Ready, Set, Enroll: What Every Health Organization Should Know About ACA Public Education and Engagement

ACA COMMUNICATION STRATEGIES WEBINAR
Introductions
Michael Freeman
Executive Vice President, Healthcare Leadership Council
Ginette Magana
National Partner Engagement Director, Enroll America
Vlad Cartwright
Executive Vice President, SevenTwenty Strategies
Jeff Oldham
Managing Director, SevenTwenty Strategies

Framing the Discussion
Under the Patient Protection and Affordable Care Act (ACA)
29 million Americans are slated to obtain private coverage through
health insurance exchanges by 2019.
12 million are expected to gain coverage through Medicaid and CHIP programs.
With the upcoming deadline for implementing the Affordable Care Act (ACA), many
organizations and individuals with a vested interest in its success, are struggling with
ensuring that the program will be accepted and supported by the general public.
BLUEPRINT
Look no further than the pharmaceutical industry's ongoing campaign to
ensure continued public support and participation in and around the
Medicare Part D program.

Learn From The Past
Draw on the federal government's successful launch of Medicare Part D, a major national health
coverage program that became law in December 2003.
Part D encountered significant technical, educational and coordination challenges at its outset,
but eight years later, the public views the program as a success.
Not unlike ACA, The Medicare Modernization Act (MMA) was passed in a highly volatile,
politically polarizing and partisan fashion.
CHALLENGES
Educating their target audience (seniors) about the new benefit.
Assisting them in enrolling during date specific periods.
Conveying their approval for the program to the general public and most importantly, their
elected officials and the media at large.

Solutions
TACTICS USED
Measure sentiment/research/test messages.
Implement a robust public outreach and education campaign partnering with trusted,
community-based organizations to ensure enrollment.
Conduct an aggressive national paid and earned media campaign to ensure ongoing public
support.
Work with HHS & other agencies to create a simple yet comprehensive web portal that seniors
could use to enroll.
Continued, ongoing educational efforts to generate support.

From Past To Present
How will we overcome our current challenges?
With ACA's initial enrollment period on the horizon, those with a vested
interested in its success would do well to emulate the pharmaceutical
industry's strategies for a successful rollout.

Connecting Uninsured Americans
with Health Coverage
The 2013-2014 Opportunity

Contents
Enroll America’s Mission
Messaging to Reach Uninsured Americans
Get Covered America Campaign

Mission: Maximize coverage
for uninsured Americans
1. Educate and Engage 2. Mobilize to Enroll
3. Work with Partners to
Ensure System works
Enroll America will execute a national education and enrollment campaign
Successful implementation of ACA requires all-out effort by government, not-for-profits,
insurers, hospitals, community health centers, health providers, and others

One Fifth of the Uninsured Live in
the Top 13 Counties and Half Live in the
Top 114 Counties
Uninsured by State
<230K 230K -
600K
600K -
1.1M
1.1M+
Number of Uninsured
CA

TX

FL

NY

IL

GA
NC
OH
PA
NJ

MI
AZ

VA

Rest
of

the
U.S.

67% of uninsured live in 13 states
Source: Census Bureau, Current Population Survey,
March 2011 and 2012

One Fifth of the Uninsured Live in
the Top 13 Counties and Half Live in the
Top 114 Counties
402K

408K

419K

434K

445K

521K

531K

657K

675K

762K

887K

1.1M

2.2M

Queens
County,
NY

Broward
County,
FL

San
Bernardino
County,
CA

Clark
County,
NV

Riverside
County,
CA

San
Diego
County,
CA

Orange
County,
CA

Maricopa
County,
AZ

Dallas
County,
TX

Miami-‐Dade
County,
FL

Cook
County,
IL

Harris
County,
TX

Los
Angeles
County,
CA

Uninsured by County
10% of the uninsured live
in just 4 counties (LA,
Harris, Cook, Miami)
20% of the uninsured live
in top 13 counties
(Top 4 + Next 9)
50% live in the top 114
counties (3.8% of total
counties in the US)

The Uninsured are a Diverse Group
12
AgeGender
EthnicityIncome (as % of Poverty Level
Male
53%
Female
47%
<138
51%
139-400
38%
19-25
17%
<18
16%
26-34
21%
35-54
34%
55-64
12%
400+
10%
White
45%
Latino
32%
AfAm
15%
Other
8%
Source: Kaiser Commission on Medicaid & The Uninsured,
October 2012

