#StateOfEnrollment: Make It Personal

Originally published April 21st, 2014 on Enroll America's State of Enrollment blog series.

Strategy: Motivate consumers by giving them personalized information

Where it was used: Our entire digital and field outreach

Notable metrics: The right message can boost intent to enroll by six percent relative to other good messages.

Best Practices to Replicate: Making sure consumers get personalized information about how the Affordable Care Act (ACA) impacts their lives motivates them and makes them feel more informed.

At Enroll America, we believe in making data-driven decisions wherever possible. One of the areas that might seem a little difficult to measure is figuring out what kinds of messages are most motivating to consumers. However, this past December and January we conducted research that helped us quantify the best messages for motivating consumers. We found that, despite testing many ideas that seemed like they would work, the best way to motivate consumers was to get them personalized information about how much financial assistance they might be able to get, and what this meant for how much they would pay for health insurance.

Picking the right message is challenging. If you talk to 10 different people, you’ll often get 10 different ideas about what to say. We thought quantitative research might be able to shed some light on which messages were making a measurable difference. So, last winter we recruited thousands of uninsured people who were eligible for the health insurance marketplaces to take an online survey. During the survey, we randomly exposed people to several different messages that were developed in consultation with experts in behavioral science and health care outreach.

Here are the messages that were tested:

• Using the Get Covered America calculator. Understanding the effect of using the calculator was the highest priority of the test. The calculator (available here) gives consumers specific, personalized information about what form(s) of coverage they might be eligible for under the ACA, and how those insurance options affect them financially. Respondents exposed to the calculator were given the opportunity to input their own information and view their customized results.
• Savings message frame. The savings message frame presented insurance purchased through the marketplace as a “good deal” financially. We wanted to test the effect of showing consumers how much money they could expect to save, relative to what they would pay without financial assistance.
• Fine message frame. The fine (penalty) message frame informed consumers of the specific details of the fine they would have to pay if they didn’t get insurance. The message made a strong case by mentioning specific dollar amounts and making explicit the trade-off between paying the penalty and purchasing health insurance.
• Risk message frame. The risk message frame explained that tens of millions of Americans will spend at least $5,000 in health care expenses every year. The idea was to motivate uninsured people to get health insurance by both informing them of their risk of having to pay, and their potential liability if they got sick or injured.

After exposing survey respondents to different message frames, we then asked them if they would be willing to pay for an insurance plan through the marketplace. As you can see in the graph below, there was a clear difference between people who used the calculator and people who saw the other message frames.



On average 63.1 percent of people seeing the other three messages said they would buy insurance, but that number increased to 66.8 percent among people who used the calculator. That increase of 3.7 percentage points relative to a baseline of 63.1 percent is equivalent to about a six percent increase in intent. In other words, for every 100 consumers that use the calculator, four consumers will be motivated to get insurance that wouldn’t have if they had been exposed to some other message instead. Over the course of months of outreach, that can really add up!

We think one of the reasons the calculator is so effective is because it provides consumers with the information that is most relevant to them: cost. How do we know that cost is one of the most relevant factors for many consumers? In our survey, we also asked people whether they felt like they had enough information about how the ACA affects them and their families. As you can see in the graph below, people who used the calculator were more likely to report that they had enough information, relative to people exposed to the other message frames.



We believe that this 3.6 percentage point difference shows that consumers aren’t that interested in broad messages or aggregate statistics represented in the other frames. What they really care about is finding out exactly what they’re eligible for and how much it may cost them. We believe the calculator is the most effective way to get that information out to consumers, which is why we made it one of the centerpieces of our outreach efforts. After completing this research, Enroll America began promoting the calculator more consistently through digital outreach, and encouraged field staff and volunteers to use the calculator when talking with consumers.

Medicine and the Market: Equity v. Choice

Originally published June 6, 2006 for the Center for American Progress

Improvements in American health care cannot be made without addressing the fundamental assumptions that underpin our ideas about what health means. That conclusion was the product of a spirited panel discussion on the role of market forces in American health care, hosted on Thursday by the Progressive Bioethics Initiative at the Center for American Progress (CAP).

Panelist Daniel Callahan, Director of International Programs for the Hastings Center, led off the discussion by talking about his new book Medicine and the Market: Equity v. Choice, coauthored with Angela Wasunna. Joining him on the panel were Willis Goldbeck, consulting director for Global Public Health Policy and Government Affairs at UCB, and Jeanne Lambrew, Senior Fellow at CAP. Susan Lee, CAP Vice President for Economic Policy, moderated.

Callahan, whose book took a comparative look at different health care systems from around the world, found that the best systems had “universal health care with carefully introduced and carefully tested market practices.” Key to his understanding is moving past the false choice between markets and government involvement. A better way of framing the issue, according to Callahan, is to view market forces as a set of tools to achieve overall social goals. Under that conceptual model, the value of particular market forces can be tested against a higher standard of equitable access to quality health care.

Callahan pointed out that in many European countries, where universal care is held as a fundamental social value, health care systems are clearly effective. He listed lower costs, higher life expectancies, broad popular support, and quality of care at least equal to the U.S. as the advantages of a comprehensive, universal approach to health care.

By contrast, according to Goldbeck, “The U.S. does not have a system of health anything.” Goldbeck characterized the U.S. approach as a “medical care and repair model” that is fragmented and disjointed. Medical care, meaning specific responses to specific conditions, is emphasized at the expense of health, a broader concept incorporating prevention and overall well-being. Shifting the public discourse to that broader concept could facilitate progress on some substantial fundamental health issues facing the country. For example, distinguishing medical necessity from medical enhancement would enable us to draw some lines around what types of treatments the health system should and should not promote.

All panelists observed that America’s market-influenced emphasis on constantly improving medical technology — called the “infinity model” because it assumes no limit to useful medical progress — has raised the costs of health care across the board. While health care has improved as a result of technology, Callahan said, “The greater the improvement, the more we spend.” An increasingly expensive medical industry raises serious questions about equality of access and long-term sustainability. The basic issue is whether advancing high tech medicine is the best way to allocate limited health care resources that might be better spent on prevention or basic treatment.

Settling the questions will not be an easy task, according to Goldbeck. “We don’t know how to define basic health care,” he said, because we expect basic care to include coverage for every medical contingency. The panelists agreed that if the expectations of the health care system are going to change, the fundamental assumptions of health policy must also change. Lambrew, for one, is optimistic about the possibility for a positive shift. Pointing to growing calls for health coverage from businesses and encouraging developments on the state level, she said that the time for universal health care as a meaningful political issue “might be sooner than you think.”