Washington Health Benefit Exchange Eastern Washington Outreach Coalition February 5, 2013 Michael Marchand Communications Director
Dec 30, 2015
Washington Health Benefit Exchange
Eastern Washington Outreach CoalitionFebruary 5, 2013
Michael MarchandCommunications Director
Today’s Agenda
▪ Overview of ACA and Exchange
▪ Exchange Governance and Build
▪ Key Challenges and Upcoming Milestones
▪ Navigator Program Update
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Impact of the Affordable Care Act
▪ Changes to private insurance, e.g., o Young adults on parent’s policies to age 26oProhibit lifetime monetary capsoMinimum spending on medical care (medical loss ratio)
▪ Closes the prescription “doughnut hole”
▪ Expands coverageo Expands Medicaid to 138%* of Federal Poverty Level (FPL)o Exchanges
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*ACA 133% = 138% due to across the board income disregards
Washington HealthPlan Finder
Vision: Redefining People's Experience with Health Care
Mission: Radically improving how Washingtonian’s secure health insurance through
▪innovative and practical solutions
▪easy-to-use customer experience
▪our values of integrity, respect, equity and transparency
▪providing undeniable value to the healthcare community (patients, providers, plans)
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Exchange Basics▪ Individuals >138% of FPL and small groups (2-50)
▪ Tax credits available for individuals 138%-400% of FPL
▪ Cost sharing reductions available for <250% of FPL
▪ “Qualified health plan” (QHP) offerings
▪ Metallic tiers of actuarial value
▪ Apples-to-apples comparisons for consumers, one-stop shop
▪ 10 essential health benefits
▪ Navigators, agents/brokers, call center
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Building The Exchange
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• HCA receives one-year $22.9 million grant to design and develop Exchange
• SSB 5445 passed creating Exchange as “public private partnership”
• Governor names Exchange Board members
• Board begins governing authority
• ESSHB 2319 passed
• Deloitte Consulting, signs on as system integrator
• Exchange names first CEO and moves into new building
• Washington becomes second Level 2 establishment grant recipient, $128 million
• Exchange moves onto own payroll and accounting systems
• Sustainability plan submitted to Legislature
• WA HBE receives conditional approval from HHS/CCIIO to operate the state exchange
• Exchange must be certified by HHS
• Additional legislative action taken as needed
• Open Enrollment begins (October 1)
2011
20122013
2014• Coverage purchased in
the Exchange begins
• Open enrollment ends March 31.
• Year 2 open enrollment in Oct.
Exchange Governance Structure
Who is represented?▪ Employee benefits specialists▪ Health care finance specialists and
economists▪ Health consumer advocates▪ Small business representatives▪ Administrators from public and
private health care
▪ Consumer advocates▪ Health insurance carriers▪ Health insurance brokers▪ Health care providers▪ Tribal representatives
▪ Technical experts
▪ Consumers▪ Consumer advocates▪ Health insurance carriers
Exchange Board Members
Eleven member, bi-partisan board assumed authority on March 15, 2012
Margaret Stanley – Chair, Retired Executive Director, Puget Sound Health Alliance
Steve Appel – Farmer, Past President of the Washington Farm Bureau
William Baldwin – Partner, The Partners Group
Donald Conant – General Manager, Valley Nut & Bolt, Assistant Professor
Doug Conrad – Professor, University of Washington
Melanie Curtice – Partner, Stoel Rives
Ben Danielson – Medical Director, Odessa Brown
Phil Dyer – Senior VP, Kibble & Prentice, and Former Legislator
Teresa Mosqueda – Legislative & Policy Director, Washington Labor Council
*Commissioner Mike Kreidler – Insurance Commissioner
*MaryAnne Lindeblad – HCA Director
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* non voting, ex officio
Important Board Policy Decisions
Completed▪ Branding▪ Criteria for qualified health plans (QHPs)▪ Premium aggregation ▪ Consumer Rating System▪ Pediatric Dental Benefits▪ Sustainability report provided to Legislature▪ Navigator program
Upcoming▪ Role of agents/brokers
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Exchange Functions & Services
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What is a Navigator?
