Enroll America Has the Right Approach to Health-Care Implementation

Implementing large-scale health-care reform is really, really difficult. As I wrote in a story today, it requires "a sweeping outreach effort alongside meticulous attention to details, and they stumble without both key elements in place." But one nonprofit has already decided to take on the challenge: introducing Enroll America.

"We want to make sure everybody gets enrolled," says Ron Pollack, the nonprofit's founder and current head of Families USA, a health-care-reform advocacy group. "This is about creating systems in each state that will make enrollment effective."

Pollack has been thinking about implementation since this summer and now has a general outline of how a nonprofit could best facilitate health-care reform (he hopes to have an official business plan in the next few months). The blueprint for Enroll America has 50 state-based consortia, each with diverse stakeholders (government officials, pharmaceutical executives, insurance companies, and nonprofits), sharing information and building effective enrollment systems to get Americans in compliance with the individual mandate by January 1, 2014. While motivations may vary, each group has a common interest: enrolling more Americans in health insurance, as to comply with the new law, and doing so in the best way possible.

These state consortia would do the bulk of the work with Enroll America acting as a conduit between the states, helping them share innovative ideas and "provide the technical assistance they'll need to do this kind of work," Pollack explains. It's an ambitious plan that, right now, hinges on funding: Pollack estimates that he needs to raise millions of dollars to get the organization up and running.

Both the government and private philanthropy groups would be wise to get Enroll America the funds they need for two main reasons, both of which have to do with their approach to implementing health-care reform.

First, the organization thinks big. Previous health-care-reform efforts show that wide-scale, coordinated efforts are the best road to implementation. Since health-care reform is largely state-based, Enroll America can serve as a crucial conduit in terms of information sharing and coordination.

Second, and even more crucial, Pollack is obsessed with systems. "This is not about sending people out to individual homes," he says bluntly. "This is about creating systems in each state that will make enrollment effective." He wants systems in which Americans could enroll at any point of access, whether it's a hospital, pharmacy, or community health center. Forms need to be simple and usable; databases need to be integrated, so a potential enrollee could learn about the Medicaid and subsidy requirements all in one place.

Systems are, as one health-policy analyst put it to me, "non-sexy," but they're absolutely necessary to successful enrollment. If you look at SCHIP, for example, you see that tiny changes to reenrollment processes, whether you have individuals enroll every 6 or 12 months, have huge ramifications for enrollment numbers. In its think-big, systems-based approach, Enroll America exemplifies the enrollment activism that we should hope to see more of in the coming months and years.