems work well and very poorly. On the same day, one client got a real-time determination from PEAK that he was not qualified for Medicaid, then was able to pick a plan and connect with an agent at the Connect for Health. That person was ready to purchase after 80 minutes.

That same day, a different client couldnt get a real-time determination, had to wait 8 minutes on hold for a call center agent, then was told to wait for a financial representative. The customer spent another 40 minutes on hold, couldnt get a real-time determination about Medicaid and was told it could take 7 to 10 days to move forward. The client stayed 2 1/2 hours at the assistance center, Spink said.

Of the 37 clients, five got real-time Medicaid determinations.

Weve seen mixed responses. Some people feel overwhelmed and nervous about the costs.(Some) are thrilled at what theyre seeing. Others, who dont qualify for subsidies feel that this is unattainable for them and leave frustrated, Spink said.

She said that health coverage guides continued at times to have trouble creating accounts.

Fontneau encouraged Spink and other workers on the ground to continue reporting their concerns.

Keep the lines of communications open, Fontneau said. Its a huge undertaking. We didnt go into this expecting things to be perfect.

As for Medicaid, Colorado director Sue Birch said that in the first 10 days, about 9,000 people applied through the online portal, PEAK. Of those, about 53 percent or 4,800 applicants had been referred from Connect for Health. Of the 9,000 applicants, 3,814 received a real-time approval or denial, while an additional 4,211 got a preliminary decision, but had to provide additional paperwork.

Birch said 47 percent of applicants went through the process without needing help from a PEAK agent.That number will continue to increase as we continue to refine the process, Birch said. She said there are more than 60 reasons that a customer can be denied Medicaid, ranging from failing to provide a Social Security number to not being a Colorado resident.

Were really pleased, but weve got to keep refining (our systems), Birch said.

Board member and health insurance executive Steve ErkenBrack of Rocky Mountain Health Plans said its critical that people get definitive answers about whether they qualify for Medicaid so they dont mistakenly sign up for private health insurance.

Fontneau said customers cant buy until Colorados Medicaid office gives them a definitive answer.At this point, we are not moving anyone through until they get a denial, she said.

Complications with all the systems will matter more as weeks pass. Coverage starts on Jan. 1, 2014 for customers who buy by Dec. 15. The open enrollment period continues through the end of March. If customers dont buy by then, they could face penalties for lack of health insurance since the next open enrollment period will not begin again until fall of 2014.