Technology Study Finds the Value in a Simple Phone Call

A study published in Health Affairs finds that a phone call with a customer service representative can boost health plan enrollment in underserved populations, including those at or near poverty level, the elderly and minorities.

Researchers have found that a phone call with a live person at the other end can prod underserved populations in California into signing up for health insurance.

The study, led by Rebecca Myerson of the University of Wisconsin-Madison and published this month in Health Affairs, finds that this simple bit of technology can boost enrollment in the Affordable Care Act Marketplace among those at or near the poverty level, as well as older Americans and minorities. Even with this assistance, however, enrollment numbers remain low, and researchers said these population still face several barriers to access.

Researchers studied roughly 79,500 consumers who had applied for coverage in Covered California during the 2019 open enrollment period but had not selected a plan, and found that a personalized phone call from a service center representative boosted enrollment by 2.7 percentage points, or 22.5 percent of the target population, amounting to an overall return on investment of 2:1.

“When a consumer was reached for a one-on-one telephone conversation, the service center representative had detailed information on the consumer’s available options,” Myerson and her colleagues reported in the study. “Representatives were able to describe to consumers the subsidies and cost-sharing reduction options for which they were eligible, clarify the parameters of specific plans available to them (including the costs and benefits of each plan, provider networks, and quality ratings), and walk them through the enrollment process if desired. Assistance was available in Spanish and other languages. This intervention could address enrollment barriers such as lack of awareness of health insurance options, low health insurance literacy or computer literacy, preference for in-language assistance, and the time and cognitive costs of sifting through options.”

The project points to both the value and drawbacks of using technology to engage consumers. Researchers noted that some forms of communication, such as automated messaging, texts and e-mails, might not be appropriate or effective in reaching target populations who aren’t comfortable with those channels, while a simple phone can with a live voice at the other end can reach and effectively engage some people.

“Several prior interventions sought to improve health insurance decisions via ‘low-touch’ outreach methods, such as presenting information in an automated online choice environment, in an advertisement, or by mail,” the researchers noted in the study. “Although these approaches are effective for many consumers, they might not be sufficient to overcome certain barriers to obtaining coverage, such as gaps in health insurance literacy, computer literacy, or internet access. Further, consumers in non-English-speaking communities may face language and informational barriers that limit the effectiveness of traditional passive outreach. 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 biggest take-away is that technology can work if it’s tailored to the targeted population. A “one-size-fits-all” approach won’t work well.

Myerson and her colleagues found the personalized phone calls don’t overcome all barriers but do result in ”modest by meaningful enrollment gains in certain populations while yielding a positive return on investment.” They reported an estimated cost per new member acquired at $224, similar to Covered California’s average lifetime commission per member for broker-assisted customers.

They also suggested developing a long-term strategy that might include longer interactions, passive nudges and reminders and even automatic enrollment.

Myerson was joined in this study by fellow UWM researcher Honglin Li, Nicholas Tilipman of the University of Illinois at Chicago, Andrew Feher and Isaac Menashe of Covered California and Wesley Lin of the University of California Los Angeles (UCLA)