Secondary Outcomes (explanation)
Choice quality: A growing literature has documented that many consumers in the United States may purchase the “wrong” plan for them based on the options available (so-called “dominated plans,” i.e., plans that cost more but provide equivalent or worse coverage than other available options) due to their lack of understanding of health insurance options. Consumers facing challenges in plan choice may be more likely to choose such plans. It is plausible that an intensive interactive information intervention could help consumers weigh their options more appropriately and steer away from these choices, with direct implications for consumer expenditure risk and well-being.
Our key outcome related to choice quality will be an indicator for whether a consumer made a choice error and selecting a dominated plan. We considered a given consumer to have selected a dominated plan under any of the following conditions: a) the consumer was eligible for a Silver 87 plan but chose a Gold plan; b) the consumer was eligible for a Silver 94 plan but chose a Gold or Platinum plan; c) the consumer was eligible for a Silver 94, $1-premium plan but chose a $1-premium Bronze plan; d) the consumer had household income greater than 200% of FPL and chose a Silver plan when eligible for a lower-premium Gold plan offered by the same insurer.
The risk mix of enrollees: We will examine the effect of the intervention on risk levels of consumers who purchased a plan in the marketplace, using the CDPS risk scores to capture consumers’ recent health spending. In particular, we will study two measures of risk mix in the marketplace: a) average market risk, driven by the health risk of consumers brought into the market by the intervention; and b) the sorting of consumers, by risk, across plans with higher vs. lower actuarial value (e.g., Silver vs. Gold tier plans), as well as sorting by issuer. The former captures the effect of the intervention on total market risk, while the latter can impact relative profits of plans across tiers and issuers.
It is possible that the intervention, like a low-touch letter intervention, encouraged healthier people to enroll in a plan. Alternately, the more intensive nature of the intervention may have lowered the barriers in making difficult plan choice decisions, which sicker patients find more valuable. By jointly examining the enrollment and plan choice decisions, we will be able to assess which frictions in the enrollment process the intervention is likely targeting and assess its implications for risk selection and sorting across plans.
Engagement with the intervention: If the outbound call intervention has a larger impact than low-touch interventions, such as reminder letters, in-depth conversations with the SCR could account for this difference. Yet, not all consumers who received an outbound call ultimately engaged in such a conversation. Some consumers who received an outbound call hung up briefly after taking the call; others let the call from the SCR go to voicemail and did not return the call.
To better understand this issue, we will examine the factors predicting consumers’ engagement with the intervention, measured by having a conversation with an SCR. Differing levels of engagement with the intervention can help to explain heterogeneous effects of the intervention across different groups of consumers, and inform future targeting of the intervention. The outcome of interest for this analysis will be whether a consumer has ever engaged with an SCR in a conversation lasting 1 minute or longer; other cutoffs such as 30 seconds, 2 minutes, or the median or mean call length will be used in robustness checks.