States find more ways to use enrollment brokers
Enrollment Brokers
Nearly nine out of 10 of the 415,000 New Jersey AFDC recipients who enrolled in managed care last year chose their health plan voluntarily, leaving the state to auto-assign an exceptionally low 11%. Disenrollment, which is allowed at any time under New Jersey’s program, has been under 1% monthly.
Lou Bodian, director of marketing for New Jersey Medicaid, says the key to that success was the state’s distribution of $1 million in incentives to enrollment brokers.
"Considering that we are paying $1 billion a year to managed care organizations, spending $1 million to make sure people make voluntary choices is well worth the investment," Mr. Bodian says.
New Jersey is one of at least 10 states (of 24 employing enrollment brokers) that use financial incentives to encourage brokers to increase rates of voluntary plan selection, according to Mary Kenesson, a Virginia consultant who recently completed a nationwide survey of education and enrollment practices in Medicaid managed care programs.
But Ms. Kenesson told a meeting of the National Academy for State Health Policy in Seattle last month that financial incentives are just one of several ways states have found to use enrollment brokers more effectively. A number of states also are giving brokers a growing role in administering programs after enrollment, she says.
Varied definitions of who counts as an auto-assignment make it difficult to compare effectiveness of financial incentives, but anecdotal evidence suggests incentives do indeed work.
According to Ms. Kenesson, seven states base incentives on the success brokers have in keeping auto-assignment rates low. Another four states provide incentives for enrollment brokers to reduce telephone response times. Two base incentives on timeliness or accuracy of enrollment information processing. And one state, Maine, provides incentives based on incidence of disenrollments or plan switches soon after enrollment.
In New Jersey, enrollment brokers received $31.48 for every AFDC recipient they enrolled in a plan, with a 20% increase in payment per enrollee once 60% voluntary enrollment was achieved and a 40% increase in per-enrollee payments for enrollees after a 75% rate was achieved.
Administrative role
Increasingly, the term "enrollment broker" may be a misnomer, as more states also turn to the outside contractors to handle a host of post-enrollment functions. Ms. Kenesson's survey found 20 states use enrollment brokers to handle disenrollment, 19 to take and report complaints about plans or providers, 14 to resolve such complaints and six play a role in formal ombudsman programs.
Indeed, enrollment brokers' role is growing even beyond Medicaid managed care. Wisconsin is using its brokers to help administer its W-2 welfare reform program. And, after positive experiences in using brokers in the rollout of Medicaid managed care, Lou Bodian, director of marketing for New Jersey Medicaid, says he is recommending the state use them in rolling out broader welfare reform.
Even so, concerns about enrollment brokers are growing. Ms. Kenesson says the emerging risks of working with brokers includes the possibility of well-intentioned "steering" of enrollees, confidentiality problems with information they get from enrollees and conflict of interest due to personal or family affiliations with health plans.
Cynthia Burnell, chief of the Managed Health Care Section of the Ohio Bureau of Medical Assistance, cited "steering" as a growing concern the state has with brokers in Ohio.
Overall, however, Ms. Kenesson's survey found relatively little concern among states over brokers. The most widely cited concern was workload management, followed by comprehension and interpersonal style.
—Jack Neff
Contact Mr. Bodian at 609-588-2811; Ms. Burnell at 614-466-4693; and Ms. Kenesson at 540-882-4431.
States find more ways to use enrollment brokers
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