Transcript Marketing Ideas - Connect for Health Colorado

Market Segments
MEOW #4 September 21, 2011
Prepared by Shana Montrose based on notes from each break-out group
discussion from MEOW #3, August 17, 2011.
Groups were asked to discuss
We will have demographic data for
potential customers from Dr. Gruber in
late September. Short of that, what
additional information seems most useful?
2. What messages are most appropriate for
this group? Are there significant subgroups?
3. What strategies should we use to reach
people in this group (or in these
subgroups)?
1.
Facilitator: Heather Hewitt
INCOME AND
EMPLOYMENT
Introduction
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Target Population: 133% to 400% of FPL; 13.5% of
Coloradoans eligible for the exchange; 39% of
Coloradoans were uninsured at some point during
the past year
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Income is very important – it touches all other
groups (age and objectors; race, ethnicity, language,
and culture; gender and family composition; and
geography and the ways we reach people)
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All groups are based on employment and income
status so messaging strategies are going to intersect
with other groups
Subgroups
Many segments:
 Different / nuanced messages based on reasons
why the individual doesn’t have insurance (e.g.,
can’t afford it, rarely get sick)
 Different / nuanced messages based on different
employment and income levels
◦ Messages for those who go back and forth between
Medicaid and subsidies
◦ Don't assume that if individuals don’t have much
money that they’re unsophisticated about making
financial choices. Low-income individuals can manage
finances well and can make sophisticated decisions.
Messages
Affordability: there will be a difference of opinion regarding what they can
afford
 Shift the attitude of people who don't see this as relevant. Get them to see
this is for them.
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◦ Use pictures, stories, and person-to-person contact to get to the heart and shift
attitudes
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Yes, you can have insurance and here’s how.
There are options and financial support. Now there is room for you on the
bus.
It’s distinct from Medicaid.
It's easier to enroll than you think.
Consider: What’s in it for me and what’s the cost if I don’t get insurance?
◦ It’s the best buy you can make. It’s a huge bargain.
◦ Without insurance, you're gambling and the exchange now puts odds in your favor –
same full-cost coverage at a reduced cost.
◦ Number one cause of bankruptcy is healthcare expenses. Use stats of catastrophic
event: How likely? How costly? What does it cost for a broken leg?
Outreach Strategies
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Employers
Social networks – community groups, churches
Safety-net organizations, “trusted hands”
Elected officials (many people call them regarding issues and they
are out in the community speaking to their constituents)
Trusted and esteemed newscasters and sports figures, like Tebow
or Elway (can act as visible spokespeople)
Town hall meetings
Local media, including television, radio, newspaper
Schools, including community colleges
Social media like Facebook,YouTube, and Twitter
Search engine marketing
Direct mail
Out-of home advertising
Funding
What can federal dollars cover, if
anything?
 Foundations, trusts, other grants
 Build partnerships with news stations,
sports teams, and other influential groups
to be champions for insurance exchanges
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Facilitator: Carol Giffin-Jeansonne
AGE AND OBJECTORS
Key Points
Two high yield groups were identified: 1825 year olds and those ages 55-64.
 Cost as primary deterrent of insurance
coverage in both groups.
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◦ Younger adults low end of the pay scale
◦ Seniors: retired, unemployed, or on fixed
incomes.
Males 18 - 34 years - higher
unemployment and uninsured rates.
 Think about style and tone
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Men
There are more uninsured men in
Colorado than women.
 Men are less concerned with healthcare
in the younger age groups.
 Men will likely represent the largest
percentage of objector population.
 Currently, affordability may be a greater
issue for women in terms of access to
coverage.
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Colorado Uninsured Statistics:
(from Kaiser State Facts)
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Total uninsured ages 19-64:
% of State population
Total uninsured non elderly adults above 400% FPL:
(Likely “objector” population or voluntarily uninsured)
Total uninsured non-elderly adults under 139% FPL
(Population that may qualify for Medicaid expansion)
Uninsured adults that could qualify for subsidies):
(Under 139% - 400%FPL)
Target population for exchange outreach:
Total non elderly adults with Dependents:
Total non elderly adults w/o Dependents:
Total uninsured non elderly adult men:
Total uninsured non-elderly adult women:
616,300
20%
83,400
355,300
264,500
347,900
181,800
434,500
337,800
278,500
What’s changed?