Facts About Coverage and
Financial Help Are Critical
Messaging will raise awareness by highlighting 4 key facts
1.  All insurance plans will have to cover doctor’s visits, hospitalizations, maternity care,
emergency room care, and prescriptions
2.  You might be able to get ﬁnancial help to pay for a health insurance plan
3.  If you have a pre-existing condition, insurance plans cannot deny you coverage
4.  All insurance plans will have to show costs and what is covered in simple language
13

89% of respondents identified one of these as the most important
fact to communicate
Source: Enroll America, November 2012

Health Insurance Marketplaces Will Oﬀer
the Coverage Option Opportunities for
All Americans
14
•  Health Insurance Marketplaces open October 1, 2013, allowing consumers to purchase and
enroll in health insurance, with coverage beginning January 1, 2014
•  Marketplace certify qualiﬁed health plans and provide an easy way to compare options
•  Continuum of coverage: Low income Americans (<138% of Federal Poverty Level) qualify for
Medicaid, Americans at 138-400% FPL qualify for the Marketplace with tax credits, and
Americans above 400% FPL qualify for the Marketplace or private plans
•  Average subsidy for each subsidized enrollee is $5,510*
Health Coverage in 2014
Marketplace Open
Oct 1 to Mar 31
Sign up on website
and select coverage
Coverage begins
Jan 1
How to
Enroll
*Source: CBO, February 2013

Enroll America Will Execute National
Education and Enrollment Campaign
Using Cutting-Edge Strategies and Tactics
15

Grassroots

Organizing

Digital
+

Social

Media

Data
&

Results

Driven

Community

Engagement

Strategic

Partners

Earned

Media

Paid
Media

Surrogates

Focus Resources in Targeted Areas
Investment Decisions Based on Research and Analytics
67% of the uninsured live in 13 states and 50% live in
just 114 counties
*May be subject to change

Campaign Driven by
Guiding Principles
17
Data-driven and metrics-based
Grassroots-focused
Coalition-based
Committed to cutting-edge online
organizing and social media tactics and tools
Building a narrative of success
1
2
3
4
5

Get Covered America Campaign
Will Target Key Audiences
Uninsured
Americans
Inﬂuencers
General
Public
Campaign will conduct outreach and messaging to speciﬁc groups
Core Audiences

Enroll America Will Work with an
Array of Partners
19
Sampling of Partners
Many stakeholders play a role in a successful enrollment effort, including:
Retailers, consumer groups, hospitals, insurers, faith-based groups, business, labor, civic groups,
community health centers, drug companies, and grassroots volunteers

ACA COMMUNICATION STRATEGIES WEBINAR 20
1. Capacity Building and Education
2. Marketplace Opens Phase 1
Enrollment
3. Coverage Begins & Phase 2
Enrollment
4. Learning and
Capacity Building
5. Marketplace Opens
•  Hire additional leadership, recruit volunteer leaders and
increase collaboration with partners.
•  Marketplace opens October 1st
•  Reﬁne Field tactics and build strong media, grassroots and
partner relationships.
•  Coverage begins on January 1st
•  Continue large-scale enrollment push to complete ﬁrst year
of enrollment
•  Debrief, learn lessons from past year, prepare for October
•  Marketplace open from Oct. 15th to Dec. 7th
•  Launch full effort w/ media, events, grassroots
June-Sept ‘13
October - Dec ‘13
Jan ‘14 - March ‘14
April - Sept ‘14
Oct – Dec ‘14
Phase Dates Priorities
Campaign Timeline Builds to
Marketplace Openings

The Need for Eﬀective Health Campaigns:
Aﬀordable Care Act
Kaiser April poll:
58% of uninsured not sure how ACA affects them
40% of overall U.S. population not sure ACA is still law of the land
Health reform law still controversial:
36% approve, 54% disapprove (CBS News poll – July 2013)
Implementation problematic, confusing
Some states implementing insurance exchanges, some refusing,
some not sure if they can make deadline.
Medicaid expansion not uniformly embraced by states.
Concerns about employers ending health coverage,
sending workers into health exchanges.

