Hundreds of thousands of consumers turned to Covered California to shop for health coverage during its third annual open enrollment period. One of them was Anthony, a 29-year-old entertainment professional from Los Angeles who wanted to renew his coverage with Covered California and possibly switch health plans. He was eager to explore the plan options offered for 2016. Like many consumers, he preferred to investigate his options through the Covered California website and expected it to be a straightforward process.
It wasn’t. Anthony’s experience on the enrollment website was not a smooth one. He had trouble understanding the instructions for entering his income. Another screen asked him to confirm changes to his application that he didn’t recall making. When he was ready to compare plans, the website’s “Shop” button was broken. At the end of a 90-minute session, he had yet to review a single health plan option. The process left him frustrated and disappointed.
Anthony was a participant in a research project sponsored by the California Health Care Foundation that tested users’ experiences with the Covered California website and online application. (The online application is part of the California Healthcare Eligibility, Enrollment, and Retention System [CalHEERS] and is jointly managed with the California Department of Health Care Services [DHCS].)
CHCF retained gotoresearch, a division of the San Francisco-based user experience and design agency gotomedia, to conduct this research over each of the last three open enrollment periods. The findings are based on unscripted, real-time observation of people applying for or renewing coverage online, and they capture sources of consumer satisfaction, knowledge, confusion, and frustration.
Like Anthony, most other participants in the CHCF-sponsored research were confronted with problems with the online enrollment process. Of 31 people eligible to enroll in or renew a Covered California health plan in the second (2014-15) and third (2015-16) open enrollment periods, only one was able to complete the task during the observed research session. Sessions lasted 45-90 minutes for renewals and 90-120 minutes for new enrollees.
CHCF’s goal in funding this research is to better understand consumers’ online experience, identify usability challenges, and offer actionable recommendations for improvements. Findings from the first open enrollment period (2013-14) showed that users had significant difficulty navigating the process online. User testing during subsequent open enrollment periods offered an opportunity to assess changes and improvements over time.
Research over three years tells us that although progress has been made, many problems from the first and second open enrollment periods persist. More should be done to make the online enrollment and renewal process work better for consumers.
The good news is that this research points to practical solutions. Room for Improvement outlines a number of steps to address frequent problems experienced by research participants. In addition, it recommends that Covered California and DHCS conduct their own user testing on a regular basis — in conjunction with regular monitoring and reporting of website analytics — to better understand and respond to the needs and challenges of online consumers.
Californians have several other channels through which they can apply for coverage: in-person (with assistance from community-based assisters, brokers, and agents, or county welfare offices), by phone, or by mail. Many people prefer these. However, providing consumers with user-friendly and efficient online experiences should also be a top priority. For millennials, one of Covered California’s key target populations, it is crucial.
Consumers deserve an easy-to-navigate experience when purchasing health insurance online. As we look ahead to Covered California’s fourth annual open enrollment period, CHCF is eager to work with Covered California, DHCS, and other key partners to make this a reality.
Catherine Teare is associate director of CHCF’s High-Value Care team, which supports policies and care models that align with patient preferences, are proven effective, and are affordable. She leads the foundation’s work on behavioral health care, including behavioral health integration in primary care and behavioral health interventions for high-cost populations. She also manages projects related to the county role in health care delivery and oral health care.
Catherine has worked at CHCF since 2011 and previously led the organization’s efforts on enrollment in public programs, with a particular focus on consumer experience. Before joining the foundation, she worked as a consultant for safety-net health care providers, foundations, and local government, providing research and policy analysis in the areas of health care financing and delivery, public and private health insurance programs for children, adolescent health, reproductive health, HIV, and youth development. She also worked as director of policy for Children Now and as a health policy analyst for the National Center for Youth Law. She received a bachelor’s degree in English from Yale College and a master’s degree in public policy from the University of California, Berkeley.