▪ Conducts public education and awareness of QHPs
▪ Distributes fair and impartial information
▪ Facilitates with enrollment
▪ Provides referrals to any applicable assistance, ombudsman or like activity
▪ Delivers information in a manner that is culturally and linguistically appropriate
▪ Executes in a fair and impartial manner
▪ May not be funded with federal grant dollars
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Who Can Be A Navigator?▪ At least one community and consumer-focused
nonprofit
▪ At least one other:▪ Trade, industry and professional association▪ Commercial fishing industry organizations, ranching and
farming organizations▪ Chambers of Commerce▪ Unions▪ Resource partners of the Small Business Administration▪ Licensed agents and brokers▪ Other public or private entities (including Tribal organizations)
and human service agencies
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Consumer Entry Points
Program Development Status
▪ Board approved the Proposed Navigator Implementation PlanoNetwork StructureoCompensationoPerformance measures
▪ Plan posted for public input
▪ Moving forward with RFP Development
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Navigator Network
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Tribal Program
Individual Navigator
Lead Organization Key Responsibilities
▪ Build local Navigator Network
▪ Coordinate outreach and education efforts
▪ Train Navigator Organization staff
▪ Monitor performance and service quality
▪ Submit required Exchange data and reports
▪ Funding agent
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Navigator Key Responsibilities
▪ Outreach
▪ Community Awareness and Education Activities
▪ Application-Enrollment Assistance
▪ Service Coordination
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Qualifications
▪ Complete Required Exchange TrainingoKnowledge and competency-basedoUnder development
▪ Pass Certification Exam
▪ Ongoing training and recertification
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Target Population
▪ Broad public education – awareness efforts
▪ Outreach Plan for each service area
▪ Application-Enrollment support to those who need one-on-one assistance
▪ Populations who experience barriers to access
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Navigator Limitations
▪ Impartial, objective information
▪ Cannot offer QHPs outside open enrollment
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Compensation Approach
▪ Grant funds for first 18 months (In-Person Assistance - pending)
▪ Exchange compensates Lead Organizations
▪ 50% Performance (Activity) Based and 50% Outcome-Based
▪ Example (next slide)
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Navigator Contract Example Total contract $360,000
Performance
Compensation (50%) $180,000
Outcome Compensation (50%) $180,000
Contract terms
Activities outlined in Statement of Work
4,200 Enrollments
50% or less in Target
Population
50% or more in Target
Population
Payment $10,000 per month x 18 months
Target 1 – 1,400
Target 2 – 2,800
Target 3 – 4,200
$48,000
$48,000*
$48,000*
$60,000
$60,000*
$60,000*
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*Add tiers for proportion of target 2 or 3 goal met – not “all or nothing”
Navigator Program Timeline
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Key Challenges
▪ Tight timeline – Oct. 1, 2013oFederal dependencies and guidance o IT flight path – scope, schedule and budget
▪ Delivery environmentoCritical inter-agency interdependencies
▪ Managing expectationsoOptions deferred to 2.0oComplex authorizing environment
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What to look for
▪ New Exchange website, email addresses: wahbexchange.org
▪ Legislative debate on sustainability plan
▪ Late winter/early spring:oRFPs, applications for Navigators, in person assisters,
and QHPsoMarketing, outreach to ramp up oSystem testing to begin, first with other systems
(integration testing), then user testing
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The Future?
▪ The exchange’s role in the marketplace
▪ Data gathering, and business intelligence
▪ Supporting delivery system and other reforms through a QHP rating system
▪ Supporting continuing consumer engagement
▪ Performance reporting
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www.wahbexchange.org
Includes information about:▪ Exchange Board
▪ Legislation and grants
▪ Policy discussion
▪ TAC and stakeholder involvement
▪ IT systems development
▪ HHS guidance
▪ Listserv registration
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More on the Exchange
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