Best Practices for Health Insurance Outreach, Enrollment, Retention & Utilization: A Train-the-Trainer Session

Amy DeMarco, MPA

Amy DeMarco, MPA

Amy DeMarco, MPA, Institute for Healthcare Advancement

Amy DeMarco led this interactive train-the-trainer session on the OERU model (Outreach, Enrollment, Retention and Utilization) for coordinating health care access for the uninsured and newly insured. This model was originally created for the Healthy Families Program, also known as California’s State Children’s Health Plan. Best practices on how to reach and engage the uninsured were introduced in conjunction with experience-based guidelines on how to enroll consumers into health care coverage through a healthcare marketplace, like Covered California, California’s state-based healthcare exchange.

DeMarco stressed the importance of following up with clients and how getting them in for an appointment may require different techniques. She also shared tips on personalizing  documents for clients  such as highlighting keywords, writing the clients name, and underlining important information to help them retain and act on the information provided. Attendees were asked to share what works best for them and what has received a positive response from the client.

Difficult health care terms were explained in plain language. The presenter also ran through several common enrollment scenarios and asked participants to role play as the CEC and the client. Then these scenarios were discussed in the larger group so attendees could learn from others’ experiences.

Emphasis was placed on the Retention and Utilization portions of the trainings because there has been a great push by the marketplaces to increase enrollment, but little support provided to enrollers or healthcare workers to help these clients use their coverage and retain their insurance long term.  Suggestions for helping clients remember to pay their bill each month and renew their coverage each year were discussed. Reasons and solutions for why clients might not retain their coverage were also discussed.

Using the teach-back method was suggested to help clients understand their coverage and what they need to do to keep it. The Ask Me 3 technique was an audience suggestion on how to ensure that clients understood the health insurance information provided to them. This technique  helps enrollment counsellors identity the client’s main concern , develop next steps for the client,, and establish why it is important for them to take these necessary steps to get, keep and use their coverage.

The Utilization section kicked off with role-play scenarios where an audience member explained to a client how they could effectively navigate the healthcare system to use their coverage. The different types of care were discussed and the presenter explained in plain language terms the attendees could use with clients to explain when go to the ER, urgent care, and primary care provider (PCP) and how seeing their PCP first in non-emergency situations could save a client money.