actûrus Quantitative Enrollee Census and Understanding StudyThe Remaining Uninsured: A Qualitative Analysis

2

Methodology

Washington Health Exchange conducted a telephone and online survey among four

groups: enrollees of a QHP or Medicaid Plan, disenrolls and those that didn’t enroll.

The following methodology was used:

• Phone: A 20-minute survey among 3,200 enrollees, disenrolls and those that began the application but

didn’t finish

• Online: A 15 minute survey among 4,800 primary enrollees

− Dialing began August 12th, 2015 and ended September 15th, 2015

− Interviews were conducted in English and Spanish

− Customer sample records included landline and cell phone numbers

− Data was weighted to better reflect the actual proportions of primary QHP enrollees vs. primary

Medicaid enrollees

3

Topline Summary

Positive re-enrollment and re-engagement rates show Healthplanfinder has a solid

foundation as a health exchange

• Approximately 2 out of 3 enrollees are likely to re-enroll and 3 out of 5 of those who moved on were

likely to re-engage if they were in need of insurance again

• 2 out of 3 QHP enrollees were satisfied with their Healthplanfinder experience

− Raising satisfaction levels to 3 out of 4 satisfied is reasonable goal

− The Healthplanfinder website was the most used channel of enrollment and method to access

information

• Healthplanfinder.org’s downtimes affected user’s satisfaction levels because it made it more

difficult to access information and to apply/re-enroll

• QHP enrollees found secondary sources of information such as community services and

agents/brokers to be very useful so future collaboration with them is recommended

• Approximately half of people felt Healthplanfinder met their expectations

• Healthplanfinder is perceived as a place to get good health insurance as 4 out of 5 enrollees are at least

somewhat satisfied with their carrier

− People also feel that Healthplanfinder does not look out for them or acts as an advocate causing a

sense of distrust that may prevent them from re-enrolling in the future

• Engagement is key as those who used their insurance and interacted with their carriers were more satisfied than those who did not

4

1% 1%

16%3%

17%

5%

34%

28%

26%

44%

7%18%

Extremely satisfied

Very satisfied

Somewhat satisfied

Not very satisfied

Not satisfied at all

Don't know/Refused

Overall Satisfaction by Sub-Population

Most people are at least somewhat satisfied however there remains room for

improvement. Unsurprisingly Medicaid enrollees were far more satisfied than the rest.

Q3 Overall, how satisfied [[IF ENROLLEES OR RENEWALS; R22=1, 2, 3 OR 4]] [are you] [[IF DISENROLLMENT OR BEGAN APPLICATION BUT DID NOT COMPLETE; R22=5 OR 6]] [were you]

with your Healthplanfinder experience? Would you say you are/were…?

Satisfaction 66% 91%

QHP Enrollees(4165)

Medicaid Enrollees(2682)

Began Application/

Didn’t Enroll(967)

Disenrolls(647)Base: Total Respondents

2%

27% 25%

17%16%

28%30%

20% 22%

6% 6%

54% 58%

5

Likelihood to Re-Engage

In addition, customers were more likely than not to re-engage if they needed

health insurance again.

Began Application

Didn't Enroll DisenrollsBase: Disenrolls And Began

Application But Did Not Complete(967) (647)

Top 2 Box 60% 59%

4% 4%

21% 23%

8% 8%6% 6%

28% 22%

32% 37%Very likely

Somewhat likely

Neither likely nor unlikely

Somewhat unlikely

Very unlikely

Don’t know/Refused

Q29. If your situation were to change in the future and you were once again in need of health insurance coverage, how likely would you be to get it through Healthplanfinder?

6

Barriers to re-enrollment

Ways to EnrollQHP New

Enrollees

QHP Renew

Enrollees

Base Enrollees Or Disenroll Or Renewals Only (322) (297)

% %

It’s too expensive for the coverage I get 41 30

I don’t trust Healthplanfinder 34 34

It’s too confusing to sign up for 30 21

I do not trust health insurance coverage through Healthplanfinder 23 22

It does not offer quality health insurance coverage 23 13

I plan to obtain health insurance coverage from a future employer 22 12

I just can’t afford it 18 16

Information is misleading 17 19

It’s not for people like me 13 12

I plan to move 7 2

I’m healthy, so I don’t need coverage 5 3

Other, please specify: 29 44

Q22. Which of the following, if any, are reasons why you are [[INSERT RESPONSE FROM Q21]] with Healthplanfinder in the future for health insurance coverage?

