Federal & State Insurance Marketplaces: OEP Lessons Learned

Scott Rathke

Open enrollment for the Federally Facilitated Marketplace (FFM) and State-Based Marketplaces (SBMs) had an inauspicious debut in 2014, one beset by a host of problems requiring a number of workarounds by insurance marketplaces and health plans alike to ensure everyone who sought coverage could access it.  Some SBMs, such as Maryland and Massachusetts, had such significant problems that they simply rebooted in 2015 with new, but now-proven, technology. Others, like Nevada and Oregon, changed their platform entirely to one supported by the FFM.

The good news is both the FFM and SBMs leveraged lessons learned from the first open enrollment to create a more efficient, user-friendly experience 2015 Open Enrollment Period.

Much of last year’s back lash was isolated to the FFM, which was utilized by 36 states. HealthCare.gov was inundated with serious system errors impacting application processing, information exchange and site access. Too many simultaneous site users caused shut downs and left prospective enrollees stuck in a virtual “hold” queue.

For 2015, the FFM underwent a comprehensive overhaul and today boasts three cloud servers to manage traffic surges. New fail-safe measures also protect data if an application gets terminated mid-way through enrollment.

The SBMs also responded to capacity challenges.  Some adopted a staggered approach which allowed consumers to browse (but not buy) plans a week before open enrollment. By “filtering” people into the system, states were able to avoid logjams and more easily identify and fix glitches. Part of this approach also included the creation and/or expansion of offline information channels, including open enrollment fairs, call centers and in-person application assistance.

Other SBMs, such as California, streamlined the open enrollment process by offering early renewals, letting returning members beat the rush while avoiding a backlog.

While the 2015 “front end” member experience is much cleaner, the functionality necessary for health plans to administer new business on the “back end” is still lacking.  Important areas like membership reconciliation and subsidy payment reporting lack developed capability resulting in manual processes for issuers.   Further, members have found renewal processing to be challenging and confusing.

To help combat these issues, the Centers for Medicare & Medicaid Services (CMS) continually seeks input from the CMS Alpha Advisory Group, a group of issuer partners who help with troubleshooting and shoring up the technical infrastructure to improve the overall user experience. These trading partners, of whom Health Plan Services is the only vendor member, have demonstrated their industry leadership with a front-line resolute focus on preparedness.

By learning from inaugural mistakes and tapping into industry expertise, CMS and the SBMs have erased some of the negative impressions left by the near-disaster that marked the first open enrollment. This has ensured that participants can access the insurance coverage they need with limited inconvenience. However, while 2015 is an improvement over 2014, there is still much work to be done.