Massachusetts Health Connector
Strategic Plan 2024–2028

Introduction

The Massachusetts Health Connector is the country’s first and longest-running state-based health insurance Marketplace, created in 2006 as part of Massachusetts state health reform (Chapter 58 of the Acts of 2006) to provide high-value coverage to individuals and small businesses in the Commonwealth and to serve as a policy and outreach hub for both state and federal health reforms designed to expand and improve health coverage.

More than seventeen years after the organization’s inception, and ten years after Massachusetts’s implementation of the Affordable Care Act (ACA), the Health Connector continues to lead the nation in its work keeping Massachusetts residents covered at a near-universal insurance rate and through innovative actions that maximize access to affordable, comprehensive, and equitable health care. This work helps ensure that residents of the Commonwealth have the opportunity to attain the highest levels of health and are protected by the critical financial safeguards enabled by meaningful health coverage.

Residents of the Commonwealth are at the core of the Health Connector’s mission, and providing low- and moderate-income individuals, families, and small employers with access to comprehensive health coverage has remained its beacon. The 2024–2028 Strategic Plan is intended to serve as a road map for the Health Connector, providing a framework to organize agency initiatives, infrastructure, policies, and practices to ensure continued success and maximum public impact. This strategic plan is intended to allow the Health Connector to respond to and meet the moment while keeping its core mission as its North Star.

Contents

The Health Connector’s Beginnings and Growth

While the Health Connector’s mission to provide health insurance to state residents and small businesses has not changed, the organization has had to evolve significantly throughout the course of its eighteen-year history in response to a dynamic health care, policy, and business landscape. Throughout periods of change, the Health Connector continued its focus on system stability, growing enrollment among eligible residents, and enhancing its member experience, adjusting course to ensure Massachusetts residents could continue to rely on Health Connector coverage and that the Commonwealth stayed true to its goals around expanding health coverage access to all residents.

Moving forward, the Health Connector will continue to draw from its greatest assets to fulfill its mission and vision: its dedicated and passionate staff, the support of its committed Board of Directors and local, state, and national leaders, collaborative relationships with state sister agencies, and partners across the health care system and in the community. The Health Connector also enjoys strong relationships with its state partners at the Division of Insurance (which regulates the Commonwealth’s commercial “merged market” in which Health Connector coverage is situated) and the state’s Medicaid program, MassHealth, with which the Health Connector shares an integrated eligibility and enrollment system, and with which many Health Connector enrollees and/or their family members move back and forth between for health coverage. The Health Connector’s current and future successes would not be possible without the support and expertise of the diverse constituencies that played a role in pressing for the advancement of the Health Connector’s mission and the aims of state and federal health reform. Nevertheless, there is still immense work to be done to ensure equitable access to affordable, comprehensive health insurance coverage for all people and communities in the Commonwealth and that the services and coverage experience provided by the Health Connector are truly “best in class.” It is with determination, gratitude, and appreciation that the Health Connector carries the torch into this next phase of its work to serve the Massachusetts public.

Looking Forward

Looking ahead to the next five years, the Health Connector will ensure the objectives and initiatives outlined in this strategic plan continue to advance its core mission and vision and are guided by its values.

Mission Statement

Advance access to high-quality health care by serving as a transparent and transformative health insurance Marketplace for Massachusetts residents and small businesses to come together and easily find, compare, and enroll in affordable health coverage.

Vision Statement

Serve as the leading state-based health insurance Marketplace in the nation by upholding the Commonwealth’s near universal health coverage rate and making it as easy as possible for all residents to enroll in and maintain high-value health insurance coverage.