Cost and trust are the two main reasons people do not re-enroll in

Healthplanfinder.

7

Expectations Met by Sub-Population

2% 2%

19%4%

24%

9%

34%

47%

14%

19%

6%18%Far exceeded

Somewhat exceeded

Met expectations

Fell somewhat short

Did not meet at all

Don't know/Refused

Healthplanfinder met around half of non-Medicaid enrollees’ expectations. Due to

Medicaid enrollees not having to worry about cost considerations, they tend to have a

more positive outlook of Healthplanfinder overall.

QHP Enrollees(4165)

Medicaid Enrollees(2682)

Began Application/

Didn’t Enroll(967)

Disenrolls(647)Base: Total Respondents

3% 2%

31% 29%

21%20%

29%30%

10% 12%

7% 7%

Q20 Overall, how well has Healthplanfinder met your expectations? Would you say Healthplanfinder…

Expectations Met 54% 84% 46% 49%

8

Healthplanfinder website -

www.waHealthplanfinder.org

Healthplanfinder customer support call center

Health insurance companies

An insurance agent or broker

Family, friends or other personal contacts

Other websites

Your doctor or health care provider

Brochures or pamphlets you received in the mail

TV, radio or newspaper advertising

Your employer

Community organizations, such as advocacy

groups or churches

Social Media (such as Facebook or Twitter)

None

Sources of Information Used by Sub-Population

The Healthplanfinder website was by far the most commonly used source of

information.

Q4. Which of the following sources of information did you use when [[IF ENROLEES OR DISENROLLS OR BEGAN APPLICATION BUT DID NOT COMPLETE; R22=1, 3, 5, or 6]] [shopping for health insurance

plans] [[IF RENEWALS; R22=2 OR 4]][ it was time to renew your health insurance] through Healthplanfinder? Did you use…

Read list; Please select one answer for each.

86%

46%

38%

24%

20%

18%

14%

12%

6%

5%

4%

3%

2%

QHP

Enrollees(4165)

%

Medicaid

Enrollees(2682)

%

Began Application/

Didn’t Enroll(967)

%

Disenrolls(647)

%Base: Total Respondents

74%

40%

18%

8%

38%

14%

28%

20%

9%

4%

6%

4%

4%

70%

46%

34%

20%

35%

25%

26%

21%

15%

16%

11%

9%

3%

84%

45%

35%

22%

26%

22%

14%

15%

10%

7%

5%

4%

1%

9

Helpfulness of Sources of Information Used by Sub-

Population

While the website was the most commonly used source of information, brokers

and navigators were the most helpful sources of information.

Q5. Using a scale of 1 to 5, “1” meaning “Not helpful at all” and “5” meaning “Extremely helpful,” please indicate how helpful the following sources of information regarding Healthplanfinder were.

Top 2 Box - % Extremely Helpful (Net)QHP

Enrollees

Medicaid

Enrollees

Began

Application

Didn't Enroll

Disenrolls

Base: Used Source For Information (varies)

% % % %

An insurance agent or broker 80 73 62 67

Community organizations, such as advocacy groups or churches 68 72 52 57

Your doctor or health care provider 61 77 69 62

Family, friends or other personal contacts 57 71 61 56

Health insurance companies 56 65 48 40

Healthplanfinder customer support call center 54 80 54 51

Healthplanfinder website - www.waHealthplanfinder.org 49 70 41 48

TV, radio or newspaper advertising 43 53 45 45

10

Channels of Enrollment by Sub-Population

The Healthplanfinder website was the strongest channel of enrollment by far. Even

Medicaid enrollees, who used more channels than the other groups still had close

to two thirds of enrollees sign up by the website.

