A Conversation with Exchange Leaders: Part One—Executives

The first open enrollment for insurance exchanges is over, but state exchange staff are as busy as ever. Over the next few weeks we’re catching up with exchange executives, policy directors, chief information officers, and communications directors while they’re immersed in evaluating lessons from the past several months, and planning for the next open enrollment which starts in a short five months. For this installment, we talked with the executive leaders of two state exchanges widely touted as among the most successful nationwide. Kevin Counihan is the Chief Executive Officer of Access Health CT. Carrie Banahan is the Executive Director of the Office of the Kentucky Health Benefit Exchange. They’re also the chair and vice-chair, respectively, of theState Health Exchange Leadership Network Steering Committee.
Reflecting back on the 2014 open enrollment period, what were the top successes from your perspective as an exchange executive?
Carrie: The primary success for Kentucky’s exchange, Kynect, was enrolling over 400,000 people. 75 percent of them did not have health insurance coverage at all when they applied through Kynect. As a result, we have made a significant dent on the uninsured rate here in Kentucky.
Kevin:  I agree. We enrolled over 200,000 people, twice our goal. Quite frankly, I think that just getting through the open enrollment period was a big success. We had a system that was relatively stable, and we had a 92 percent satisfaction rate. Given the complexity involved in implementing this law in its first year, it feels like a good accomplishment.
Can you describe something you learned mid-course that turned out to be very important?
Kevin: We recognized the importance of scaling back our technical requirements for our systems integrator.  In January 2013 (see pg. 21-25) we scaled those back by 30 percent, and, if we had not done so, we might be in a different position. Focusing on doing fewer things consistently well instead of more things inconsistently well was a good decision for us.
Carrie:  One thing we learned was that, because of the complexity of the ACA, a lot of people did not understand certain requirements, such as the affordability test. For next year we’re working to have more explanation in the application and on our website. We’re working with our in-person assister and agent communities to explain things in simpler, more understandable terms.
What are some best practices that you will carry forward into 2015 and future years?
Kevin: Collaboration with the insurance carriers to help us design systems and processes was important. That got them under the tent so they started owning the solution more than if it were dictated to them. We almost overcommunicated with the different stakeholder groups. That took a lot of time, but it was helpful to build statewide support.
Carrie: I would echo what Kevin said about collaboration with the insurance issuers and other partners. We have a monthly meeting with all of the issuers and we have an Issuer Liaison Office, where we have staff that are dedicated to specific issuers. The support of the agent community and the in-person assisters has been invaluable. And as a state agency, we’ve been working closely with the Department for Medicaid Services and the Department of Insurance.
Kevin: I also think celebrating success with the staff was important. We’re only as good as our staff, and we did different things like parties or events to keep morale up. Nobody does it perfectly all the time, but recognizing the staff is something we want to continue.
Carrie: Our governor hosted a reception at the governor’s mansion to bring recognition to the people behind the scenes. Things like that really go a long way in boosting morale.
From your perspective as an exchange executive, can you discuss your priorities and upcoming opportunities you see as you plan for 2015 and beyond?
Carrie: We are going to make significant improvements to our SHOP (Small Business Health Options Program). We were very disappointed in our SHOP enrollments, so that will be our primary focus.
Kevin: We are focused on trying to make the enrollment and retention experience as easy, simple, and intuitive as possible. We’re previewing a new application for tablets and smartphones, which we found that many young people use as their primary way to get online. We’re also introducing an avatar for certain areas of the application to provide further explanation where people had the most difficulty. We’re maturing as a business. We’re going through some significant system stabilization, and tripling the number of people working on customer service issues.
Carrie: Another opportunity is that in Kentucky a decision was made to allow individuals and small employer groups to keep their pre-ACA policies. Through our marketing efforts this fall, we’ll be working to encourage them to enroll in Kynect.
This blog series is produced by the State Health Exchange Leadership Network, a project that supports exchange leaders and staff, housed at NASHP. The State Health Exchange Leadership Network is supported by state contributions and the Robert Wood Johnson Foundation.