In a bit of good news for health plans and brokers, CMS on May 5 said that HealthCare.gov’s Direct Enrollment (DE) function will be made available outside of the official open-enrollment period, AIS has learned. The technology — which connects systems used by brokers and carriers directly to HealthCare.gov to enable subsidy calculations and enrollment — previously wasn’t available for special enrollment periods (SEPs).

In a conference call, CMS said it was targeting July 10 as a start date, pending testing. Access to the DE function will make it easier for brokers to enroll people in an exchange-based health plan if a qualifying event — such as marriage, divorce or loss of a job — triggers eligibility for the SEP. CMS did not respond to AIS’s request for comment on the DE function.

“We hear good things about the Direct Enrollment agent path from clients that had agents enrolling on behalf of consumers,” says Toby Rogers, an executive at LinkedHealth, at technology firm that works with private and public exchanges. But “integrating with [HealthCare.gov] for Direct Enrollment is still time consuming and costly to implement and maintain in-house.”

Industry observers warn that enrollment though the exchanges will continue to be hamstrung until health plans and WBEs are able to assist consumers in applying for exchange-based coverage and subsidies using their own websites without having to redirect applicants to HealthCare.gov midway through the process. Eligibility Verification as a Service (EVaaS), a system being considered by CMS, would let consumers shop for health plans and apply for subsidies through websites run by insurance carriers and WBEs without being redirected to HealthCare.gov.

Without outside assistance, a significant number of consumers wind up abandoning their enrollment application because of a process known as the “double-redirect.” After shopping for health coverage through a WBE or on a health plan’s portal, consumers are then redirected to HealthCare.gov where they complete their Qualified Health Plan (QHP) application. Once that is completed, they’re transferred back to where they started and the enrollment is finalized. “It’s a jarring experience for the consumer. As soon as they leave our site, we lose them if they don’t complete the process at HealthCare.gov…and then we can’t help them,” says Shane Cruz, chief technology officer at GoHealth, a Chicago-based WBE, who heads the Association of Web-Based Health Insurance Brokers (AWHIB).

While WBEs can initiate a consumer’s enrollment, the vast majority of them don’t wind up completing the process. Based on consumer feedback, LinkedHealth estimates between 50% and 75% of those applicants are lost. Chini Krishnan, CEO of GetInsured, also a WBE, estimates the percentage of enrollees who complete the process could be as low as the single digits because of the existing process requiring users to complete verification across multiple websites that lack a cohesive brand experience.

GetInsured, along with GoHealth, eHealth.com, GetInsured and Towers Watson, launched AWHIB last November to educate policymakers and governmental technical staff on the role WBEs play in helping consumers find appropriate health coverage. The consortium also is working with CMS to implement EVaaS.

According to Deft Research, 10% of people who signed up for coverage through HealthCare.gov did so through an agent or WBE and 13% came through an insurer’s website.

In 2013, CMS’s Center for Consumer Information and Insurance Oversight (CCIIO) began to consider the EVaaS concept. Behind the scenes, the EVaaS interface would seamlessly connect to HealthCare.gov and pass application information to CMS so that the exchanges could determine eligibility and calculate subsidies without redirecting the consumer to the federal portal. Although CMS has been interested in EVaaS, the agency hasn’t indicated when it might become available as the agency has focused efforts on other pressing issues such as enrollment reconciliation. There is little optimism that it could be ready in time for the Nov. 1 start of the 2016 open-enrollment period, and some doubt if it will be ready the following year. Tools such as pop-up help windows, text recovery and email recovery can help reconnect consumers to the WBEs, “but the EVaaS approach is the longer term solution,” says Rogers.

After just two enrollment cycles, the number of people buying health coverage through public insurance exchanges has begun to flatten. Industry observers contend that meaningful enrollment can’t be achieved unless carriers, insurance brokers and benefits consultants are able to enroll consumers directly...or create a system where consumers can do it themselves.

“EVaaS is a critical tool to drive future enrollment growth. All of the low-hanging fruit is mostly gone. When you look at enrollment on some of the large state exchanges, it only went up a few percentage points,” says Krishnan. EVaaS, he contends, could double or triple exchange-based enrollment.

The interface used by WBEs and carriers to enroll people in exchange-based coverage isn’t designed for consumers who want to enroll on their own. The hope for EVaaS is that it would offer alternate portals to HealthCare.gov and give consumers a simple way to shop for, and enroll in, coverage on their own online.

“There isn’t a good do-it-yourself alternative to HealthCare.gov,” adds industry consultant Peter Nakahata, a former senior advisor on exchanges at CCIIO. WBEs that operate their own websites, and have partnerships with employers, big-box retailers and tax preparation firms, could reach uninsured consumers in a wide variety of settings and continue to expand the reach of the marketplace, he says.

And although public exchanges experienced an overall enrollment gain from 2014 to 2015, retention rates generally were lower than expected. Just getting someone enrolled isn’t the end of the game. Making it easy for them to make their first payment is also important. If people don’t see value after the first year, they’re not going to re-enroll, says Cruz.

Cruz and other WBEs say the role of HealthCare.gov should be to verify eligibility by connecting to the IRS, Social Security Administration and Dept. of Labor, but should leave the consumer shopping experience to WBEs and health plans. “Turbo Tax or H&R Block don’t send you to the IRS’s [website] in the middle of the process. The health insurance buying process should work more like that,” he asserts. Moreover, many consumers want and need sophisticated shopping tools that aren’t available on HealthCare.gov or state-based exchanges.

Excerpted from the 5/1/2015 issue of AIS’s Inside Health Insurance Exchanges

© 2015 by Atlantic Information Services, Inc.