Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
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February 2009 Issue Brief:

Increasing Access to Health Insurance for Children and Families: Innovative Health Plan Outreach and Enrollment Efforts

Blue Cross Blue Shield of Massachusetts Foundation

Blue Cross Blue Shield of Massachusetts (BCBSMA) established Blue Cross Blue Shield of Massachusetts Foundation (BCBSMAF) in 2001 as an independent philanthropic entity. BCBSMA provided an initial contribution of $55 million and continues to contribute to the Foundation generating a current endowment of approximately $108 million. Foundation activities fall under three closely coordinated branches: 1) grantmaking, 2) policy research, and 3) capacity-building programs for nonprofit Massachusetts health care organizations. Over time, information from the grantmaking operations have informed BCBSMAF’s policy work.

Leader in Health Reform Efforts

In the years leading up to the passage of Massachusetts’s groundbreaking health reform law in 2006, BCBSMAF played a critical role in gathering and analyzing the data needed to craft the 2006 law. Under the auspices of its Roadmap to Coverage initiative, BCBSMAF commissioned The Urban Institute to analyze what the state was currently paying to cover its uninsured residents; what it would cost to implement a near universal health plan; and potential ways in which such a plan could be implemented. Beginning in 2004, BCBSMAF released 13 reports and policy briefs that influenced and informed policymakers and lawmakers working to cover the uninsured in Massachusetts.

Support of Outreach and Enrollment Efforts

Since its establishment, BCBSMAF has funded grantees to enroll uninsured individuals in the state’s Medicaid program. Providing those funds has made BCBSMAF a significant player in efforts to enroll residents into public health insurance coverage, supplementing the often sporadic state efforts in this area. In 2005 Governor Romney proposed reinstituting previously halted state funding for outreach and enrollment activities and made maximizing enrollment in Medicaid a priority. In July 2005 the state legislature approved $500,000 to be distributed in the form of grants to community organizations conducting outreach and enrollment activities. In that same year, BCBSMA sought to enhance the state’s efforts and contributed $250,000 to the Foundation’s existing outreach and enrollment grant budget of $400,000, resulting in a total BCBSMAF distribution of $650,000 for outreach and enrollment.

With the passage of the state’s health reform law in 2006, legislators included $3 million to fund outreach and enrollment activities. BCBSMAF, meanwhile, continued to make outreach and enrollment grants totaling $400,000. While the state grants focused solely on enrollment for Medicaid and Commonwealth Care and Choice programs, BCBSMA also included outreach and enrollment for prescription drug plans for seniors and the state health safety net fund. However, due to the national recession and a state budget deficit, Governor Patrick announced in January 2009 that $3.5 million in outreach and enrollment grants would be eliminated in the 2010 budget. That change would make BCBSMAF the primary source of funding support for outreach and enrollment activities in the state.[1]

Connecting Consumers with Care (CCC) is BCBSMAF’s major funding vehicle to support comprehensive outreach and enrollment. Total CCC funding for 2007 was $490,000 (exceeding the initially budgeted funding level). Individual grants ranging from $15,000 to $25,000 have been awarded to a mix of community based organizations, community health centers, and select hospital-based programs.

The program has two goals: a) enroll eligible residents in appropriate coverage programs, and b) ensure that the outreach and enrollment workers are professional

and well-trained. To achieve these goals, BCBSMAF looks for grantees that:

1) work closely with and understand the needs and characteristics of the populations they serve;

2) are familiar with MA Medicaid online Virtual Gateway portal and paper applications; and

3) have relationships with local primary care physicians serving Medicaid beneficiaries so new beneficiaries can be quickly connected to the health care system.

With more than 42 coverage plans available in Massachusetts, outreach and enrollment professionals are critical for connecting residents with the right plan to suit their needs and circumstances. To ensure grantees have all the information necessary to assist their communities, BCBSMAF regularly organizes technical assistance events such as in-person conferences to educate grantees and exchange information between the foundation and grantee staff.

Moreover, professionals have valuable field experience that can help state officials understand the practical impact of reforms, the implementation challenges, and possible ways to address these challenges. Recognizing the value of these insights, BCBSMAF has worked to open communication between state government and the outreach and enrollment professionals. In June 2006, for example, BCBSMAF organized a technical assistance session to explain the state’s new reforms and gather grantee concerns about the coming changes. The concerns and suggestions raised at this session were developed into a briefing document that was distributed to state decision makers. In November 2006 BCBSMAF engaged the Executive Director of the newly formed Massachusetts Commonwealth Health Insurance Connector Authority to participate in an open-dialogue meeting with outreach and enrollment professionals. At this session the grantees demonstrated their commitment to being a resource to the community and pointed out some forms of health coverage in Massachusetts of which the Connector was not yet aware.

Lessons Learned

BCBSMAF is dedicated to sharing information about the success of its funded programs. In 2007 to strengthen evaluation of funded programs, the Foundation changed grantees’ reporting requirements from bi-annual to monthly. Reports collect both quantitative data, such as volume of visitors and numbers enrolled, and qualitative data, such as best and worst experiences working to enroll

clients, providing valuable information to BCBSMAF about the progress of health care reform and its impact on grantees’ communities. Those monthly reports are then summarized by the Foundation, and those summaries are distributed to grantees and state decision makers.