Medicare Part D Campaign Research
Mass communications –
TV advertising, direct mail – do not sufﬁciently inform target population
Potential enrollees want detailed information from a credible source
Most want to hear from a doctor or pharmacist
Overly simplistic messages, cute slogans considered insulting
When people are spending their money, they want hard facts
All outreach needed to steer clear of political persuasion

Going Retail with the Campaign
Medicare Today campaign
Over 400 national, regional and local organizations
Seniors
Health providers
Employers
Caregivers
Retail centers
Faith-based groups
Community organizers recruited in all 50 states

Medicare Today: Lessons Learned
Recruit partners who can reach all sectors of your target population
Expand your reach – train the trainers
Don’t make people come to you. Go to them.
Grocery store and pharmacy events
Senior center programs
Congressional town halls
Hospitals and doctor’s ofﬁces
Focus on local, not national, media.
Consumer-friendly “news you can use”
Develop state-based news hooks
Create attention-getting materials, videos

Health Access America:
Reaching the Uninsured
Ten test cities
linking uninsured with public, private coverage resources
Cleveland
Memphis
Nashville
Columbia, SC
Baton Rouge
Corpus Christi
Saginaw
Las Vegas
Las Cruces, NM
Raleigh, NC

Evaluating the Campaign
Did people sign up for the program?
Over 85 percent of Medicare beneficiaries have some form of prescription drug coverage
Most difficult challenge – reaching low-income seniors with information about financial assistance
Monitoring through annual surveys
Do you have drug coverage?
Is the program making your prescriptions affordable?
Is the enrollment system easy to use?
Ask for specific positives, negatives

Target Populations
Segments of the population with disproportionate uninsured rates
Small business owners and employees
Families with children
Young people
Latino Americans

Research Shows Health Coverage
Outreach Need, Challenges
Health insurance information not easily accessible
54% said they did not know of a reliable source for information about coverage
73% of families with children
66% said they weren’t likely to look for information because it would be unaffordable anyway
Health insurance not an easy sell
Difﬁcult to convince people, if healthy, to spend money on something they don’t currently have
Different than Medicare outreach – where value of prescription drugs for seniors is more clear

Communications Research Findings
Communication must come from a credible source
Corporate interests instinctively distrusted.
Best sources are experts without company ties.
Contact must be repeated and persuasive
A simple, objective just-the-facts approach doesn’t move people to act
Messages about affordability have to be handled with tact
Wrong language can sound patronizing, condescending

Lessons Learned
Know your environment
What programs are in place? Who are leading public, private players? Is their low-income
ﬁnancial assistance available?
Build a strong partner network
Local individuals, organizations can reach more people, achieve quicker credibility than
Washington, D.C.
Leverage already-existing events
Much energy can be wasted trying to create enrollment “events.” More sensible to piggyback on
something already in place.
Localize your message
Local spokespeople, local verbiage , local icons. Difﬁcult to nationalize a campaign with personal
impact.

Lessons Learned
Utilize the local media
Community-based media gets closer attention. National sources get glossed over.
One-on-one counseling is vital
On personal ﬁnancial matters, large group communications set stage. Personal conversation
closes the deal.
Make outreach easy
Small business owners, parents have little free time. Schedule events accordingly.

Results
1,125 health insurance education events
33,122 attendees
16,405 enrollees
Results underscore the importance of strategic, aggressive outreach to
link uninsured Americans with coverage

Learnings from Branded Eﬀorts:
Campaigns for five brands in support of Part D, Medicare Advantage, Medicaid and
Special Needs Plans in support of education and enrollment
Confirm the findings from Health Access America and Medicare Today efforts
41 Markets covered nationwide with diverse demographic range (age and ethnicity)
Direct contact with target audience in familiar settings with trusted sources is key
Critical to understand how your audiences make decisions and who can ultimately
assist in influencing their decision
Taking advantage of existing local events or sponsoring with local partners provides
both an audience and credibility
Local organizations and providers key to disseminating information (from a trusted
source)

Results of Branded Eﬀorts:
2,054 events
1,200 provider partnerships
Over 3,500 community and faith-based organization partnerships
Millions of print materials distributed through local community and faith-based
partnerships
Enrollment in over 90% of target markets exceeded goals for census growth

Would You Like More Information?
To learn more about the services offered
by SevenTwenty Strategies contact
Jeff Oldham
Jeff.Oldham@720strategies.com
202.962.3955
This session has been recorded and will be placed at:
http://www.720strategies.com/webinars

Ready, Set, Enroll: What Every Health Organization Should Know About ACA Public Education and Engagement

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Ready, Set, Enroll: What Every Health Organization Should Know About ACA Public Education and Engagement