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

▪ info@wahbexchange.org

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More on the Exchange

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