Guarantee Issue
 New ratings ratios, age, geography, etc.
 Annual and lifetime caps
 No rescissions
 Etc.
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Layered Messaging
Layer 1: Notification (You will need
insurance coverage or pay a penalty in
2014 and it applies to you unless…..)
 Layer 2: Basic information
 Layer 3: Detailed information
 Layer 4: Interactive information
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◦ Use links to move user between layers or
identify terminology or concepts
Messaging to Young Adults
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Convince them they need insurance by presenting some very real,
relatable examples when not having insurance is disastrous.
Craig Hospital and catastrophic injuries, perhaps videos
Emphasize injury more than sickness or wellness benefit (“I can get
over pneumonia, but not a torn ACL.”)
Need to convey benefit/cost effectiveness of insurance provided at
exchange versus just a catastrophic plan. Essential benefits package
will inform this (“is it richer than I want?).
◦ TONIK
◦ “How will this benefit me?”
◦ Explain terms, benefits in language they will understand, perhaps in a
brochure, etc. (“6th grade reading level, 8th grade listening
comprehension level)
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Tech modalities: youtube, facebook, google+, twitter, texts
Frame marketing in a way that perhaps stigmatizes not having
health insurance (“Dude…Think student loans are bad?”)
Ages 18-34: Considerations
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Early range of age group has a high uninsured rate. 30% up to age
26 have no health insurance roughly 1.2 million nationally
Early range of age group may be on parent’s coverage until age 26.
This group is more likely to have a volatile employment status
This group will have the lowest income
Cost will be an issue
This group may be the most willing to pay the penalty
On a personal level health coverage will be considered to be less
critical of a priority (unless pre-existing condition)
This group will be the least familiar with health insurance concepts
and terminology
Attachment to provider networks or individual providers will be
limited.
Age 18-34: Outreach tools
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Insurance industry and organizational marketing.
(This will be the single most important outreach
mechanism. We need to work closely with and learn
(or adopt) marketing strategies from carriers)
PSAs, Web ads
Social Media, facebook, twitter, texting, etc.
You Tube
Universities
Parents with children approaching the end of
dependent coverage.
Youth groups and organizations
Faith-based groups and churches
Business groups and HR managers
How will it affect me if…?
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I’m a student
I’m on my parent’s plan
I’m unemployed or employment is part time
I’m employed and my employer provides
affordable coverage
◦ I’m employed but coverage is not affordable?
◦ I’m employed but my employer does not offer
coverage or dropped coverage
◦ I’m self-employed
How will it affect me?
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Why do I have to have health insurance?
What does the government consider affordable for someone like
me? In short, how much could I end up paying out of pocket for
this
If I choose not to purchase insurance what penalties (not just
money) will I be subject to?
When do I have to start thinking about this?
How long can I stay on my parent’s coverage?
Am I ever exempt?
What’s the penalty?
How much will coverage cost?
How do I get coverage and what are my choices or options?
What kind of coverage do I need based upon my current health
status and lifestyle?
Will these plans actually cover or help cover my costs if I have a
bad accident or injury?
Age 18-34: Advantages
◦ Improved affordability compared to current
system?
◦ Subsidies and premium tax credits based upon
income level
◦ Medical coverage for injuries and accidents.
◦ Catastrophic coverage
◦ Debt and asset protection
◦ Bankruptcy avoidance
◦ Stop gap option between periods of employment.
Messaging to Objectors
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For objecting older adults real, live
representatives may be the best approach for
targeted outreach – no marketing campaign is
going to convince them.
Emphasize personal responsibility
Emphasize how they could save money by
enrolling now versus later
Present data from more sources perceived to be
more “neutral”
Educate how seniors can become eligible for
financial help
Need to elucidate who will be exempted
Age 35-55: Considerations
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Interest in the exchange may not be immediate in 2012, 13,
or 14. Many will be currently covered by existing plans. That
may make the transition somewhat transparent for a large
part of this group.
