Editor's note: Dawn Hunter is director, healthcare, and Jessica Bettelheim is research analyst, healthcare, at Market Strategies International, a Portland, Ore., research firm.

Over the last decade, the use of market research online communities (MROCs) has gained steady traction, offering a research methodology that has the potential to cost-effectively produce rich and valuable insight over an extended period of time. Though MROCs are generally seen as a qualitative research method, it is perhaps more appropriate to view them as a vehicle for a robust, mixed-method approach. Depending on how the community is designed and the types of activities that take place within it, researchers can facilitate online conversations, discussion boards and image sharing as well as surveys of varying length to gather quantitative data, from an entire group or subset of participants.

MROCs, while designed to replicate the kind of online conversations people might otherwise have through social networks (such as Facebook), have the added feature of gathering people with a vested interest in conversing on a similar topic. MROCs, therefore, can serve as an ideal platform for companies to directly interact with customers, as research on product and advertisement testing also engages the consumer directly. Many, if not most, of the MROCs employed today and written about publicly are private, branded communities comprised of participants recruited from a company’s own database or from a panel of respondents who have stated experience using specific brands or products. In this way, companies gain rich insights from their current customer base and feedback on existing and future products.

In this article, we provide a unique take on MROCs and share an experience outside of the traditional brand-sponsored community with a population not previously studied in this manner: uninsured consumers shopping for health insurance during the implementation of the landmark Affordable Care Act (ACA).

Rare opportunity to study a new market

The ACA rollout was an unprecedented and significant event in the history of U.S. health care, one that offered a rare opportunity to study a new market of shoppers as they went through the journey of selecting health insurance plans. We were eager to learn more about their process, questions, struggles, successes and failures. But because of the polarizing nature of the topic, we weren’t sure how this audience would engage. Would they be willing to share their journey with us and with each other?

We began by fielding a study of 2,741 adults between February 20 and March 13, 2014. Qualified respondents were 18-64 years old, self-identified health care decision makers, uninsured for at least the prior six months and not eligible for Medicaid. Our panel recruitment partner for this effort was ROI Rocket, which had access to more than 1 million, 100 percent double opt-in, IP- and USPS-verified and digital-fingerprinted members.

From these respondents, we narrowed the pool of potential recruits to our MROC named Healthcare Happens. We did this by looking at stated intention to enroll before the government’s deadline of March 31, targeting a mix of subsidy-eligible and -ineligible uninsureds and combing through open-ended responses to identify high-quality candidates – people who seemed willing to contribute meaningfully and extensively in an online discussion forum. After contacting the narrowed pool of candidates, we recruited 62 individuals to our MROC.

We built Healthcare Happens on Dub’s IdeaStream platform, a Web-based insight and co-creation community platform designed for longitudinal communities, combining qualitative and quantitative tools from blogs and forums to ideation exercises and picture galleries.

Over the course of nine weeks, from March 13 through May 16, we facilitated nearly 40 community activities, including 20 discussions, five quick polls and about a dozen surveys. Community members uploaded photos and videos – often without prompting. And they frequently started discussions of their own about pressing topics as they tried to navigate the health insurance buying process. The result was rich insight about their struggles and successes with scant political commentary.

Our MROC was private but we did ask members about their general use of social media on this topic. We found that many members weren’t comfortable discussing information such as health status or finances via their personal networks but did feel comfortable discussing these topics with an online group of like participants. As one participant from the research mentioned, “I honestly wouldn’t have used social media . . . I do though feel that being chosen to be a part of this community has helped and made me feel . . . comfortable enough to open up and discuss the process of choosing a health care plan and all the questions I may have not received answers to if I had not been involved here.” This is just one reason why the creation of MROCs is so valuable: They allow researchers to facilitate these types of conversations in a way that is maximally productive and observable.

As moderators, we were active participants within the community, getting members to introduce themselves and helping to make connections between them based on shared interests or locations. Once the bonds were established, community members were able to engage more freely and openly with each other, learning from their interactions rather than us simply posing research questions. However, the role of the moderator is critical and should not be undervalued. Community members must feel welcomed, valued and encouraged to participate with each other, a goal the moderator carefully orchestrates early on in the community. Exercises that create interactions and establish bonds make the difference between a successful or failed community.

One of the things we learned along the way is the importance of adjusting when unanticipated circumstances interfere with your research goals or timeline, something that happens to researchers far more than we like to admit. In the middle of our community, there was an unexpected enrollment extension of two weeks to April 15. This presented a challenge because we had some members who had already enrolled and others who now planned to take advantage of the two-week extension. As a result, we were unable to execute on some of our planned activities during those two weeks, yet we still needed to generate enough exercises to sustain interest among all community members. During that time frame we categorized members further and created different exercises for each group (the enrolled and the delaying). We also set up exercises that everyone could participate in so that the interaction remained steady. It was not what we planned but ended up being a valuable lesson in detail, planning and flexibility.