Ways to EnrollQHP

Enrollees

Medicaid

EnrolleesDisenrolls

Base Enrollees Or Disenroll Or Renewals Only (4165) (2682) (647)

% % %

Healthplanfinder website – www.waHealthplanfinder.org 66 59 65

An insurance agent or broker 13 3 12

Healthplanfinder customer support call center 11 14 10

A health center or hospital 3 10 4

In-person help at another location, such as a church or a

community center2 4 3

Filling out and sending in a paper application 1 4 2

None of the above 2 4 3

Don’t know/Prefer not to answer 1 2 1

Q1. Ultimately, through which of the following ways did you [[IF NEW ENROLLEE OR DISENROLL; R22=1, 3 OR 6]] [enroll for] [[IF RENEWAL; R22=2 OR 4]] [renew your] health insurance through

Healthplanfinder?

11

Offers quality health insurance coverage

Offers the right amount of plans for me to choose from

Offers affordable plans

Has health insurance coverage I would recommend to others

Is for people like me

Offers plans that are a good value for the money

Is trustworthy

Offers access to the best doctors

Helps me understand health insurance

Protects my personal health information

Is there when I need them

Looks out for my best interest

Acts as an advocate between me and my health insurance company

Helps me understand how to file taxes relating to health insurance

Perceptions of Healthplanfinder

Q15. Please tell me how much you agree that the following statements describe Healthplanfinder, by using a scale of 1 to 5, with “1” meaning “Does not describe at all” and “5” meaning

“Describes extremely well”. The higher the number, the more the statement describes Healthplanfinder.

75%

72%

69%

69%

68%

67%

63%

62%

62%

60%

57%

52%

43%

41%

QHP

Enrollees(4165)

%

Medicaid

Enrollees(2682)

%

Began Application/

Didn’t Enroll(967)

%

Disenrolls(647)

%

Base: Total Respondents

Top 3 Box

Healthplanfinder is perceived to offer the right number of affordable, quality health

plans.

87%

87%

85%

88%

83%

84%

76%

79%

82%

84%

80%

80%

56%

64%

56%

57%

59%

55%

66%

59%

57%

68%

58%

57%

61%

71%

69%

62%

61%

61%

58%

65%

63%

60%

66%

55%

52%

45%

43%

12

The website used words and phrases that were easy to

understand

I trusted that my personal information would be kept safe

I felt confident using the website

I was able to find the information I was looking for in a timely

manner

The website made it easy for me to find the information I was

looking for

The website made it easy for me to understand how health

insurance works

The website was available when I needed it

Levels of Health Literacy

While all groups agreed that the website used words and phrases that were

easy to understand, there is still health insurance literacy work to be

accomplished.

Q16. You mentioned you visited the Healthplanfinder website. Using a scale of 1 to 5, “1” meaning “Strongly disagree” and “5” meaning “Strongly agree,” please indicate how much you agree with the following

statements regarding the Healthplanfinder website. Use any number between 1 and 5; the higher the number, the more you agree.

57%

49%

43%

39%

37%

36%

32%

QHP

Enrollees(3581)

%

Medicaid

Enrollees(1989)

%

Began Application/

Didn’t Enroll(680)

%

Disenrolls(544)

%

Base: Used Source

Top 2 Box - % Strongly Agree (Net)

76%

74%

67%

60%

59%

57%

68%

58%

54%

41%

35%

35%

35%

46%

61%

52%

45%

38%

38%

36%

35%

13

Offers quality health insurance coverage

Is for people like me

Offers affordable plans

Has health insurance coverage I would recommend to others

Is trustworthy

Protects my personal health information

Offers plans that are a good value for the money

Offers the right amount of plans for me to choose from

Is there when I need them

Offers access to the best doctors

Helps me understand health insurance

Looks out for my best interest

Acts as an advocate between me and my health insurance company

Helps me understand how to file taxes relating to health insurance

Perceptions of Customers with and without Prior

Insurance

Q15. Please tell me how much you agree that the following statements describe Healthplanfinder, by using a scale of 1 to 5, with “1” meaning “Does not describe at all” and “5”

meaning “Describes extremely well”. The higher the number, the more the statement describes Healthplanfinder.

55%

53%

52%

52%

50%

50%

48%

46%

43%

42%

40%

39%

33%

22%

56%

57%

57%

54%

57%

58%

52%

47%

52%

47%

48%

48%

43%

30%

T2B – (Describes Extremely Well)

Had Insurance Prior

Did not have Health

Insurance Prior

Base: Total Respondents (varies)

Customers without prior insurance had a more positive perception of Healthplanfinder

across the board than those who had insurance prior.

