nevada health link december 3, 2014 new legislator policy briefing
TRANSCRIPT
Presentation Topics
• Transition to Supported State Based Marketplace
• Open Enrollment Overview• Consumer Case Resolution Initiative• Exchange contact information
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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
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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)
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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
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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
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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
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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
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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
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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
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In person assistance• Enrollment stores in Las Vegas and
Reno opened November 15th
• Staffed with brokers, agents, navigators and Medicaid enrollers
• Well received• Positive consumer experiences• Ability to get immediate assistance
with website, insurance related questions
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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
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Overview
Issues surrounding 2014 Plan Year Open Enrollment well documented• Enrollment • Eligibility• Advanced Premium Tax Credit• Billing• Repeating data anomalies and
inconsistencies
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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
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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
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 Exchange2014 Issues
Shawna [email protected]
Constituent ServicesMatt [email protected]
Executive DirectorBruce [email protected]