Values Guiding the Health Connector

  • Person-centeredness: The real lives of residents of the Commonwealth who rely on Health Connector coverage or are touched by its policies, and how their needs differ based on lived experience, will remain at the center of all program design, policy-making, and operational decisions.
  • Equity: Health Connector practices and policies will advance equitable access to comprehensive health coverage and health coverage that promotes equitable health outcomes.
  • Value: Health Connector coverage will provide members with meaningful access to health services with minimal barriers due to cost, while centering the importance of an economically sustainable health care system and being good stewards of public (state and federal) resources.
  • Reliability: The Health Connector will serve as a reliable and trustworthy source of coverage to the residents it serves, and as a dependable and steady business and policy partner to its stakeholders.

The Health Connector’s 2024–2028 Strategic Plan was developed based on staff, management, and the Board of Directors’ careful reflections on the Health Connector’s work to date and opportunities for heightened impact in the years ahead. It also incorporates feedback solicited from a diverse set of external stakeholders, including Board Members, carriers, navigator organizations, legislative and congressional offices, health care advocates, employers and health insurance brokers, and state and partner agencies via surveys assessing the Health Connector’s successes, challenges, and opportunities moving forward.

This strategic plan outlines eight broad goals and associated initiatives that fit within four overarching focus areas identified through the planning process:

  • Improve and modernize the applicant and enrollee experience
  • Maintain and strengthen organizational structure and system reliability
  • Improve equitable access to affordable health insurance coverage
  • Deliver high-value coverage options to the residents of Massachusetts

A Commitment to Using the Health Connector as a Tool for Promoting Equity

The Health Connector recognizes that both state and federal health reform and the creation of the Health Connector were direct policy responses on behalf of the Massachusetts and American public to an inequitable health coverage landscape that left key populations (e.g., Black and Hispanic populations, immigrant groups, those who don’t speak English as a first language, lower-income individuals, people with health issues, LGBTQ+ people, workers without employer-based coverage, and small employers) out of the health and economic protections afforded by health coverage. The Health Connector, therefore, understands itself to be explicitly charged with using the policy, program, and business tools at its disposal to name and counter these structural problems as they are encountered in its work. The Health Connector will continue to act with intention as it centers racial equity and other forms of equity into existing program and policy work it does in the public interest, as well as future initiatives spurred by this strategic plan. Further, the Health Connector recognizes that equity in the context of health insurance is a distinct (and underexplored) dimension of the equity agenda that it aims to more deeply articulate and act upon.

The Health Connector also recognizes the importance of championing diversity, equity, and inclusion throughout the Health Connector’s internal day-to-day operations, in addition to its service to the public and the work that will be animated by this strategic plan.

Adoption and Use of 2024–2028 Strategic Plan

The 2024–2028 Health Connector Strategic Plan will serve as a set of guideposts for the work of the Health Connector and its staff over the next five years. Outlining a common vision towards which the agency can advance, the strategic plan is also intended to (1) strengthen the foundation of the Health Connector to be adaptable and agile, and (2) better prepare the organization to respond to opportunities to advance its mission and surmount potential obstacles on the road ahead.

Annually, the Health Connector will establish and align its focus and priorities for the coming year with the goals outlined in the strategic plan. The yearly process will allow the Health Connector to remain responsive to changing dynamics, intentionally identifying its tactical approach, and precise in quantifying its expected achievements and progress measurements. The strategic plan document will be regularly used to assess the direction of existing and future agency initiatives to ensure that they align with agency priorities and goals articulated in the strategic plan.

Areas of Strategic Focus, Goals, and Initiatives

a diagram of the four strategic plan focus areas as detailed in the plan

Improve and modernize the applicant and enrollee experience

Modernize and streamline the experience of applicants and enrollees to ensure that they can obtain and maintain health insurance coverage with ease. Individuals should be able to easily and independently navigate and access Health Connector tools and resources, with minimized administrative burdens or bureaucratic obstacles.

