Marketing Ideas - Connect for Health Colorado

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Ma
rket 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

1.
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)?


INCOME AND
EMPLOYMENT

Facilitator: Heather Hewitt

Introduction


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




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)



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.


Use pictures, stories, and person
-
to
-
person contact to get to the heart and shift
attitudes


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


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

AGE AND OBJECTORS

Facilitator: Carol
Giffin
-
Jeansonne

Key Points


Two high yield groups were identified: 18
-
25 year olds and those ages 55
-
64.


Cost as primary deterrent of insurance
coverage in both groups.


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


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.


Colorado Uninsured Statistics:
(from Kaiser State Facts)


Total uninsured ages 19
-
64:




616,300


% of State population





20%


Total uninsured non elderly adults above 400% FPL:


83,400


(Likely “objector” population or voluntarily uninsured)


Total uninsured non
-
elderly adults under 139% FPL


355,300


(Population that may qualify for Medicaid expansion)


Uninsured adults that could qualify for subsidies):


264,500


(Under 139%
-

400%FPL)


Target population for exchange outreach:



347,900


Total non elderly adults with Dependents:



181,800


Total non elderly adults w/o Dependents:



434,500


Total uninsured non elderly adult men:



337,800


Total uninsured non
-
elderly adult women:



278,500


What’s changed?


Guarantee Issue


New ratings ratios, age, geography, etc.


Annual and lifetime caps


No rescission
s


Etc.


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


Use links to move user between layers or
identify terminology or concepts


Messaging to Young Adults


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. (“6
th

grade reading level, 8
th

grade listening
comprehension level)


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


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


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…?


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?


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


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


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


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?


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?


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


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)


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


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?


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



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


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.


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


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.


How to obtain insurance if…


If employed


If unemployed


If self
-
Insured




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


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:


Employee share of the premium exceeds 9.5% of
income.


Employer plan does not have an actuarial value of at
least 60%


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


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


100
-
150% FPL: 94%


150
-
200% FPL: 87%


200
-
250% FPL: 73%


250
-
400% FPL: 70%


RACE, ETHNICITY,

LANGUAGE, CULTURE

Facilitator: Susan Downs
-
Karkos

Data Needs


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


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, non
-
cumbersome way to get services

Outreach


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.


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.


GENDER AND FAMILY

Facilitator: Joe
Campe

Data Needs


Are women insured under Medicaid at
higher rates?


Marital status?


Education level?


Children vs. no
-
child?


Where are the subgroups currently?


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. no
-
child, Exchange vs. Medicaid coverage, Health
status (chronic disease vs. not, disability)

Subgroups


Young invincible are still important for
gender, determining how to get to young
invincible based on gender


Preventative health may change what women
think

GEOGRAPHY AND
DISTRIBUTION
CHANNELS

Facilitator: Joel
Rosenblum

How to reach people


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)


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


Metro Areas


Electronic




Contained communities with infrastructure (likely on I
-
25 and I
-
70, Resort
Communities, Grand Junction, Fort Collins)


Electronic and some human presence



Contained communities without infrastructure (Gunnison, Alamosa)


Mostly human presence


Local newspapers



Rural (Deer Trail)


Mostly human presence


Local newspapers


Billboards




Colorado Springs
-

or other communities that may present a unique problem


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


Questions for Discussion

1.
What themes emerged across all
groups?

2.
From a marketing perspective, should
we think about segments this way or a
different way?