Enhanced Direct Enrollment: What Carriers Need to Know

Six months ago, HealthSherpa became the first entity approved to use CMS’s innovative Enhanced Direct Enrollment (EDE) pathway, a technology that allows us to provide a white-labelled and customized Marketplace enrollment and plan management platform to our carrier, broker, and employer partners.

Since then, we’ve run over 100,000 applications through the new pathway, and have helped 7 carriers go live with EDE to better serve their own members, with a dozen more on the way. Our experience has given us deep insight into how powerful EDE can be: in the right hands, it will fundamentally alter the dynamics of the Marketplace.

Here are the four most important lessons we’ve learned about EDE to date:

Lesson #1: EDE transforms the relationship between carriers and their members

EDE might have “enrollment” right in the name, but treating it as yet another small improvement to the enrollment process would be a mistake. EDE doesn’t just dress up the Marketplace application in more user-friendly packaging - it completely transforms the end-to-end enrollment and policy management process, and with it, carriers’ relationship with their clients.

Put simply, with EDE, once a prospective member arrives on a carrier’s white-labeled site, they never have to leave. Consumers can quote, shop, enroll, and renew without redirecting to Healthcare.gov - and once they’ve enrolled, they can also pay their first premium, resolve data matching issues, report changes and download tax forms all on the carrier’s white-labeled portal.

In this way, EDE gives carriers total control over the user experience and their relationship with their members. Every time they log in to the branded EDE portal and are able to easily fulfill their post-enrollment needs, the carrier builds goodwill and positive associations with their brand. When it comes time to renew, happy members will want to stay in that carrier’s ecosystem.

Lesson #2: EDE dramatically lowers the cost of acquiring and retaining Marketplace members

In the past, conversion rates for Marketplace enrollment have been low, forcing carriers to spend hundreds of dollars to acquire a single consumer. EDE changes that, making it easier than ever for consumers to self-enroll, and increasing conversion by 180% over the old Direct Enrollment process.

How does that work? Firstly, EDE gets rid of the confusing double-redirect to Healthcare.gov that caused many consumers to drop out of the enrollment process altogether. Secondly, if a consumer had a Marketplace plan the prior year - and about 80% do - EDE surfaces an application that is prefilled with the previous year’s information.

These two changes don’t just improve conversion - they also make enrolling 70% faster. When conversion is higher and enrollment is more efficient, each dollar carriers spend on marketing goes further, opening up new channels and bringing down the cost per acquisition.

The cost benefits of EDE go far beyond enrollment. Members can self-serve for all post-enrollment tasks, without needing member support representatives to make lengthy 3-way calls to the federally facilitated Marketplace. And when November rolls around, they can renew in just five minutes by updating their pre-filled application. All of this helps reduce year-round staffing needs and administrative costs.

Lesson #3: Open Enrollment experience is key.

Any new technology has bugs, edge cases, and areas for improvement that only become evident with consistent use. HealthSherpa went live with EDE last Open Enrollment, which allowed us to submit over 100,000 applications through the EDE pathway. That experience has quickly enabled us to work through the growing pains that come with a new technology build and provide partners with “version 2.0” before any other vendors have launched their versions of EDE.

Open Enrollment and Special Enrollment are also fundamentally different. The circumstances of consumers who enroll during SEP require them to be more diligent, and member support representatives have time to get on the phone with them and dive into the nitty-gritty. In contrast, during Open Enrollment, both carriers and consumers are time-crunched and need to get things done quickly and efficiently. HealthSherpa is the only EDE vendor with experience in both “seasons,” which has allowed us to create a platform that caters to the needs of carriers and their members year-round.

Lesson #4: Awareness is still low

Because EDE was released during the busy final weeks of Open Enrollment last year, many issuers didn't have a chance to become familiar with it. As a result, some issuers have been left vulnerable to misinformation, with would-be vendors claiming the now defunct Direct Enrollment Proxy pathway is the same as EDE, or asserting that they are live with EDE when they have not yet received approval. Yet other vendors claim that they are “in the final stages of approval,” a misrepresentation of the CMS approval process.

Carriers who are approached with such claims should check CMS’ canonical list of entities approved to use EDE, available here. As of May 2019, HealthSherpa is the only entity approved for EDE that licenses its technology to carriers.

While some carriers have already gone live with or begun launching EDE, many others are still trying to discern whether EDE is a good fit for their organization. Carriers who are hesitant to make the jump should remember that given EDE’s power to increase enrollment and improve member retention, waiting to adopt it could put them at a disadvantage for years to come.

Last year, HealthSherpa brought 5 carriers live with EDE during open enrollment. Our out-of-the-box EDE solution makes it easy for issuers to quickly acquire Enhanced Direct Enrollment for their members and brokers and begin realizing the value immediately. This can all be done quickly with little impact on internal processes or their technology teams.  

At HealthSherpa, we pride ourselves on consistently being the first to innovate new technologies around ACA enrollment. Launching EDE represents our greatest accomplishment to date, and it’s one that we know will revolutionize the business of selling Marketplace coverage. But in the meantime, with November just around the corner, we have our sights set on a more modest goal: preparing ourselves for the smoothest Open Enrollment yet!

If you are a carrier and would like more information on how to use EDE to grow your business, contact us at ede@healthsherpa.com. We’d be happy to set you up with a demo so you can see firsthand just how powerful EDE is.