1. Ensure residents can seamlessly and quickly enroll in and easily maintain coverage

  • Work to identify and remediate friction points within the application and enrollment process to minimize barriers to coverage related to administrative processes, or any aspects of enrollment and coverage maintenance experience that are unduly time consuming or confusing. Partner with MassHealth on elements of this work that relate to the Health Connector and MassHealth’s shared integrated eligibility and enrollment system (HIX)
  • Update written communications and required notices to applicants and enrollees to provide clear and effective messages about coverage and actions that need to be taken, with special attention to individuals who prefer a language other than English or who may not have familiarity with health care terminology or “legalese”
  • Expand how and where members can make premium payments to minimize the number of people who fail to enroll or who lose coverage due to limitations in available premium payment options

2. Provide a more user-friendly, streamlined online experience for residents and members engaging digitally with the Health Connector

  • Enhance online systems for applicants, members, employers, employees, and brokers for a more streamlined, modern, user-friendly experience when accessing and editing their information
  • Review and overhaul the public-facing, informational Health Connector website to modernize and update information and ensure that it is easy to navigate and identify needed information

Measuring Outcomes

  • Increase in member enrollment

  • Decrease in involuntary member terminations or transitions resulting from administrative burdens

  • Increase in satisfaction rate of enrollees regarding their experience applying for, enrolling in, and maintaining Health Connector coverage

  • Improved collection of timely feedback from Navigator organizations and assisters on the impact of Health Connector efforts to reduce administrative burdens

Maintain and strengthen organizational structure and system reliability

Ensure Health Connector staff and systems can adapt and grow to reliably meet the needs of state residents and an ever-evolving health coverage, technology, and business landscape.

1. Foster an inclusive work environment that centers professional growth and staff empowerment

  • Maintain and enhance clear organizational structures and systems of accountability that provide an environment for all staff to thrive and excel in their public service roles
  • Cultivate a workplace culture that thoughtfully and intentionally centers diversity, equity, and inclusion

2. Ensure, invest in, and cultivate reliable Health Connector organizational functions

  • Continue to prioritize stability and precision in IT and integrated system maintenance and implementations, contact center operations, and customer service interactions
  • Effectively manage vendors that execute fundamental aspects of Health Connector business that face applicants, members, carriers, and/or governmental partners to ensure they embody the Health Connector’s values, mission, and commitment to precision and excellence
  • Utilize the expertise and insights of carriers, Board members and partner organizations to implement incremental improvements in Health Connector annual Seal of Approval (plan certification) process

Measuring Outcomes

  • Increased job satisfaction, employee performance and professional growth, and agency efficiencies

  • Improve staff retention rates through strengthened professional development of internal staff, improved training, and clearer job functions

  • Establishment of an ongoing utilization of new internal diversity, equity, and inclusion educational initiatives

  • Increased incorporation of stakeholder and community partner input as part of the annual Seal of Approval process

Improve equitable access to affordable health insurance coverage

Use available policy, operational, and communication tools to reduce and remove barriers that prevent access to affordable health insurance coverage for all Massachusetts residents.

1. Expand equitable access to affordable health coverage

  • Reduce racial and ethnic disparities in health insurance coverage rates while maintaining a high overall coverage rate statewide
  • Improve the Health Connector’s offerings of culturally and linguistically appropriate supports to residents applying for, enrolling in, and maintaining health coverage
  • Shield low- and moderate-income residents from excessive health care costs as the Commonwealth and nation continue to grapple with systemic solutions to underlying health care cost growth issues and our members continue to face affordability challenges in other facets of their lives
  • Collaborate with other state health care payers to align and execute on coordinated goals around population health and health equity to achieve scale for maximum public/market impact
  • Deliver and elevate affordable, high-value health insurance coverage options to small group market using existing policy tools and processes
  • Identify and analyze best practices and innovations of stakeholder partners and peer State-Based Marketplaces that effectively promote equitably designed and affordable health coverage

2. Evaluate and address health equity initiatives through data analytics and community engagement

  • Improve data collection from Health Connector enrollees to further identify and address inequities in health coverage rates, ultimately informing policy and outreach initiatives and future innovations
  • Reduce the impact of social, financial, linguistic, cultural, geographical, and technological barriers on access to health insurance coverage
  • Create a recurring forum for the Health Connector to engage with and receive feedback and perspectives regarding coverage access challenges from Health Connector members and residents – particularly those from communities that have historically not been engaged as strongly for policy and program input, but who depend materially on the services provided by the Health Connector