This group will likely have the highest income
This group is more likely to have a stable employment status
This group is more likely to have insurance coverage already
This group will be less willing to pay the penalty than the first
group
Health coverage will be a medium to high priority
This group will be familiar with health insurance concepts
and terminology
Providers and provider networks will be a higher priority,
since they will probably be established in this age group.
Age 35-55: Outreach tools
Insurance industry and organizational
marketing. (This will be the single most
important outreach mechanism. We need to
work closely with and learn approaches
from carriers)
 Brokers, insurance agents and navigators
 PSAs, Web ads, Web sites, Printed media
 Call centers and (robo-calls?)
 Faith-based groups and churches
 Businesses, business groups, HR managers
 Financial consultants and advisors
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How will it affect me if…?
◦ I’m unemployed or employment is part time
◦ I’m employed and my employer provides
affordable coverage
◦ I’m employed but coverage is not affordable?
◦ I’m employed but my employer does not offer
coverage or dropped coverage
◦ I’m self-employed
How will it affect me?
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How does this affect the plan and coverage that I or
my family are currently on?
Does the new law require me to change coverage?
Will these new laws cause my employer to drop my
coverage?
Will this new law make it easier for my employer to
offer coverage?
Will this new law impact my salary?
Under what circumstances would I have to use an
exchange?
What advantages are there in purchasing coverage
through an exchange?
How will it affect me?
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When do I have to start thinking about this?
Am I ever exempt, especially between jobs?
Can I stay in the same provider network?
How does this address my family’s coverage?
How portable is this new coverage?
What’s the penalty?
How much will it cost?
What about premium cost growth?
How do benefits compare to current coverage?
How do I get coverage and how does this affect benefit
choices?
What kind of coverage do I need based upon my current
health status age, location, and lifestyle?
Age 35-55: Advantages
◦ If you are currently covered process may be
transparent
◦ Improved affordability compared to current
system?
◦ Subsidies and premium tax credits based upon
income level
◦ Catastrophic coverage
◦ Debt and asset protection
◦ Bankruptcy avoidance
Age 55-65: Considerations
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Nationally, 4.3 million people in this age group were
uninsured in 2008. That is probably higher now
Currently, this group may be too old to afford insurance
in the individual market. The exchange and guarantee
issue provide better opportunities for coverage
This group will be the highest users of health care
across the 3 groups
This group has the highest incident of chronic illness.
Health coverage will be a high priority
Provider network concerns will be especially important
Age 55-65: Considerations (cont)
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This group is the most likely to have insurance
coverage already, assuming that they can afford it
This group may be the most likely to have premium
increases
This group will be the least likely to choose paying a
penalty over coverage.
This group will be familiar with health insurance
concepts and terminology
This higher age range of this group will be looking to
bridge the gap to Medicare
This group may have a declining income
This group is likely to have a less stable employment
status over time
Age 55-65: Outreach Tools
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Insurance industry and organizational marketing.
(Note: this will be the single most important
outreach mechanism. We need to work closely
with and learn approaches from carriers).
Brokers, insurance agents and navigators
Organizations like AARP
PSAs, Web ads, Web sites, Printed media
Call centers and (robo-calls?)
Faith-based groups and churches
Businesses, business groups and HR managers
Financial consultants and advisors
How will it affect me if…?
◦ I’m unemployed or employment is part time
◦ I’m employed and my employer provides
affordable coverage
◦ I’m employed but coverage is not affordable?
◦ I’m employed but my employer does not offer
coverage or dropped coverage
◦ I’m self-employed
◦ I’m considering early retirement
◦ I’m at risk of lay off or declining salary
How will it affect me?
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How does this help me get coverage if I don’t’ have it or currently can’t afford it?
How does this help me if I get laid off or retire early?
How does this help me in the time gap before qualifying for Medicare, especially if
age qualifications for Medicare increase or if benefits are means tested?
Should I think about this coverage as supplemental insurance (Medigap) when I do
qualify for Medicare?
When do I have to start thinking about this?
Am I ever exempt, especially between jobs?
Can I stay in the same provider network?
How portable is this coverage?
What’s the penalty?
How much will coverage cost?
