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Improve Customer Acquisition and Member Experience with Enhanced Direct Enrollment (EDE)

Shopping, enrolling, and managing health insurance is about to get much easier for your consumers during OEP/AEP. A new program created by the Centers for Medicare & Medicaid Services (CMS) called Enhanced Direct Enrollment (EDE) would give health plans the ability to provide a significantly improved and full-featured customer experience.

The Three Challenges with Enhanced Direct Enrollment

1. Health Plan consumers are subjected to what is known as the ‘double redirect’ process to complete their Marketplace application. This process frequently confuses consumers trying to complete their application, and health plans lose potential sales. The ‘double redirect’ process requires a consumer to navigate from the health plan’s website to the healthcare.gov (Federal Marketplace), log in to the Marketplace and complete an eligibility application, then finally return to the health plan to enroll. Because the Marketplace application can be complicated, the health plan cannot directly help the consumer work through the process to successfully return to the health plan’s website, leading to a little success rate in the direct to the consumer sales channel.

2. Agents also must go through the ‘double redirect’ process and while agents are experienced professionals, they have a higher success rate of enrolling consumers using the ‘double redirect’ process, but it remains a complicated process.

3. Additionally, when healthcare.gov website traffic is high on busy days, agents are subject to the dreaded ‘waiting room’ and are not able to quickly meet a client’s needs whether in person or by phone. As a result, consumers get lost in the process and either switch channels, call another agent or give up.

The Solution: Better end-to-end visibility to data and an improved customer experience

Because of this complex system to enroll, carriers have a significant blind spot when it comes to acquiring new members. Simply put, health plans do not have useful end-to-end data about its full customer’s experience with the Marketplace. When health plans cannot accurately track the ‘fall-off’ point for consumers, it is impossible to provide helpful information to consumers to help get their application back on track and through to submission.

With Enhanced Direct Enrollment (EDE), health plans can completely change that experience for the better. Now consumers and agent/brokers will be able to apply, shop, enroll and manage policy changes to Marketplace health plans without having to log in or visit healthcare.gov at all. That means that when a customer starts their application online, they can remain on the health plan website for the entire experience to complete their enrollment. Moreover, because EDE will allow a health plan member to manage their information throughout the year, health plans will benefit by being able to service their members even when open enrollment ends entirely.

We are working in direct partnership with CMS as part of the EDE alpha team to consolidate and simplify the enrollment experience for our health plan clients. We’re piloting the EDE functionality using our digital enrollment platform, SalesConnect. Throughout the pilot, our health plan clients will receive conversion rates and funnel reports so that they can better understand their customer’s journey to submit an application and identify any pain points along that journey.

SalesConnect EDE Tool GuideWell Connect

Digital enrollment platforms that offer EDE not only improve the customer’s experience and make enrolling easier; they’re also beneficial to health plans. Moving from classic Direct Enrollment to Enhanced Direct Enrollment allows us to provide our clients’ consumers with a fully-integrated and seamless experience to apply, shop and enroll for coverage and as well as manage their plan.

Want to learn more? If you’re attending AHIP’s National Conference on the Individual and Small Group Markets on March 14 - 15, 2019 don’t miss the panel session on Enhanced Direct Enrollment: Lessons Learned and Looking Ahead, where GuideWell Connect’s Senior Director of Product Delivery, Rob Fitzgerald will be participating.

Rob is accountable for the product management and delivery at GuideWell Connect (“Connect”), responsible for SalesConnect, GWC’s consumer and agent/broker-facing digital Shop and Apply application with integrated Enhanced Direct Enrollment. He has 17 years of experience in the health insurance industry, particularly in sales, enrollment and consumer data. Prior to his current role, he has managed enrollment & billing systems, spent several years in U65 market segment strategy, and led a large issuer’s implementation of the ACA/healthcare.gov. Rob actively participates in strategic and operational workgroups directly with CMS for healthcare.gov.

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