Measuring Outcomes

  • Increase rate of enrollment among eligible individuals in a qualified health plan by at least five percent

  • Decrease in the rate of uninsured individuals in the Commonwealth, especially among populations that historically have lower rates of enrollment, including Black, Hispanic, and immigrant populations, and in the Commonwealth as a whole
  • Increase in language access supports for applicants and enrollees, including through the Health Connector’s application, communications and notices, its contact center, and accessibility of multi-lingual Navigators and enrollment assisters available statewide with a particular focus on communities with greater rates of uninsurance, and geographically isolated regions
  • Increase in number of individual lives enrolled in small group enrollment through the Health Connector for Business and utilization of unique platform features to access more affordable and high-value health insurance coverage
  • Increase in member engagement opportunities and methods of outreaching applicants and members
  • Establishment of organizational processes to intake and incorporate community voices and input into Health Connector policy, program, and operations work in more deliberate ways

Deliver high-value coverage options to the residents of Massachusetts

Enhance affordability for members and those within the merged market (the state’s combined individual and small group insurance markets) more broadly, ensuring that members can use their coverage to access health care services that enable them to attain their highest level of health and financial stability.

1. Ensure Health Connector coverage is comprehensive, affordable, and meets residents’ needs

  • Leveraging the Health Connector’s unique combination of state purchasing power and position as a state actor and market setter in the commercial insurance market, collaborate with other state health care purchasers to align on strategies, and measures surrounding health care affordability and cost-containment for all residents of the Commonwealth and purchasers, thereby increasing the Commonwealth’s impact on affordability, cost containment, and value.
  • Using state data and institutional thought partners, explore opportunities for the Health Connector to lead and innovate with respect to underlying health care cost containment
  • Use available tools, policies, and processes to expand access to physical health, behavioral health, and dental services, particularly among populations underutilizing such services
  • Explore and consider new and innovative approaches to health insurance that could be adopted to support equitable access to care at an affordable price-point
  • Develop more precise point of view and agency agenda on the meaning of equity in a health insurance context, and construct and preserve equitable policies and program design attentive to members’ distinct health and dental care needs through the Health Connector’s Seal of Approval process
  • Use the Health Connector’s policies, programs, and business strategies to ensure a competitive and stable health insurance carrier market
  • Identify and respond to health care access issues faced by Health Connector members

2. Increase awareness of the value and brand of Health Connector products

  • Use data-driven messaging to communicate the benefits of health insurance coverage to individuals and small businesses across the state, as well as the benefits of obtaining coverage through the Health Connector specifically
  • Promote health literacy and health insurance literacy in linguistically and culturally appropriate ways on topics such as health insurance terminology, the benefits of having health coverage, and how to use coverage

Measuring Outcomes

  • Increased satisfaction in surveys of Health Connector members and applicants
  • Increase in public awareness among state residents, small businesses, and health insurance brokers regarding the existence and role of the Health Connector
  • Decrease in delayed or forgone care due to cost, provider availability, or other barriers

Conclusion

The Health Connector looks forward to advancing this next phase of its work delivering the health care access and financial protections afforded by comprehensive health coverage to the Massachusetts public and serving as the nation’s leading state-based health insurance Marketplace. Health Connector leadership and staff will work with its Board of Directors, MassHealth leadership, and external stakeholder partners to be guided by the principles and guideposts outlined in this strategic plan and by the mission of the agency and its focus on promoting and improving access to high-value, affordable health insurance coverage.

Health Connector leadership and staff will provide updates to its Board of Directors and the public on the progress made in advancing the goals and objectives outlined in the strategic plan and looks forward to continuing to challenge itself and hold itself accountable to further expanding and strengthening its impact in the Massachusetts health coverage landscape.