What about premium cost growth especially due to changes in health status or
usage?
How do benefits compare to current coverage?
How do I get coverage and how does this affect benefit choices?
What kind of coverage do I need based upon my current health status, age, location,
and lifestyle?
Age 55-65: Advantages
◦ Improved affordability compared to current
system (?)
◦ Better stop gap options prior to Medicare
◦ Makes individual market coverage more certain
and possibly more affordable
◦ Subsidies and premium tax credits based upon
income level
◦ Catastrophic coverage
◦ Bankruptcy protection
◦ Debt and asset protection
Identify exemptions to the Individual
Mandate (Responsibility) provisions
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Financial hardship
Those without coverage for less than three months
If the lowest cost coverage option exceeds 8% of an
individual’s income
Individuals with incomes below the tax filing
threshold (in 2009 the threshold for taxpayers under
age 65 was $9,350 for singles and $18,700 for
couples).
Religious objections
American Indians
Undocumented immigrants
Incarcerated individuals
Tax Penalty
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Specific Tax Penalty:
◦ The greater of $695 per year up to a maximum of three times that
amount ($2,085) per family or 2.5% of household income.
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Penalty Phase-in
◦ 2014: $95 per person (capped at $285 per family) or 1 percent of
household income
◦ 2015: $325 (capped at $975) or 2 percent of household income
◦ 2016: $695 (capped at $2,085) or 2.5 percent of household income
◦ 2017 and after: The $695 penalty is indexed for a cost-of-living
adjustment and must be rounded to the next lowest multiple of $50.
For families, the flat-dollar penalty is capped at three times the indexed
value for an individual. For example, if in 2017 the penalty is $700, the
capped amount would be $2,100. As in 2016, the individual mandate
penalty is the greater of the flat-dollar amount or 2.5 percent of
household income
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Describe how the penalty will be assessed and indicate that
violators are not subject to prosecution for tax evasion.
Highlight and define key terms and concepts
(leave take home handouts or websites for
these concepts and terms, FAQs, etc.):
Specific terms such as: Premium
subsidies, Premium tax credits, Cost
sharing, Co-pays Deductibles, FPL, ESI, etc.
 General concepts such as: Individual,
Small group, Large group insurance
markets, Guarantee issue, pre-existing
conditions, etc.
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How to obtain insurance if…
If employed
 If unemployed
 If self-Insured
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Purchasing options inside and outside of
the exchange (Note: the real question
here is what the heck is an exchange and
how do I use it? Also how can I get help
using it?)
Coverage Options for:
Dependent coverage through age 26
 Essential benefits package
 The heavy metal benefit tiers including
catastrophic coverage
 Maintenance coverage vs. catastrophic
coverage
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Premium Credits and Cost Sharing:
Eligibility
Individuals and families with incomes between
133-400% FPL to purchase insurance through the
Exchanges.
 Limited to U.S. citizens who meet income limits
 Employees who are offered coverage by an
employer are eligible for premium credits if:
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◦ Employee share of the premium exceeds 9.5% of
income.
◦ Employer plan does not have an actuarial value of at
least 60%
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Legal immigrants who are barred from enrolling
in Medicaid during their first five years in the U.S.
Premium Credits and Cost Sharing:
Credit levels
◦ Tied to the second lowest cost silver plan in
the area
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Up to 133% FPL: 2% of income
133-150% FPL: 3 – 4% of income
150-200% FPL: 4 – 6.3% of income
200-250% FPL: 6.3 – 8.05% of income
250-300% FPL: 8.05 – 9.5% of income
300-400% FPL: 9.5% of income
Cost Sharing Subsidies
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100-150% FPL: 94%
150-200% FPL: 87%
200-250% FPL: 73%
250-400% FPL: 70%
Facilitator: Susan Downs-Karkos
RACE, ETHNICITY,
LANGUAGE, CULTURE
Data Needs
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It would be helpful if other data dimensions
that are collected, such as around income,
employment status, etc. are also broken
down by race/ethnicity
How are different ethnic groups receiving
health care and insurance today?
Information on immigration status - for
instance, legal immigrants who may have
been here less than five years, will not qualify
for public benefits, but can purchase in the
exchange and receive subsidies. Who are
they?
