How Phone Calls Impact Affordable Care Act Marketplace Enrollment

Personalized phone calls improved enrollment results among certain subgroups enrolling in California’s Affordable Care Act marketplace and the intervention had a positive return on investment, according to a study published in Health Affairs.

However, the method did not prove meaningful overall for improving enrollment among individuals who started the enrollment process but did not complete it.

Over 79,500 individuals applied to enroll on Covered California, the state of California’s Affordable Care Act marketplace, but failed to enroll in a plan. The researchers divided this population into a treatment group that received a personalized phone call and a control group that could contact Covered California but did not receive a proactive, personalized call.

Individuals in the treatment group had the opportunity to work with the call center representative while on the phone in order to select a plan. Representatives left a voicemail with contact information for those who did not answer the phone call.

The study found that the personalized telephone call successfully led to a higher enrollment in California’s Affordable Care Act marketplace. Specifically, the treatment group, which received the personalized phone call, had a higher enrollment rate by 1.3 percentage points or a 10.8 percent higher rate than the control group yielded.

Those who received the personalized phone call were more likely than the control group to enroll in the Affordable Care Act marketplace by 2.7 percentage points or 22.5 percent.

“Despite higher enrollment rates in the treatment group for many subgroups, overall enrollment in the study population remained low,” the researchers found.

The study observed specific subgroups within the population of enrollees, assigning subgroups based on age, race and ethnicity, income, language preference, and whether or not they were referred from Medicaid.

Among those whose language preference was Spanish, the personalized phone calls increased enrollment by 3.2 percentage points or 74.4 percent and raised Hispanic consumers’ enrollment by 2.3 percentage points 31.1 percent compared to the control group.

Additionally, individuals who were referred to the marketplace from Medicaid had 53.7 percent—2.9 percentage points—higher enrollment when they received a personalized phone call. Those with incomes under 150 percent of the federal poverty level who received a personalized call had a 4.0 percentage point or 47.6 percent higher enrollment rate than those who did not receive a call.

Individuals over the age of 50 experienced the biggest positive impact as a result of the personalized phone—5.1 percentage points or 34.2 percent increase compared to the control group. The researchers stressed the implications that this statistic could have for policymaking, given that seniors in this age group are more likely to require chronic disease management.

Apart from assessing the enrollment rates of different populations, the researchers also analyzed the return on investment. They found that the return on investment of implementing personalized phone calls reached 102 percent.

“When comparing the size of enrollment effects across groups, we did not detect differences by referral source, income, Spanish spoken language preference, race and ethnicity, or age,” the study stated.

States have introduced various methods to support consumers’ decision-making processes when they are considering Affordable Care Act health plan coverage. However, these approaches often fall short for underserved populations, such as those with low healthcare literacy, low computer or internet access, or language barriers.

“These concerns have led to increasing interest among policy makers, navigators, and consumer organizations in developing novel outreach methods to address diverse barriers to enrollment,” the researchers explained. 

The study found that the personalized phone call approach did not produce significant results in improving access to coverage among individuals that started but did not complete the enrollment process previously.

Missing the call, finding alternate sources of insurance coverage, and finding marketplace coverage to have lower value are three reasons that the researchers provided which may have motivated this low enrollment.

As of late December 2021, 13.6 million individuals selected Affordable Care Act marketplace plans. Other public payer programs have taken a similar approach to helping enrollees find a health plan that works for them.