14

Reason for Disenroll/Didn’t Enroll

Expense is the most common reason for leaving or not finishing the application. However for those who

didn’t complete the application, poor customer service experience and technical difficulties are causes

that can be fixed.

Began Application

Didn't Enroll Disenrolls

Base: Disenrolls And Began Application But Did Not Complete 967 647

% %

Too Expensive/Can't Afford It (Net) 32 24

Too expensive/can’t afford it – general 26 19

Too expensive/can’t afford it – premiums specifically 11 9

Too expensive/can’t afford it – co-pays and deductibles 8 7

Too expensive/can’t afford it – prescriptions 4 3

Other personal situations (marriage, divorce, death in family, etc.) 18 10

I/my spouse got a job with health insurance 6 26

Poor experience dealing with Healthplanfinder/poor customer service 13 11

Technical difficulties (website or general) 13 10

Not worth it/Not valuable/Poor coverage 8 8

I qualified for Medicare 2 13

Q28. Why did you [[IF DISENROLL; R22=6]] [discontinue your health insurance coverage][[IF BEGAN APPLICATION DID NOT COMPLETE; R22=5]] [not finish your application for health insurance coverage]

through Healthplanfinder?

15

Prior Health Insurance Status

More than half (63%) of households surveyed had health insurance in the past year. Didn’t

Enrolls had the highest percentage of previously uninsured.

Previous

Health

Insurance

Total

63%

34%

3%

Yes

No

Refused

Q10. Did you or anyone in your household have health insurance in the year prior to first contacting Healthplanfinder, such as through your employer, your spouse’s employer, a union, Medicaid/ Washington

Apple Health, etc?

30% among QHP enrollees

39%* among Medicaid enrollees

% Previously Uninsured

*Significantly higher than QHP enrollees

40%* among Didn’t Enrolls

26% among Disenrolls enrollees

Customer Service

17

The greatest strength of the Call Center was that the staff was very respectful to

their feelings.

Call Center Customer Service

1% 1% 3% 1%5% 2% 8% 3%

5%2%

3%5%

12%

6%

10%12%

24%

18%

16% 23%

52%

71%61% 56%

Strongly agree (5)

4

3

2

Strongly disagree (1)

Don’t know/Prefer not to answer

The call center staff treated me with respect

QHP

Enrollees

Medicaid

Enrollees

Began Application/

Didn’t Enroll DisenrollsBase: Source Used (1898) (1074) (449) (294)

Top 2 Box 76% 89% 76% 79%

Q17. You mentioned you contacted the Healthplanfinder customer support call center. Using a scale of 1 to 5, “1” meaning “Strongly disagree” and “5” meaning “Strongly agree,” please indicate how much you

agree with the following statements regarding the Healthplanfinder customer support call center. Use any number between 1 and 5; the higher the number, the more you agree.

18

All groups agree that improvements are needed for timely resolution of issues.

Call Center Problem Resolution Timeliness

2% 1% 2% 1%

34%

11%

35% 35%

10%

8%

8% 9%

11%

13%

12% 14%

18%

20%

13%16%

25%

47%

30% 25%

Strongly agree (5)

4

3

2

Strongly disagree (1)

Don’t know/Prefer not to answer

They were able to resolve my issue in one call

QHP

Enrollees

Medicaid

Enrollees

Began Application/

Didn’t Enroll DisenrollsBase: Source Used (1898) (1074) (449) (294)

Top 2 Box 42% 67% 43% 41%

Q17. You mentioned you contacted the Healthplanfinder customer support call center. Using a scale of 1 to 5, “1” meaning “Strongly disagree” and “5” meaning “Strongly agree,” please indicate how much you

agree with the following statements regarding the Healthplanfinder customer support call center. Use any number between 1 and 5; the higher the number, the more you agree.

19

The agent or broker treated me with respect

I trusted the agent or broker had my best

interest in mind

I felt confident having the guidance of an

agent or broker

The agent or broker helped me understand

my coverage options

The agent or broker explained key health

insurance terms

Opinions of Broker Assistance

All groups agreed most strongly that the agent or broker they dealt with treated

them with respect.

