What Is Enhanced Direct Enrollment (EDE)?

It’s no secret that the way to add new members and keep the ones you have is through great customer service—and great customer service comes through direct relationships. The challenge with the ACA Marketplace is that you may be one or more steps removed from a direct relationship by design, which limits your ability to communicate with your members and their ability to see the true value that you can offer them.

Luckily, the Centers for Medicare and Medicaid Services (CMS) created EDE.

Enhanced Direct Enrollment (EDE) with HealthSherpa is like your own personal HealthCare.gov. It gives you the same APIs as HealthCare.gov but with added data and marketing tools that will increase sales for you and your agent/broker partners while improving your brand recognition, customer loyalty, and operational efficiency. With EDE, consumers can do their whole enrollment without leaving your site, and you’ll be able to see where they are in the process and reach out to them as needed to help them complete their application. It’s the full solution, from quote to effectuation, for your ACA business. EDE is an essential tool in any carrier’s individual strategy toolbox—and HealthSherpa is the market leader.

What is EDE?

When HealthCare.gov went live for the first time in 2014, the only way to enroll was directly through the website. Carriers essentially had to wait to receive referrals from the site, which happened only after a customer elected coverage. This arrangement was intended to ensure that customers were receiving all of their service through a single source, regardless of what plan they selected.

The reality is that customers then had a relationship with both HealthCare.gov and with the carrier for the plan they selected. Carriers were limited in their ability to help guide customers through the plan selection process to ensure they got the best fit for their needs, and they didn’t get much insight into their potential members. 

In an effort to provide carriers with a better experience, including more shopping guidance and follow-up for their customers, CMS created a method for the full enrollment process to take place off of HealthCare.gov. EDE launched in 2018, and HealthSherpa was there from the start as the first private marketplace granted access to the EDE portal. To this day, HealthSherpa remains the No. 1 provider of EDE services, with more than two dozen of the largest carriers trusting us with handling their EDE solution -- allowing us to account for over 90% of all EDE enrollments for the past two years. We continue to work with the CMS on enhancements to EDE that benefit carriers and their sales partners to provide the best and most streamlined experience for their members.

How does EDE help Carriers?

Simply put, EDE widens your sales funnel to let new customers in and increases your communication and support opportunities to keep those new customers come renewal time.

EDE offers benefits to your sales, marketing, support and operations in myriad ways.

Sales and Marketing

You have marketing campaigns and internal sales teams to increase your market share for ACA coverage. But up until now you’ve relied on a disjointed experience where you can quote customers on your own website but not enroll them. And in terms of tracking customers through the funnel, HealthCare.gov has been a black box.

HealthSherpa EDE enables you to originate new member sales and pull leads over from HealthCare.gov into your own white-labeled marketplace exclusively displaying your own products—and to track the journey throughout using UTM codes. Plus, built-in reminders throughout the enrollment experience encourage customers to save their progress, which then enables you and your sales teams to send targeted messaging to customers to complete their applications. HealthSherpa EDE’s full suite of customer analytics and CRM support tools will unlock the full potential of your internal sales efforts.

Here are some examples of what you can do with EDE:

• Conduct personalized outreach with custom resume links to allow consumers to pick up exactly where they left off
• Message last year’s customers and encourage them to renew their applications this year
• Use HealthSherpa’s lead and enrollment exports to prioritize lead outreach based on how likely they are to convert

HealthSherpa is the leader in agent and broker sales of ACA individual plans. We help you tap into a large agent pool and make it easy for you to empower your sales partners to drive higher conversion rates—a natural win-win.

Customer and Partner Loyalty

New carriers are entering (or reentering) the ACA individual market every year. It’s more important than ever to stand out from the crowd. Having your own sales channel isn’t just a sound strategy at this point; it’s table stakes for success.

HealthSherpa’s EDE not only provides tools that empower your marketing and sales teams, but they provide customers with an industry award winning customer experience. And it does so with your unique branding and messaging, so you can help yourself stand out from the crowd while adhering to CMS guidelines and a top-rated experience.

Where this experience really takes off is renewals. Typically one of the easier sales in any business, renewals have been a significant challenge in the ACA marketplace because 1) you want to encourage customers to shop for the best plan on an annual basis, and 2) you’d like (and they’d most likely like as well) to keep the same health insurance provider. With HealthSherpa EDE, you’re able to start messaging customers months in advance and lead them to your coverage offerings that are best suited to their individual needs. EDE increases your ability to keep customers while also cutting down on operational and service costs.

Operational Efficiency

EDE not only gives you more options and flexibility in building your customer base, it does so with great efficiency. Whereas some services may take months or more to set up, HealthSherpa EDE’s modular frame and underlying infrastructure can get you to market faster, without worrying about whether your plan and customer data will be accurate and compliant with CMS requirements. 

EDE runs on the same APIs as HealthCare.gov. That means you (and your customers) are getting exactly the same enrollment experience—just with your exclusive branding and products. The average enrollment takes less than 10 minutes, which is great for customers and also enables your support team to handle more service needs, more efficiently.  On the back end, you get accurate data formats to track enrollments, effectuations, broker/agent IDs, IRS forms (1095-A) and more. Everything you need to service your customer base and get them into your own member systems comes standard with HealthSherpa EDE.

Take the Next Step

The ACA individual marketplace is still in its early years but the strategies for capturing market share are rapidly improving. None of those strategies are complete without EDE—and HealthSherpa is the clear leader in providing white-label carrier and agent EDE solutions. If you’re serious about being a leader in the individual market, you know that you need to address sales, marketing, operations and customer loyalty. EDE handles it all, and all in a package that’s as data-driven as it is customer-focused.

To learn more about EDE, contact us at [email protected].