Transcript Presentation to the Legislative Committee on Health Care April 9
Nevada Health Link
New Legislator Policy Briefing December 3, 2014
Presentation Topics
• Transition to Supported State Based Marketplace • Open Enrollment Overview • Consumer Case Resolution Initiative • Exchange contact information 2
SUPPORTED STATE BASED MARTKETPLACE TRANSITION
What is an SSBM?
Supported State Based Marketplace • Exchange provides health plan qualification and certification services, oversees and underwrites the cost of in-person assistance programs, develops and funds marketing and consumer outreach efforts, acts as liaison between carriers and federal hub.
• Federal government provides technology: the eligibility and enrollment operational platform utilized by the Exchange.
• “Halbig-proof”, subsidies safe 4
Part of Multi-Agency Team
The Exchange works with a multi-agency team for project management • Centers for Medicare and Medicaid Services (CMS) • Nevada Governor’s Office • Division of Welfare and Supportive Services (DWSS) • Division of Insurance (DOI) • Enterprise IT Services (EITS) 5
Stakeholder Liaison
The Exchange also works with external resources and stakeholders for the benefit of Nevada’s consumers • Consultants on technology integration and messaging • Insurance carriers • Brokers and agents • Exchange enrollment facilitators 6
Technical Resource
• Developed a pathway to successful transition • Set benchmarks • Configuration milestones • Set up and transition milestones • IT Security milestones • Organization and resources milestones • Managed carrier onboarding and transitioning 7
Operational Resource
• Plan certification • DOI, Exchange and carriers working together • New market entry – Time Insurance Company (PPO) • Marketing and outreach • Educational and promotional campaigns • Sponsor events and enrollment stores • Broker and agent education • Must register with CMS • Complete specified training • Facilitator education • Navigator program required as SSBM • Complete specified training 8
OPEN ENROLLMENT
Goals
• Don’t burn the house down again, please • Improve the consumer experience • Mitigate/eliminate root causes of last year’s issues • Provide expanded access to in-person assistance 10
Strategies
• Adopt federal technology platform to: • Make signing up easier and faster • Assure data capture and transmission • Leverage federal technology infrastructure and resources • Transfer premium billing and collection activities to the insurance carriers • • End the need for reconciliations Minimize the potential for misallocation/errors • Emulate successful outreach programs of other states • Create brick and mortar enrollment assistance centers • Integrate community calendars, other tools 11
The New Platform
Significant changes in Healthcare.gov from 2014 • Streamlined application form: 76 screens reduced to 16 • Can handle 250,000 simultaneous users • Ability to window shop for plans without creating an account • Back button • Authorization/verification at conclusion of the process rather than page by page
Does it work?
• Yes!
• Positive press • “ Health exchange enrollment off to a smooth start” – Las Vegas Sun • “Health coverage enrollment gets good early reviews” – Las Vegas Review Journal • “Reviews good for Nevada Health Link enrollment” – KLAS TV • No substantial/widespread consumer complaints • No constituent services complaints 13
In person assistance
• Enrollment stores in Las Vegas and Reno opened November 15 th • Staffed with brokers, agents, navigators and Medicaid enrollers • Well received • Positive consumer experiences • Ability to get immediate assistance with website, insurance related questions 14
Initial Assessment
• 90 day race • Early results and impressions are positive • Messaging has been successful • Technology has been stable and robust • Demonstrating the value of the exchange as a technical and operational resource, impact of state specific marketing and outreach 15
CONSUMER CASE RESOLUTION INITIATIVE
Overview
Issues surrounding 2014 Plan Year Open Enrollment well documented • Enrollment • Eligibility • Advanced Premium Tax Credit • Billing • Repeating data anomalies and inconsistencies 17
Remedial Actions
Committed, “all hands on deck” efforts as soon as problems began to reveal themselves • Constant communications with vendor • Requested reporting by issue type to track trends • Development of vendor ‘Special Case Resolution’ group • A staff member and a representative of Xerox are meeting with each carrier to review open cases and identify opportunities for resolution 18
Added Resources
Strategic initiative to more quickly move consumer issues toward resolution and closure • Two existing vacant staff positions have been filled and dedicated to resolving consumer issues • Public Consulting Group has been retained and begun work on reconciling enrollment and financial discrepancies • Prioritized, continuous and full-time effort 19
Root Causes Addressed
Enrollment will be through federal platform, minimizing potential for issues created by prior system failing to properly capture and share data Billing will be handled by the carriers, ending the need for financial reconciliations and payment allocation errors
CONCLUSION
Progress
• Managed transition to an SSBM successfully • Navigated the first days of open enrollment successfully • Messaged the importance of coverage and the availability of local in-person assistance successfully • Resolved last year’s greatest dissatisfiers successfully
Open items
• Consumer case resolution • Termination of Xerox relationship • Structural transformation to better reflect the SSBM model
Contacting the Exchange
2014 Issues Shawna DeRousse [email protected]
702.486.5262
Constituent Services Matt Robinson [email protected]
775.687.9936
Executive Director Bruce Gilbert [email protected]
775.687.9926