A Joint Project of The California Health Benefit Exchange, the Department of Health Care Services (DHCS) and the Managed Risk Medical Insurance Board (MRMIB)
Executive Summary
Guiding Principles
The plan reflects the following principles articulated by the Project Sponsors. These principles served as the guide for the consultants and staff in the development of the plan’s components and will guide its implementation as the Project Sponsors move forward.
Guiding Principles:
1. Promote maximum enrollment of individuals in coverage – including subsidized coverage in the Individual Exchange and Small Business Health Option Program (SHOP), Medi-Cal and Healthy Families programs, as well as for individuals who can purchase coverage without subsidies.
2. Build on and leverage existing resources, networks and channels to maximize enrollment into health care coverage, including close collaboration with state and local agencies, community organizations, businesses, and other stakeholders with common missions and visions.
3. Consider where eligible populations live, work and play. Select tactics and channels that are based on research and evidence of how different populations can best be reached and encouraged to enroll and, once enrolled, retain coverage.
4. Marketing and outreach strategies will reflect and target the mix and diversity of those eligible for coverage.
California Statewide Marketing, Outreach & Education Program:
5. Establish a trusted statewide Assisters Program that reflects the cultural and linguistic diversity of the target audiences and results in successful relationship and partnerships among Assisters serving state affordable health insurance programs.
6. Ensure Assisters are knowledgeable of both subsidized and non-subsidized health coverage and qualified health plans and that Assisters are equipped with the information and expertise needed to successfully educate and enroll individuals in coverage, regardless of the type of program for which they are eligible.
7. Promote retention of existing insurance coverage in public programs and the individual market, as well as in employer-based coverage.
8. Continue to learn and adjust strategies and tactics based on input from our national partners, California stakeholders, on-going research, evaluation and measurement of programs’ impact on awareness and enrollment.
As we move forward and continue our own critical outreach, we will learn from and coordinate with others’ good work in all areas. Other states and national partners are engaged in their own research, messaging and creative development around launching these new marketplaces. We will continue to coordinate and share with them so that our plans – both theirs and ours– can be informed by best practices and key learnings from around the country. We will also continue to coordinate with partners and stakeholders in California who share our vision and are already engaged in programs promoting health insurance coverage (e.g., foundations, hospitals, community clinics, health plans, etc.). This in-state coordination and national sharing commitment will be a critical component of our work in the coming years as California and the nation embark on the biggest change in promoting affordable health coverage since Medicare.
Situation Analysis and Plan Overview
Creating a new health care system (an “exchange” or “marketplace”) designed to operate for a state as large and diverse as California, which must successfully reach an uninsured target of more than five million multi-ethnic, multi-language Californians, is a Herculean task requiring a significant investment. Those without legal status are not included in our targets, but many of them will live with those who are. This is just one of many challenges facing this new marketplace. Add the need to serve small business, and it is clear that what California needs is an aggressive outreach, public awareness and Assisters Program based on the utilization of a wide variety of tools: careful research; targeted mass, social and paid media; public relations; partnerships with a wide array of community, faith, labor, industry, health care, business and other organizations; and a simple, web-based enrollment portal.
This plan incorporates all of these tools. In addition, as required, the plan’s elements for outreach include consideration of core principles and opportunities for seamless coordination with public coverage programs and the Project Sponsors: The California Health Benefit Exchange, the California Department of Health Care Services (DHCS) and the Managed Risk Medical Insurance Board (MRMIB) as well as the programs they administer: Medi-Cal, Healthy Families, Access for Infants and Mothers program, Pre-Existing Condition Insurance Plan, Major California Statewide Marketing, Outreach & Education Program: Risk Medical Insurance Program and other state health insurance programs. The California Office of Patient Advocate will also be providing outreach, education and consumer assistance.
In the development of this plan, we paid careful attention to California’s complex linguistic and cultural diversity, especially among potential marketplace enrollees, partners and stakeholders. Further, the sheer size of California, its expensive and broad media markets (we have 11 distinct media markets as well as 13 threshold languages) and California’s complex urban and rural communities, necessitate collaboration with a wide range of stakeholders, foundations and influencers.