Messaging
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How do the messages that are being developed for the mainstream
resonate with these subgroups? We anticipate that many messages
around cost, for instance, may not be as effective with these groups.
Emphasizing doing what is best for your kids and taking care of
your family are messages that will work
Need to create a trust. (Also need to verify that Department of
Homeland Security won't have access to this data. If they do, then
the undocumented parents of citizen children are not going to
enroll their kids.)
Emphasize that you have all materials/communication available in
Spanish
Messages that include that those with linguistic and cultural
differences are welcomed to join the HIE, those differences are
honored and that there is interpretation available
Emphasize ease of use - there is a clear, user-friendly, noncumbersome way to get services
Outreach
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Navigators who are of the same cultural/linguistic background of
those targeted for enrollment in HIE.
◦ They can work through churches, cbos and others to engage with the
population and help them navigate the coverage process. They have the
trust of the population.
◦ The exchange should provide grants for this purpose.
◦ Choice Administrators is developing I-Pad technology to help people
like navigators enroll diverse participants in HIE-like programs.
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Find a core group of people from a particular racial/ethnic/linguistic
background who would be eligible. Work within that group and
expand it outwards.
Develop simple, one-page FAQs that could be translated into a
variety of languages and used by navigators with diverse
populations.
Remember that often the staff themselves of cbo's may qualify they themselves are a target audience.
Facilitator: Joe Campe
GENDER AND FAMILY
Data Needs
Are women insured under Medicaid at
higher rates?
 Marital status?
 Education level?
 Children vs. no-child?
 Where are the subgroups currently?
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Messaging
Women think their child’s health is more
important –the children need sports/school
physical and women may be more likely to take
care of those needs
 Young invincible response is different based on
gender
 Confounded with age, gender, family, marital status
 Subgroups: Men and women by age, Student
status, Marital Status, Education, Children vs. nochild, Exchange vs. Medicaid coverage, Health
status (chronic disease vs. not, disability)
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Subgroups
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Young invincible are still important for
gender, determining how to get to young
invincible based on gender
◦ Preventative health may change what women
think
Facilitator: Joel Rosenblum
GEOGRAPHY AND
DISTRIBUTION
CHANNELS
How to reach people
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People more trusting of their municipal government than
state government in many of the smaller or more rural areas
- so it would make sense to market through chambers (for
the SHOP), brokers, and a partnership with municipality in
larger communities
Go through PTA, School boards, libraries, local newspapers
The smaller communities will be very difficult - most people
congregate in the schools or churches so can organize town
hall meetings -- create a local resource to work within the
schools and/or churches
Need face-to-face human help in many of these smaller areas
and there is a real place for a convener
Have an office within 100 miles (or a certain set mileage) of
these areas - can't rely on electronics.
How to Reach People (cont)
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Resort communities are difficult because it's hard to
target who is a full-time resident and who is only
there part-time or just owns a second home.
Clinics might be a really good place for marketing in
the Mountains
Need to use the provider community as part of the
marketing
Should likely only need the huge push for the first
enrollment -- re-enrollment should be much easier
Rural investment will be high since will need a human
presence (non-profits, provider community, churches,
etc)
Subsidies speak to ranchers
“Need” Groups rather than Actual
Geography
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Metro Areas
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Contained communities with infrastructure (likely on I-25 and I-70, Resort
Communities, Grand Junction, Fort Collins)
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Mostly human presence
Local newspapers
Rural (Deer Trail)
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Electronic and some human presence
Contained communities without infrastructure (Gunnison, Alamosa)
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Electronic
Mostly human presence
Local newspapers
Billboards
Colorado Springs - or other communities that may present a unique problem
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How to deal with communities who don't trust government or oppose PPACA?
Work through chambers, political organizations, churches and brokers
Human Presence
Need to work on messaging depending
on the community -- get informed
 County Departments of Health
 Providers
 Churches
 Brokers
 Chambers
 Carriers (working with exchange)
messaging to current clients
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Questions for Discussion
1.
2.
What themes emerged across all
groups?
From a marketing perspective, should
we think about segments this way or a
different way?