Continue to be vulnerable

As we mentioned previously, the reason we decided to create a MROC was that we were eager to learn more about the process, questions, struggles, successes and failures of the uninsured. While we suspected there might be some challenges, especially given the functionality issues with the federal and some state exchange Web sites (the primary enrollment platforms), our MROC revealed that uninsured shoppers were and will continue to be vulnerable on many levels. Here are a few things we learned in our study:

• Literacy of health insurance and health provider systems was low. As an example, with only one week left before the sign-up deadline, almost half of the members could not identify the correct definition of co-insurance from a list of only four possible definitions. In a Washington Post article (“New challenge for Obamacare: Enrollees who don’t understand their insurance plans”) one new plan member “does not understand why he is getting charged for hospital bills when he already pays the insurance company every month. And he did not grasp this thing – a deductible – that was $4,000.”

• Previously-uninsured shoppers were overwhelmed by the process of evaluating and choosing a health insurance plan and did not know what to look for. One participant shared that they had trouble “understanding the plans better and just what I needed in a plan. Insurance companies tend to use complicated jargon that tends to make me feel dumb.” One shopper even admitted to using “eenie meenie miney mo” in choosing between different plans. In these cases, while companies may have acquired a new customer, the loyalty they might exercise will be negligible at best and probably based on apathy or fear of engaging in yet another stressful shopping experience.

• These shoppers lacked the knowledge needed to make an informed decision. Facing a lack of information, lack of knowledge about where to find help and fear of making the wrong decision, some potential buyers walked away from the process altogether: “The whole process was confusing. I didn’t know which plan would benefit me more, then the site shut down for a while and between doing my taxes [and] taking care of [my] ill girlfriend, the deadline passed. I’ll have to wait till November.”

So, even though our uninsured members were actively participating in a MROC about signing up for health insurance, and they fully intended to sign up before the deadline, many were stalled by concerns about being able to pay for coverage and by confusion and fear about making the wrong choice. It is likely that this audience will struggle to navigate these waters for some time. And, if confusion and cost concerns trump benefits at the end of the day, higher than expected turnover rates and opt-outs in 2015 will be the result.

Pinpoint areas for innovation

As stated earlier, branded communities are valuable and should not be ignored. However, the primary use of MROCs today is focused on an existing customer base. The insight gleaned, while valuable, helps companies work toward what Clayton Christensen, a recognized expert on innovation and growth, calls “sustaining innovation.” This means innovations that incrementally improve existing products and services. There is significant un-tapped potential in using MROCs as a method to learn more about non-customers or potential customers. In particular, MROCs could be used to gain insight into shopping habits and decision-making processes to pinpoint areas for other innovation. These insights would have the potential to cause what Christensen calls “low-end disruption” (meeting the needs of consumers who are over-served by current market offerings) and “new market disruption” (meeting the needs of non-customers or emerging markets who aren’t currently being served by any competitor in the market).

As the cost of gaining new customers is significantly higher than the cost of retaining current customers, MROCs can be used as a vehicle for better understanding the mind-set of the latent buyer. By learning more about the needs, frustrations and desires of non-customers and potential customers, companies can develop products and services that snare new customers during the shopping process, thereby gaining market share from competitors or even opening untapped markets. Further, the characteristic longevity of an MROC (that a community can continue in existence for an indefinite period of time) has the added advantage of allowing researchers to surface emergent themes and pursue different avenues of in-depth investigation. Recognizing, for example, that the shopping process is just that – a process – researchers can study participants over a period of time to glean insight about the customer mind-set at different stages in the process. This leads to better understanding of the challenges and obstacles shoppers face at each stage to pinpoint areas where they are being underserved or which represent potential drop-off points. MROCs can, and should be, leveraged to understand more about the shopper and potential buyer, as opposed to only learning more from the current customer.

A testing ground

Though this MROC only continued a few weeks after the enrollment deadline, there was potential to continue probing this group of shoppers (now mostly new enrollees) about their use of a new plan, successes and failures, perceived benefits and perhaps to track their use of and loyalty to their new plans. Even during the shopping process, it is possible to use a community as a testing ground for different types of messaging and educational materials that could improve the shopping process. Whether the community is private-branded, private-blinded or third-party neutral (as was the case with our community), insurance companies and health care providers alike would find value in creating or subscribing to MROCs such as these in order to understand the frustrations of potential customers, therefore kick-starting the creative process of innovating solutions to meet their needs. One example of an audience that hasn’t been studied much in this manner to date – but that offers rapidly growing potential – is seniors who are getting ready to enroll in Medicare for the first time. And, of course, there are plenty of examples outside of health care as well, like the first-time home or car buyer.

As we have seen the shift to more customer-centric approaches within organizations not only in health care but in other industries, gathering deeper insight will become a higher priority. MROCs take that engagement and inspiration to a whole new level.