Aaron Karjala Reviews Cover Oregon’s Development and Launch
Aaron Karjala is the Chief Information Officer for Cover Oregon and has been working on the Oregon health insurance exchange framework for the past couple of years. The exchange, Cover Oregon will be easily accessible for the entire population and seamlessly accessible.
In an interview with Karjala we discuss the steps that were taken to create Cover Oregon and important challenges faced to incorporate eligibly and effective plan matching.
Anna Belle Abraham: Could you tell us more about Cover Oregon HIX efforts to make the exchange discoverable?
Aaron Karjala: There is a network of community partners to help the entire Oregon population get health insurance whether it’s commercial insurance or Medicaid. We specifically brought in an Oregon marketing firm who is setting up campaigns and marketing strategies around earned media and paid media. The paid media strategy will include television ads, radio, billboards, web banners, search engine optimization, so that when people do a search for an exchange or Cover Oregon we come through at the top of the query.
Our intent is to reach out with campaigns to the entire state both in metropolitan areas as well as in rural areas. We’ll be traveling around the state holding community meetings in the Portland Metro Area and down the I-5 Corridor. We’ll also go out to the small coastal towns, to northeastern Oregon, southwestern Oregon etc. to offer coverage information to the entire state. Our target population seems to change as we learn more and more.
We’ve also partnered with commercial insurance agents, who act as a sales-force to provide access to the exchange and do outreach activities for Cover Oregon. Our mission is to get them into the exchange and enrolled. We ultimately want to get health coverage to everyone.
ABA: How will individuals and small business be able to choose the right plan for their selves, their families or employees with Cover Oregon?
AK: Once people are in the exchange we’ve made a significant investment in user design and technology to help match them to their best plans.
We started with input from UX2014, which was a multi face consortium that identified the different types of people who would be coming into the exchange and what they would be looking for. Ultimately it produced a medium for a fidelity wireframe. We took that and brought in another firm, Dwight Digital, to build out an initial user design. Part of the way we did it was through an interactive prototype that allowed us to do end user and usability testing.
We came up with a hypothesis about the best way for making the shopping experience an effective one and giving individuals, small business employees and the like access to plans that would best suit their needs. After a year of testing what we found was that people have different needs depending on their life circumstances and insurance plan preferences. You’ve got some searching for every single detail and others wanting to be guided through the process to let Cover Oregon suggest plans according to their needs.
ABA: How would you describe the user experience with Cover Oregon?
AK: What we found is that there is no one-way to match individuals and families to their plans. We’ve had to design the site with multiple ways to do so. The first experience is similar to Turbo-Tax. This scenario will guide individuals by asking them questions one at a time. The answers to those questions will continuously refine the plans offered to them. It’s fairly simple and seamless. Otherwise, they can pop out of that TuboTax-like option and look at the whole universe of plans we have to offer one-by-one and narrow the search themselves.
Essentially what we’ve done is given it a very interview-type feel. It’s a process that allows you to start with all options available, and then set filtering tools to narrow down those options before you make a plan selection.
ABA: Much focus has been placed on the web presence of the exchanges, however support contact centers will also need to be put in place to help consumers participate, what is Oregon doing to integrate these the web interface and the contact center interfaces?
AK: We believe the call center is just as important to achieving our mission of getting people covered within Oregon. To support this we’ve already hired and are in the process of training about 70-80 staff members to build the call center. The staff are in an interim training on all the ins and outs on health coverage so they can guide people who decide not to use the online portal through the process.
The base approach that we took actually lent itself to an integrated environment for the call center. The core of the exchange is actually a customer relationship management solution at Siebel. Siebel is configured to do all of the work for the exchange both for the web portal as well as for the call center workflow. The web portal basically has technology we can leverage to make it more web-friendly by applying a lot of visual design. We were then able to reuse and configure the workflows for the call center representatives. There are now call center portal screens being used by representatives as effective tools where they can see the information people are interacting with on the web along with additional helpful information.
The other thing that we chose to do was implement a cloud-based telephony solution, which does call routing and workforce management around scheduling and will ultimately allow us to do chat functionality.
This technology will integrate with an individuals’ CRM, which will detect their phone number and if they’ve already entered their phone number on the web it will bring up all the information we have about that person. We understand the complexity of this solution and much like tax solutions; we are taking all the necessary measures to do identity proofing in order to access private information off the federal systems. We’re trying to make it fairly seamless for those who are using the portal and want to jump onto the call center and get that next level of help.
ABA: There has been a lot of focus on streamlining the eligibility and enrollment experience for consumers at the exchanges, how did Oregon approach this and what were some of the obstacles you had to overcome on the way?
AK: The big challenge with eligibility and enrollment, whether it be the commercial insurance plans or Medicaid is that you have to make multiple systems talk with each other. An exchange is not really an exchange unless it’s connected to other things. Cover Oregon doesn’t create the products or the coverage plans – we provide them for people, so they can easily compare them, shop apples to apples and make connections. The interfaces have been a formidable challenge, and our approach to it has been through partnerships.
Oregon invested a year and a half of twice-a-week meetings that started out with CIOs to lay out a strategy on the approach to connect systems together. Then we had our technology staff meet twice weekly to design the interfaces and connections to seamlessly get plan information to the end user. They were quoting information for small businesses, which is done by going through a whole group of options then getting an actuary analysis that sends employee rate information back depending on how the make up of the group looks, all of which required interfaces. The eligibility itself doesn’t require interfaces with the carriers because we have that in the system, but once you determine eligibility and someone selects a plan and has to enroll that requires an interface both for the plan and as well as all the financials around that.
Our meetings were spent doing application development sessions where we would come with the proposed technology solutions and then work through those with the carrier. Our goal was to actually minimize the impact on the carriers while maximizing the consumer experience. We also pushed for interface and the technology system modernization so that ultimately the population could have a seamless experience with the exchange.
We did the same thing on the Medicaid side where we worked with Orion Health Authority to determine how to connect to the Medicaid system. We needed to be able to check existing Medicaid enrollment – a crucial step in the Medicaid eligibility process, then go through a process of plan selection. This selection process has to be done dynamically, unlike the carrier plans. Then ultimately do a Medicaid enrollment. Over the last year, we’ve worked very closely with the health authority to build those connections for it to be effortless to the end user.
ABA: Once the 2014 deadline to launch the exchanges is behind us, it’s clear that ongoing feedback will need to be provided to the plans to get them the data they require to improve benefit design and successfully participate in the exchanges, has this been a focus area for Oregon
AK: We have service level agreements specified in our contract and we’re going to do what we call Business Activity Monitoring, which is automatically monitoring the interfaces as they are functioning. For example if we send out quotes for a small business, and we notice that a carrier continues to return an invalid response, we will automatically notify that carrier. That’s a lot of the work that we did over the last year with those carriers just to give you an idea of the scope of the meetings that we had. One notable thing I can say and that seems to stick in people’s minds is that when we would have these carrier meetings we would have about 30 to 40 people on the site and about 80 to 100 participating off-site via WebEx.