Q18. You mentioned you contacted an agent or broker to get information about Healthplanfinder. Using a scale of 1 to 5, “1” meaning “Strongly disagree” and “5” meaning “Strongly agree,” please indicate how

much you agree with the following statements regarding the agent or broker you contacted. Use any number between 1 and 5; the higher the number, the more you agree.

89%

80%

79%

79%

77%

QHP

Enrollees(985)

%

Medicaid

Enrollees(209)

%

Began Application/

Didn’t Enroll(198)

%

Disenrolls(142)

%

Base: Used Source

Top 2 Box - % Strongly Agree (Net)

84%

79%

78%

77%

76%

84%

73%

71%

73%

71%

85%

80%

74%

72%

72%

20

Opinions of Community Organization Assistance

Almost all Disenrolls felt as though the community organization they dealt with

treated them with respect.

They treated me with respect

I trusted they had my best interest in

mind

I felt confident having the guidance of

the community organization

They helped me understand my

coverage options

They explained key health insurance

terms

Q19. You mentioned you contacted a community organization to get information about Healthplanfinder. Using a scale of 1 to 5, “1” meaning “Strongly disagree” and “5” meaning “Strongly agree,” please indicate

how much you agree with the following statements regarding the community organization you contacted. Use any number between 1 and 5; the higher the number, the more you agree.

79%

69%

67%

66%

65%

QHP

Enrollees(155)

%

Medicaid

Enrollees(160)

%

Began Application/

Didn’t Enroll(103)

%

Disenrolls(32)

%

Base: Used Source

Top 2 Box - % Strongly Agree (Net)

89%

84%

82%

74%

72%

78%

67%

62%

58%

55%

97%

80%

71%

68%

65%

21

Ways to Improve

Customers were very clear when asked

what they wanted improved. The

Healthplanfinder website was the most

common problem people had both when

signing up and just to gather information.

Failure to solve existing problems was

another major touch point.

Q30. And finally, is there anything else you would like to add that will help Healthplanfinder better meet the needs of residents here in Washington?

Q23. What has been your most positive experience with Healthplanfinder?

Q9. In what ways could Healthplanfinder have been easier to use during the [[IF NEW ENROLLEE, DISENROLL OR BEGAN APPLICATION BUT DID NOT COMPLETE; R22=1, 3, 5 OR 6]] [application process]

[[IF RENEWAL; R22=2 OR 4]] [renewal process]?

After having issues with

the website, I called

customer service only to

be left on hold for a long

time and then they

couldn’t even resolve my

problem…

Carrier Information

23

Carrier Satisfaction

Four out of five QHP enrollees are satisfied with their carrier, while nine out of

ten Medicaid Enrollees are pleased with Washington Apple Health.

Q13 How satisfied are you with your current health insurance company? Would you say you are…?

QHP Enrollees Medicaid EnrolleesBase: Currently Have Health

Insurance Company(3900) (2496)

Satisfaction 82% 90%

4% 3%5% 3%

9%4%

36%

26%

33%

40% B

14%24%

Extremely satisfied

Very satisfied

Somewhat satisfied

Not very satisfied

Not satisfied at all

Don’t know/Refused

24

Insurance Usage

Three quarters of those who have insurance use it.

Q24. Have you used your health insurance in 2015 – such as for doctors’ visits, hospitalizations, health screenings, etc.?

QHP

Enrollees

Medicaid

Enrollees

Base: Enrollees Or Renewals (4165) (2682)

74%

24%

2%

76%

22%

2%

Yes

No

Don’t know/Prefer not to answer

25

Base: Total Respondents (3041) (801) (1877) (584)

1% 12%4%

9% 9%

10%35%

38%

35%

23%

15%8%

QHP - Insurance User QHP - Non User

Extremely satisfied

Very satisfied

Somewhat satisfied

Not very satisfied

Not satisfied at all

Don't know

1%11%

2%

5%4%

6%25%

31%

42%

32%

27% 16%

Medicaid - InsuranceUser

Medicaid - Non User

Carrier Satisfaction (Insurance User vs. Non User)

Q13 How satisfied are you with your current health insurance company? Would you say you are…?

Q24. Have you used your health insurance in 2015 – such as for doctor’s visits, hospitalizations, health screenings, etc…?

Satisfaction 86% 69% 94% 78%

Those that have used their insurance are more satisfied with their carrier than

those who have not.