Our initial input came from a wide array of sources, including from a series of meetings the Projects Sponsors held across the state, from stakeholders’ written communications with the Project Sponsors, and a review of a wide array of background material (see www.hbex.ca.gov for background material and the report on stakeholder recommendation on outreach and assistancehere). This plan has been presented to the Exchange Board and the public twice allowing for both written and oral feedback from stakeholders aboutstrategies and best practices for marketing, eligibility, Assisters/Navigators, enrollment and retention programs for individual targets with distinct cultural differences, as well as tactics to reach individuals with special literacy, health care literacy and/or language needs. Many groups participated in information sharing including the Project Sponsors.
We heard from small community-based organizations as well as those serving state-wide constituencies. The Final Work Plan presented here and adopted by the Project Sponsors reflects this extensive feedback from stakeholders, Project Sponsors and Board Members. In addition to this input of stakeholders, we also reviewed primary and secondary data to further identify the targets, their media habits and preferences for receiving information. We reviewed materials from and had discussions with other exchanges, including those in Massachusetts, Maryland, Colorado, Washington, Washington, D.C., and New York. And, we conducted four initial focus groups (two in English and two in Spanish; results are available on the Exchange website).
Using this information, we developed a plan that combines a mix of marketing campaign elements, including paid advertising, media relations, community education, grassroots outreach, partnerships, small business outreach, social media, and direct marketing. Capitalizing on partnerships to extend our reach and impact, the plan relies on a focused and clear voice. The goal is to build a distinct and resonating brand that includes our Project Sponsors and their programs, at the same time embracing the many cultural and linguistic differences in California that will ultimately lead to the enrollment of the millions of eligible Californians who lack healthinsurance. Finally, the plan provides a comprehensive Assisters Program to make sure those individuals who need or prefer one-on-one assistance get the information they need to facilitate enrollment in the plan best for them.
This marketing program is proposed to be organized in seven discrete phases; each one corresponds to the work needed for the pre-enrollment, open enrollment and retention and reinforcement- work necessary for the delivery of the program to the millions of Californians currently without insurance beginning in September 2012 and ending in December 2015.
We have outlined each phase as they relate both to timing and project components. This phased approach will allow us to: (1) take into account research and key learnings and adjust our tactics; (2) be responsive to public demand and to be able to course correct as this new, dynamic program unfolds and;(3) submit the budget to the federal government in phases. Phase I is called “Build Out.” During this phase (September –December 2012) we will be putting in place all the strategies and tactics designed to generate maximum awareness of the marketplace, finalizing the plan for potential paid media, working with stakeholders and others to begin a potential grant program for public outreach, planning for the launch of the first preenrollment period (October 2013) and completing the all-important research that will guide the creative development, messaging and materials necessary for the entire program. Beginning in 2013 (Phase II), we will start the public outreach and grant program developed in 2012.
We have included only the Phase I and Phase II related budget options. The paid media plan and budget will be refined to make the advertising buysthat are a critical component in Phase II. All other budget decisions, as we have noted in the discussion of options and actions, are based on what project partners and the Exchange Board ultimately decide.
Throughout this process, the Project Sponsors have closely collaborated in an interactive process that has allowed for the sharing of information, comment and edits as the draft was being developed. This collaborative model resulted in this Final Work Plan. We are continuing to work with Project Sponsors to develop staffing requirements, and specific budget requirement as they related to the various plan elements.
The goal is to significantly reduce the estimated 4.6 million uninsured Californians who will be eligible for coverage in 2014.2It is based around a “no wrong door” enrollment approach where public and private programs are easy for consumers to understand and navigate, with enrollment the end goal.
But, it will not be enough to simply increase awareness and educate the public about the new marketplace. Many barriers exist for enrollment of our targeted populations. While there is a dedicated effort in this plan for an Assisters Program to help our targets enroll, we will be embracing the messages that emphasize “help is here.” Those messages are key to getting audiences beyond their anxieties and the complexities involved in considering, choosing and then enrolling in a health care plan.[…]
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