National study and Paducah Sun story illustrate value of local Kynectors, who would be far away if exchange is abolished

Gwyn Artz, left, of Lexington talked with Miriam Fordham about
signing up for health insurance through Kynect during the opening
of a storefront in Lexington's Fayette Mall. (Herald-Leader photo)

Read more here: http://www.kentucky.com/opinion/op-ed/article44546313.html#storylink=cpy

Critics of Republican Gov. Matt Bevin's plan to dismantle Kynect, the state's health insurance exchange, often cite the loss of most locally responsive "Kynectors" as a reason for him to reconsider. Now a study published in Health Affairs supports this argument, finding that programs with such local, in-person "assisters," as the study calls them, are the most successful at signing people up for coverage.

Kynectors are exchange employees in every county who help those unfamiliar with health insurance navigate the system. In 2014, they held more than 3,000 events for enrollment and education, and are credited with helping more than 500,000 Kentuckians sign up for health insurance.

Bevin said during his campaign and re-iterated at his inaugural speech Dec. 8 that he would dismantle Kynect and shift to the federal exchange, calling the state exchange "redundant."

If Kentucky does that, customers will still have access to assisters, but they will be located in a customer service center "hundreds of miles away," outgoing Gov. Steve Beshear said in a plea for Bevin to keep Kynect. Funding for exchange assisters would decrease by 75 percent.

The Health Affairs study found that consumers who received in-person assistance were more than twice as likely to successfully enroll compared to those who tried to enroll online without any assistance, and those who received local assistance were the most successful.

“Assister programs play a vital role in supporting consumers particularly when assisters maintain ongoing relationships with consumers,” lead researcher Rachel Grob told the Center for Patient Partnerships at the University of Wisconsin-Madison.

“Our synthesis of the evidence from the first two years of open enrollment also highlights that assister programs are successful when assisters come from, and are situated from within, communities that they serve; when local programs are well coordinated; and when post enrollment issues can be addressed," she said.

In brief, according to Grob, “evidence from the field suggests that enrolling cannot be separated from educating and engaging—and that assisters are positioned to do this work.”

Lindsay Nelson, state coordinator for outreach and enrollment with Kentucky Primary Care Association, told the Lexington Herald-Leader that this has also held true in Kentucky.

She told the Herald-Leader the system wouldn't have worked if it had hired people from outside Eastern Kentucky to work in the region that is the greatest beneficiary of the expanded Medicaid program.

"People in the counties with the higher rates of signups say personal connections have helped spur friends and neighbors to sign up," the Herald-Leader reported.

The Health Affairs study also found that in addition to clients needing an average of two to four hours of help, and more than half of them coming back for a second session, assisters were heavily involved in the post-enrollment work because many consumers did not understand their coverage provisions.

Bill Wagner, executive director of the Family Health Centers of Louisville, shared a similar story at the Friedell Committee for Health's annual meeting in October.

He said Kynectors often "end up becoming case managers" for their patients even after they have chosen their insurance, helping them find providers who accept Medicaid, helping them with their health literacy and helping them understand how to maintain eligibility.

"Having the boots on the ground from the Kynectors, having the close working relationship with the Kentucky Health Benefit Exchange [Kynect's official name], I think has really helped us provide more ongoing care and coordinated case management around insurance, so I worry about that if that were to change," Wagner said.

Genevieve Postlethwait of The Paducah Sun wrote recently about the role of Kynectors, including keeping their clients informed about regulatory changes, particularly the one that only allows 30 days to change their address when they move or they will loose Medicaid eligibility; the importance of not missing appointments; and understanding the penalties involved if they don't have insurance.

"It's not necessarily the case anymore that there aren't enough primary care providers,but the problem is that people who are newly insured don't have the knowledge of how to access providers, how to set up appointments. Or if they hit bumps along the road, they don't know how to manage an insurance company," Monique Zuber, executive director of the United Way of Paducah-McCracken County, told the Sun "It's hard enough for those of us who have been insured for a long time."

Jackie Eubanks, Kynector program manager with Mayfield-based West Kentucky Allied Services, concurred. "With the expanded Medicaid, there's this huge group of people who are covered now, but they don't know what to do," she told the Sun. Later adding that people need time to change "their paradigm and get into a new way of thinking. It doesn't happen overnight."  (The Paducah Sun is behind a paywall.)