BCBSMAF-funded organizations have had a great impact on enrollment. Collectively, grantee organizations report that they are seeing around 8,000 to 10,000 individuals a month. By August 2007, the overwhelming number of new health insurance applications had created a backlog within the state Medicaid screening process. Grantee reports consistently listed that backlog as a barrier to access; applications were lingering in the system for as long as six to eight months. Based in part on the data from the monthly report summaries, concern over the problem grew. After it was publicly reported in the Boston Globe, senior state health officials restructured the screening process for applications in order to increase screening capacity.[2]

The Foundation’s work has helped to build capacity among grantees. Some organizations were initially completing about five electronic enrollments per month. BCBSMAF provided technical assistance and helped grantees use the online enrollment system. The resulting decrease in processing time enabled a higher volume of enrollments.

BCBSMAF grantees’ unique organizational assets, such as established relationships with specific subgroups of the uninsured population, have contributed to their successful enrollment efforts. Two organizations that worked closely with non English speaking residents were able to build upon their understanding of the relevant cultural norms to allay clients’ fears about providing their personal information and connect them with health care. Other organizations engaged local businesses. One example is a Safe Shops Initiative, a Boston Public Health Commission program originally funded by the U.S. Centers for Disease Control and Prevention that focused on reaching 19–31 year old males who commonly lack insurance. The Foundation has funded this effort for two years, supporting its staff

as they travel to Boston area auto body shops to educate employees (mostly young males) about insurance options and to screen and enroll employees on-site.

The population of BCBSMAF grantees has evolved since the state health reform initiative. In 2007, BCBSMAF increased available funding and received double the number of applicants. Of the 24 selected grantees, 11 were new, and 13 were renewals. This year some grantees have “graduated” from simple outreach and enrollment activities to case management under a separate three-year funding program. These grantees have already enrolled most of their target population and are now focused on ensuring beneficiaries are receiving the best care possible.


The Foundation is currently involved in long-term strategic planning discussions around the issue of outreach and enrollment. One idea under consideration that will enhance its funding efforts is to introduce more technological innovations, such as providing grantees with laptops to enroll residents in the field. BCBSMAF remains fully committed to the outreach and enrollment of uninsured state residents. “We will not abandon our Connecting Consumers with Care grant program until we know the state is in it for the long haul and we have built a good infrastructure,” shared Phillip Gonzalez, Director of Grantmaking.

Blue Cross Blue Shield of Massachusetts

In 2007 following the Massachusetts health reform efforts, private health plans were permitted to offer plans to individuals and families with incomes 300 percent of FPL and higher through the Massachusetts Health Insurance Connector’s Commonwealth Choice program. Blue Cross Blue Shield of Massachusetts (BCBSMA) responded to a state request for proposals to offer a product for 18–26 year olds who cannot obtain health insurance through their employers. BCBSMA is now one of six private health plans to offer a Young Adult Plan (YAP), which is a low-premium, cost-sharing product, available with or without a pharmacy benefit; deductibles and co-pay requirements vary by plan. The BCBSMA plan — Essential Blue Young Adult— is the only one of the six not to have an annual benefit maximum.

While the state is responsible for enrollment in Essential Blue YA and all other Commonwealth Choice plans, each health plan conducts outreach and marketing for its products. BCBSMA outreach efforts for Essential Blue YA focus on advertising and email campaigns. The plan also hired a “brand ambassador” for the product, who takes a branded vehicle to events where the target age group is present, such as concerts and auto shows. Additional outreach for all Commonwealth Choice plans was conducted in 2007 through a $3 million advertising campaign, funded by the Commonwealth Connector, tied to the Boston Red Sox, and featured on the New England Sports Network. Cover Your Bases — Connect to Health was an integrated communications campaign targeting men age 19 to 39, since this age group

represents the majority of uninsured in the state. The campaign included television and radio advertising that ran during Red Sox games, as well as print ads in community, ethnic and college newspapers. Additional outreach planned for 2008 through the Commonwealth Connector includes partnerships with ZipCar, colleges  universities, and web outreach, including social networking sites.

To date, BCBSMA has been successful in enrolling young adults, most of whom were first-time insurance buyers. However, it is more difficult for the state to measure the overall successful enrollment of uninsured young adults across all options available to this population — Commonwealth Care, Commonwealth Choice, and the expansion of dependent coverage up to age 26. As of June 2008, 8,882 individuals aged 19–26 were enrolled in Commonwealth Choice Young Adult Plans; 41 percent of these individuals were enrolled in Essential Blue’s YAP.[1]

In addition to outreach on Essential Blue YA, BCBSMA had a companion campaign from May-December 2007 to promote other new products available directly through BCBSMA. Prior to health reform, BCBSMA offered six health insurance products; currently they are offering over 50 products. This amount of choice has been overwhelming for consumers, so BCBSMA has created a family of products called Get Blue to make iteasier to decide and developed outreach activities to help consumers understand product options. Outreach for these products included seminars in malls and hotels, paid online and television advertising, and print marketing materials. BCBSMA also utilized call centers with expanded hours, with many staying open until midnight during the days before the campaign ended. Outreach and education will continue to be vital to the success of both the health reform efforts in MA as well as increasing enrollment in the myriad new health insurance products available to consumers through health reform.

[1] Governor Patrick Outlines Emergency Recovery Plan to Stabilize Budget, Position State for Economic Recovery.” Available at:; accessed 2/3/2009.

[2] Dembner A. “Uninsured Face Health Plan Delays.” The Boston Globe, August 11, 2007.

February 2009 Issue Brief