The next generation of direct enrollment: Improve customer acquisition and member experience with Enhanced Direct Enrollment (EDE)

Posted on July 3, 2018


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

EDE 101 – three direct enrollment challenges EDE will address for health plans and consumers

1. Today, health plan consumers are subjected to what is known as the ‘double redirect’ process in order to complete their Marketplace application. This process frequently causes confusion for 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), login to the Marketplace and complete an eligibility application, then finally return back to the health plan in order to enroll. Because the Marketplace application can be complicated, the health plan cannot directly help the consumer work through the process in order to successfully return back to the health plan’s website, leading to a very low success rate in the direct to consumer sales channel.

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

Starting this year with Enhanced Direct Enrollment (EDE), health plans have the ability to 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 login or visit healthcare.gov at all. That means when a customer starts their application online, they can remain on the health plan website for the entire experience to complete their enrollment. And because EDE will allow a health plan member to manage their information throughout the year, health plans will benefit by being able to fully service their members even when open enrollment ends.

This year, we’re 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.

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 full-integrated and seamless experience to apply, shop and enroll for coverage and as well as manage their plan.

For more information about how to integrate EDE with your customer experience, contact us today .