Enhanced Direct Enrollment: Changing the Game in the Individual Marketplace

By now, the secret is out that healthcare reform is a complex and ever-evolving program that even some industry professionals still struggle to completely understand; not to mention the average consumer who is forced into navigating the complex and changing exchange options available to them all governed by an alphabet soup of acronyms. The advent of the Federally Facilitated Marketplace (FFM), and what is known in the industry as "Direct Enrollment" (DE) was a great first step in providing consumers a mechanism to apply for financial assistance and shop for coverage that met their needs. However, it introduced new challenges to insurers by diluting their ability to attract and retain policyholders. While the healthcare industry, at large, has rapidly progressed toward integrated user experiences, it simply did not exist with the federal marketplace and the Direct Enrollment process. This meant that insurers offering products through the federal marketplace had very little control over the customer experience and the enrollment process. Until recently, the only integration available with the FFM was the "double redirect" method. Simply put, this experience required an insurer to push their prospective customer out to healthcare.gov with a pat on the back and a "Hope we see you again real soon!" The customer had to create another login, fill out another profile, and was then able to see other carriers' plan options as well. Additionally, this left the original insurer with little ability to track the consumer, offer assistance, or ensure that they made it back to their own site to finish the transaction. You can see why it has been a challenging and frustrating process for insurers.

Toward the end of 2017, CMS announced the next evolution of the Direct Enrollment consumer shopping experience. This new experience, called Enhanced Direct Enrollment (EDE), offers true integration with the FFM, providing insurers and web brokers the ability to control the complete user experience from quoting, applying for a subsidy, and enrolling in a plan, without having to direct the consumer to other sites or systems. This new process will provide a huge advantage to insurers over the classic approach to direct enrollment. It allows partners to keep all consumer interactions within the boundaries of their own software, while still receiving subsidy and eligibility determinations directly from the FFM. It is a game changer for anyone participating in the federal marketplace!

Over the last twelve months Colibrium has been working diligently with CMS to develop our EDE product and become a certified EDE partner. Our product consists of a new user experience as well as dozens of API integrations that will facilitate real-time data exchange directly with the FFM – out of sight of the end user. The development of our new user interface allows a user to complete their financial assistance subsidy application, prove their identity, and receive an accurate eligibility determination instantly – all without leaving the health plan's website. Additionally, consumers will have the capability to manage and retrieve all CMS required notices right there within the application. These are but a few of the features and advantages enabled through the new EDE product from Colibrium.

From a software development perspective, the EDE Add-On project at Colibrium has been incredibly complex, consisting of thousands of development hours to code and implement the features and processes required to support a seamless marketplace experience for consumers. Thousands of additional hours have been spent putting the application through exhaustive testing cycles to ensure the stability and accuracy of all data exchanges with the FFM. On top of the product development itself, CMS requires all potential EDE partners to undergo a rigorous audit process. Using a third-party auditor, we have had to undergo a deep and diligent scrutiny of our security and privacy framework, our user interface, and all our connections and integrations with the FFM and its back-end systems. Only partners that can demonstrate adherence to the strict requirements set forth by CMS will be approved to connect to the FFM. Colibrium is in the final stages of approval with CMS for our EDE Add-On product which will be available for carriers as soon as this year's OEP.

Colibrium is committed to the individual on-exchange market and the payers offering their plans there. By investing in and supporting the Enhanced Direct Enrollment process, we will be able to offer our clients and their constituents a robust and refined experience for managing all aspects of their on-exchange journey. To learn more about our EDE consulting services, our EDE Add-On product, or to request a demonstration, please contact us: info@colibrium.com.