26

Perceptions of Price by Tier

Silver tier respondents feel they are getting a fair or great deal.

QHP New QHP Renewal

I am paying too

much

I am paying a

fair amount

I am getting a

great deal

I am paying too

much

I am paying a

fair amount

I am getting a

great deal

Base Enrollees Or Renewals: 724 917 359 768 1,091 307

% % % % % %

Catastrophic 2 1 - 1 - 1

Bronze 45 27 28 48 33 31

Silver 45 65 68 43 59 62

Gold 8 7 4 8 8 6

Platinum - - - - - -

Missing/Blank - - - - - -

R4. Plan Tier

Q26. Which of the following statements best describe your opinion?

27

Reason for Carrier Dissatisfaction

As expected, QHP Enrollees overall were much more concerned about expense and cost

of coverage, while Medicaid Enrollees were dissatisfied with customer service measures

and the quality of coverage.

QHP New

Enrollees

QHP Renew

Enrollees

Medicaid New

Enrollees

Medicaid

Renew

Enrollees

Base: Not Very Satisfied Or Not At All Satisfied With Current Health Insurance Company 296 262 147 25

% % % %

Co-pays/Coinsurance/deductible too expensive 52 52 5 4

Premiums too expensive 45 54 4 1

Confusing information from health insurance company/benefits or coverage not clear 41 42 32 42

Health insurance company does not provide good value/coverage isn’t worth it 35 40 22 10

Preferred doctor/hospital/specialist not in network 29 24 36 35

Health insurance company does not provide high quality coverage 27 23 38 23

Poor customer service from health insurance company 25 28 22 32

Too little information/communication from health insurance company 22 27 33 30

Health insurance company not easy to get in touch with/not responsive 15 23 26 14

Too much information/communication from health insurance company 2 2 2 3

Other, please specify: 21 27 26 35

Don’t know/Prefer not to answer 1 1 3 1

Q14. Why are you [[INSERT ANSWER FROM Q13]] with your current health insurance company?

Demographics

29

Targeting Sub-Populations – Demographics

QHP

EnrolleesMedicaid Enrollees

Began Application

Didn't EnrollDisenrolls

Base:(4,165)

%

(2,682)

%

(967)

%

(647)

%

Gender

Male 46 46 51 48

Female 54 54 49 52

Age

18-34 24 58 39 34

35-54 40 31 37 35

55-64 36 11 24 19

Ethnicity/Race

White or Caucasian Only, Non-Hispanic 67 72 63 56

African American or Black Only, Non- Hispanic 2 2 4 2

Other Race Only, Non-Hispanic10 9 12 8

Hispanic – White or Caucasian 3 2 4 7

Hispanic – African American or Black0 0 0 0

Hispanic – Other Race 7 3 8 19

Two or more races, Non-Hispanic 2 2 2 1

Two or more races, Hispanic 0 0 0 -

Prefer not to answer 9 10 7 7

QR12 Age Group

QR9. Gender

QD5 What is your marital status?

QD3. Race/Ethnicity

30

Targeting Sub-Populations – Demographics

QHP

EnrolleesMedicaid Enrollees

Began Application

Didn't EnrollDisenrolls

Base:

(4,165)

%

(2,682)

%

(967)

%

(647)

%

Marital Status

Married 50 24 33 46

Single 28 58 41 31

Living together 4 5 7 5

Divorced/Separated 9 9 12 11

Widowed 3 2 2 2

Education

Less than high school graduate 3 6 12 5

High school graduate or G.E.D. 15 33 23 14

Some college or an Associate's Degree 35 37 33 31

Bachelor's degree 26 15 18 29

Graduate or professional degree 16 6 9 17

QR12 Age Group

QR9. Gender

QD5 What is your marital status?

QD3. Race/Ethnicity

31

QHP

Enrollees

Medicaid

Enrollees

Began

Application

Didn't Enroll

Disenrolls

Base:

(4,165)

%

(2,682)

%

(967)

%

(647)

%

Metal Tier

Catastrophic 1 - - 2

Bronze 36 - - 41

Silver 56 - - 49

Gold 7 - - 8

Targeting Sub-Populations – Demographics

QD6. What is the highest level of education you have completed?

QR4. Plan Tier

QR5. Plan Carrier