The Affordable Care Act (ACA) offers an unprecedented opportunity for Connecticut to increase the number of people covered by health insurance. An important measure of the ACA’s success in Connecticut is its ability to enroll underserved populations through Access Health CT (AHCT) — the state’s new health insurance marketplace — into private insurance plans or Medicaid. This evaluation focuses on the consumer experience of the AHCT enrollment effort between December 2013 and March 2014, with emphasis on the experiences of underserved urban populations, as well of the navigators and in-person assisters who helped them. The goal was to identify factors that facilitated or impeded enrollment and outreach during the first open enrollment period in order to provide recommendations to enhance future targeted outreach and enrollment efforts. The evaluation was conducted and designed by CARE: Community Alliance for Research and Engagement at the Yale School of Public Health, using a multi-method approach. Alycia Santilli of CARE gave this presentation on 8/21/14 to a special meeting of the AHCT Board of Directors.

1. Evaluation of the Enrollment Experience in Connecticut
Raising up the Voices of Urban Consumers,
Assisters and Navigators
Jeannette Ickovics, PhD
Alycia Santilli, MSW
August 21, 2014

2. AIM: To evaluate Access Health CT enrollment
process from the perspective of consumers as well
as Assisters and Navigators
GOALS
1) Identify factors that facilitated or impeded enrollment and outreach,
particularly among underserved populations
2) Identify how consumer experience and satisfaction vary between in-person,
helpline and website
3) Identify consumer demographic characteristics that influence their
experience and satisfaction (race, education, age, etc.)
4) Identify factors that facilitate or impede the enrollment efforts of in-person
assisters and navigators

3. METHODOLOGY
SURVEYS
• 164 in-person surveys
• Consumers after enrollment
attempt
FOCUS GROUPS &
KEY INFORMANT INTERVIEWS
• 121 phone surveys
• Uninsured CT residents
6 Assister focus groups
in each region
6 Navigator phone interviews
in each region

4. KEY FINDINGS
In-person Assistance Stands Out
• Provided critical service for consumers unable to
navigate helpline and website
• Easier to get and use information
• Rated information significantly better
• Versus helpline or website

5. AVG RATING OF INFORMATION PROVIDED
(0=WORST, 10= BEST)
6.4
7.2
9.5
10
8
6
4
2
0
website (n=42) helpline (n= 17) in person (n=154)

6. ABILITY TO GET NEEDED INFORMATION
19
35
19
28
24
19
24
33
0
5
2
94
100
90
80
70
60
50
40
30
20
10
0
never sometimes usually always
%
website (n=42) helpline (n= 17) in person (n=154)

7. KEY FINDINGS
High Rates of Consumer Satisfaction
• 95% reported application and enrollment processes
were definitely or somewhat easy
• 90% would definitely recommend AHCT, and an
additional 9% would probably recommend AHCT
• Latinos, blacks and those with less education reported
higher satisfaction

8. DIFFERENCES IN SATISFACTION BY RACE
(0=WORST, 10= BEST)
9.3
9.5 9.6 9.8
8.5
8.9
9.3 9.4
8.3
8.6
8.9
9.3
10
8
6
4
2
0
application process enrollment process AHCT overall in-person information
Latino/a (n=78) Black (n=43) White (n=38)

9. KEY FINDINGS
Consumers Information Needs
• Priority: cost and availability of financial
assistance for insurance premiums
• Most common reason for non-enrollment:
need more information
• Translation: 98% of Spanish speakers who
needed an interpreter always got one

10. AHCT NON-ENROLLMENT
Total sample
n= 164
Did not enroll
n= 40
Enrolled
n= 124
24 needed additional information
16 will enroll at a later date
6 had technical problems
4 reported that insurance was too expensive

11. AHCT REACH
0 10 20 30 40 50 60 70 80 90 100
word of mouth
family/ friends
news programs
TV commercials
newspaper ads
library
Internet
radio commercials
percent of respondents
Informal Networks: Consumers mostly heard about
AHCT through ‘word of mouth’ and ‘family and friends’

12. AWARENESS OF AHCT
UNINSURED RESPONDENTS
25%
40%
35%
applied did not apply never heard of AHCT

13. KEY FINDINGS: ASSISTERS and
NAVIGATORS
Factors that facilitated enrollment
• Resource coordination and support:
o Outreach team
o Helpline
o Brokers
o Assister network
• Technology functioned properly
• Consumers did not have complex needs or
family situations

14. KEY FINDINGS: ASSISTERS and
NAVIGATORS
Factors that impeded enrollment
• Poor coordination and teamwork
• Lack of promotional materials and support
• Technology challenges
• Training gaps

15. RECOMMENDATIONS
1) Raise awareness of AHCT among hard-to-reach
populations through systematic, culturally
competent, targeted outreach.
2) Maintain a coordinated year-round program of
in-person assistance in all regions of the state of
sufficient size and strength to meet the needs of
underserved populations.

16. RECOMMENDATIONS
• Outreach
• Management and Coordination
• Training and support
• Year-round operation

17. RECOMMENDATIONS
Outreach
• Target consumers less likely to have heard of
the marketplace
– Spanish speakers, men, less education
• Adopt grassroots outreach strategy
• Leverage “word of mouth” strategy
– Latinos, African Americans, young adults under 35
• Improve/tailor marketing support for events
– web, social media, flyers, on-site

18. RECOMMENDATIONS
Management and coordination
• Improve communication and coordination
– Access Health CT
– Department of Social Services
– Office of the Healthcare Advocate
– Those providing in-person assistance
• Fund and strengthen Navigator function
– To preserve crucial regional coordination and oversight
of in-person assistance

19. RECOMMENDATIONS
Enhance support
– Training
– Technology: website, wi-fi access, laptops
– Real-time troubleshooting (helpline and IT support)
– Language translation

20. RECOMMENDATIONS
Provide year-round operation
• Ongoing outreach and in-person enrollment
assistance in underserved communities
• In-person assistance to help consumers use,
maintain and renew insurance coverage

21. FUNDERS