Applying a Social Enterprise Solution to Outreach & Enrollment

February 12, 2019 | By Shelli Quenga, Director of Programs, Palmetto Project and Heather Bates, COO, Transform Health


Last year was a whirlwind for the thirty-five-year-old Palmetto Project in South Carolina, a statewide nonprofit whose mission is to identify innovative strategies to address the social and economic challenges in the state and put them into action. The nonprofit is no stranger to solving big problems. When the Affordable Care Act (ACA) passed in 2010 and shortly thereafter in 2013 the Navigator grants were announced, the Palmetto Project was front and center in a state whose politicians were largely against the ACA, and still has not expanded Medicaid. The Palmetto Project staff were serving consumers who desperately needed and wanted health coverage, convening state partners, and persisted in leading the way in sharing and implementing best practices from around the country—and this past open enrollment period was no different.

The past two years have faced strident cuts and threats to the ACA and outreach and enrollment across the country. These threats coupled with a movement towards further marketplace privatization as evident in the proposed 2020 National Benefit and Payment Parameter rule, and the need for increased funding to address social determinants of health and health disparities, as well as a shortage of accessible, affordable health care, and in South Carolina—no Medicaid expansion, the myriad challenges are constant. Against all of these odds, the Palmetto Project staff decided to do what they always do and bring their strength and expertise to bear to meet the people of South Carolina. As a result, they transformed their traditional nonprofit public education and enrollment model into a social enterprise for sustainability and are now the first, nonprofit insurance broker in the state and the first in federally facilitated marketplace states. 

Transform Health featured the statewide program as one of their panelists during the Families USA Health Action 2019 outreach and enrollment session in Washington, DC, and were met with all kinds of outstanding questions, so we thought we would tackle just a few of those in this blog post.

What’s changed since transforming into a nonprofit broker model?

We remain consumer-focused and still serve as a one-stop shop, not-for-profit, mission-driven statewide leader. Our staff is referred to as Resource Specialists, they are all licensed insurance agents, and we all collect a salary. This means that our motivation is not driven by the number of enrollments. We remain a mission-driven, consumer-focused not-for-profit that aims to meet the needs of our community. We are motivated to meet consumers where they are and help them full stop. We not only took on marketplace enrollments this past open enrollment, but we helped people enroll in Medicare plans as well.

What were some of the key lessons learned from this open enrollment period?

Some of the key lessons we learned included things like, taking the licensing exam takes time and you must study and prep for it, and even when you do that, you may have to take it a few times!

But all in all, some of the most important takeaways for us were:

1. Take a consultative approach to problem-solving. Ask, “what problems do you need to solve? What is most pressing in terms of priorities?” In some cases, this may not be enrollment in health insurance through that may be what got them in the door. Rather, a top priority may be helping the person enroll in food and/or housing support programs.

2. Adopt social work principles and meet the client where they are.

3. Licensed agents garner a different level of respect in private and public professional circles. It can give you a different level of credibility with state agencies and regulators that you may not otherwise have. You may be able to access the information you otherwise wouldn’t be able to obtain.

4. By serving the whole person, there is no “wrong door.” With our new agency outlook, we have access to more doors to help consumers solve really big problems.

5. If you thought health care was complicated, we have one word for you: Medicare!

How did you do?

All told, we enrolled nearly 800 individuals in a Marketplace plan during this past open enrollment with a team of 9 full-time resource specialists, one of whom didn’t come on board until the last week of November, in her first open enrollment season, and still was able to enroll 23 families in coverage.

Nearly 350 of the total enrollees were new consumers to the Marketplace. This number is significant for us because it demonstrates an ongoing need for outreach in order to identify and educate newly eligible individuals. We knew outreach was important, but this just affirmed it for us.

Julie Gaithers of the Palmetto project at her desk
Figure 1: Julie Gaithers, Lead Resource Specialist, Palmetto Project

Our effectuation rate, the rate at which people have paid their first premium to enter into a binding contract for the coverage year,is at an all-time high at 95%.We were ecstatic over this because again, it reaffirmed that outreach and education to consumers remain critical.

Not only that, we just learned thatwe are the third highest performing agency for our regionthat runs from Horry County, down the coast, and across to Augusta. If you know South Carolina, you know that there is great variation in these communities and with our small but mighty and dedicated staff we really made an impact!
Most of SC experienced a 5% increase in enrollment. However, in the Charleston area, that increase was an incredible 8%. Since we are based in Charleston, this is really a basis of pride for us, though we do remain humble that we still get to do what we love every day. There is also a well-defined opportunity in Beaufort County and the surrounding areas. By contrast to the Charleston area growth, those areas experienced only a 1% increase in Marketplace plan enrollment. The area is severely underserved by licensed agents contracted to enroll consumers in Marketplace coverage so now we have a target and work plan leading into next year.

Can anyone convert their nonprofit enrollment into an insurance broker model?
That question is best answered by researching your state’s regulations. In most states, there is no rule against setting up a nonprofit insurance agency, but there may be other pertinent regulations regarding income generation by state or county agencies that would preclude most state universities or county libraries from adding the agency component to their health care access work, or even allowing staff to work as licensed insurance agents through a sub-contract arrangement with a nonprofit agency. However, even when you answer those questions, you still must make a case to your nonprofit leadership and obtain buy-in. Each state’s approach may be a little different. There is no cookie-cutter approach to it, but there is a road map.

What’s next?
We are looking forward to diving more deeply into learning Medicare, as well as ensuring that we have enough trained staff on board to address the demand for next year. Additionally, we are looking at workflows and work planning to make sure we are triaging work the right way and playing to the strengths of each staff member. The partner outreach never stops either, we continue to let people know we are here and share our lessons learned. In a word, training, training, and more training. Of course, we are still enrolling people and now we have moved into helping them understand their plan, navigate the health care system, and ensure they stay covered throughout the course of the year.

a group selfie of the Palmetto Project staff
Figure 2: Palmetto Project Staff

If you would like to learn more about the Palmetto Project and their new nonprofit broker model, Insure South Carolina, contact Shelli Quenga at and follow their progress via Twitter. To learn about Transform Health, contact