The challenges of ACA marketplace enrollment: Results from big data and campaign-style tactics in the Kansas city area

In the fall of 2013 the Health Care Foundation of Greater Kansas City (HCF) undertook a major effort to increase insurance coverage among the estimated 200,000 uninsured people in their service area. HCF took a multi-tiered approach, providing direct incentive funding for organizations to train Certified Application Counselors (CACs) and conducting outreach activities through multiple modes of contact. Throughout the open enrollment period, HCF efforts involved knocking on nearly 60,000 doors and mailing communication to 68,000 households. HCF was committed to making real-time changes to their outreach strategies in order to increase effectiveness. Short-term evaluation efforts were canceled due to low response rates and it is too soon to assess the longer term impact of HCF outreach efforts. Overall, the experience highlights the role for local entities in providing education on health insurance and federal policy and the limitations of big data campaign-style tactics for identifying the uninsured and evaluating outreach activities, particularly those using phones as the primary contact. Experience also suggests the need for close collaboration between outreach and enrollment activities.