Health Insurance Marketplace Support
Healthcare Program Operations

Health Insurance Marketplace Support

U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Consumer Information and Insurance Oversight (CCIIO)

The Health Insurance Marketplace was established under the Affordable Care Act to increase access to affordable, comprehensive health insurance. Since 2012, DFC has provided operational support to the Centers for Medicare & Medicaid Services related to the implementation of the Health Insurance Marketplace, including the facilitation of data quality assurance and process improvement activities, management of the Qualified Health Plan application and certification process, and the collection and interpretation of Marketplace feedback.

Our Challenge

The enactment of the Affordable Care Act (ACA) in 2010 formalized a commitment to improving the affordability, accessibility, and quality of health care in the United States. Qualified Heath Plans (QHPs) available to consumers on the Health Insurance Marketplace are subject to rigorous reviews that ensure compliance with the standards established by the ACA, and must be certified by CMS. DFC has been tasked with ensuring that insurance issuers can easily access and understand certification-related information, that they have what they need to submit error-free applications, and that they continue or increase their participation in both the Individual and Small Business Health Options Program (SHOP) Marketplaces.

Our Strategy

DFC supports CCIIO in the implementation of the Health Insurance Marketplace, including the certification of QHPs to be offered on the Marketplace. DFC’s support involves data quality assurance and process improvement activities related to the QHP application review process; integrated operational planning and management to coordinate the execution of the QHP application process; and issuer communications related to QHP certification. DFC also provides strategic communications planning, branding, and materials development support to increase awareness of the SHOP Marketplace.

Our Results

DFC has recognized subject matter experts in many key areas related to CCIIO operations, and is often called upon to complete important data analysis and reporting requirements, including reporting sent to the White House and Congress. Since the Health Insurance Marketplace’s inception, DFC has been instrumental in establishing numerous, major operational improvements. For example, in 2015, DFC implemented an entirely new system that automates the distribution of communication from CCIIO to insurance issuers and other Marketplace stakeholders. This system allows CCIIO to send custom emails to thousands of recipients with the push of a button, while simultaneously tracking metrics such as open and bounce rates. In 2016, DFC worked with CCIIO to develop a system to track issuer applicants that stratifies issuers by risk, allowing CCIIO to pinpoint those issuers needing additional assistance or outreach. In addition, DFC has developed a suite of products, including factsheets, messaging, videos, and graphics, used to better market and promote use of the SHOP Marketplace, and manages a strategic email outreach campaign to distribute these materials to small employers and organizations.