washington health benefit exchange€¦ · -release survey (apr 2016)-compile results/categorize...
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Washington Health Benefit Exchange
Operations CommitteeJune 16, 2016
Pam MacEwan, CEO
Strategic Operational Business Plan
▪ Tie to the Strategic Plan adopted by the Board
▪ Reflects careful deliberation and goal setting aimed at providing a complete and meaningful picture of the Exchange’s business strategy.
▪ Core Outcomes:
▪ Define and Deliver Operational Excellence
▪ Increase Number of Insured and Access to Affordable Coverage
▪ Advance Consumer Choice and Decision-Making
▪ Promote Equity Across System
▪ Board Strategic Plan Priorities
▪ Establishes the priorities and the timeframe during which they are to be completed and demonstrate measureable improvement. Foundation for the Business Plan.
▪ Operationalize Strategic Plan; outcome: HBE Business Plan
▪ Not new work; report what is accomplished
Business Plan; Progress to Date
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▪ Identify Department Priorities and Goals
▪ Establish Department priorities in alignment with Strategic Plan
▪ Enculturate the Business Plan
▪ Implement Business Plan - every employee understand how their work contributes to the Department priorities and ultimately the Strategic Plan
▪ Commence Monthly Reporting Cadence
▪ Leadership Team regularly reviews and updates the Business Plan to reflect progress to date related to the Strategic Plan
▪ Leadership Team reports to the Exchange Board on the progress of the Strategic Plan
▪ SharePoint location: https://wahbexchange.sharepoint.com/teams/execteam/SitePages/Home.aspx
Business Plan – What’s Next?
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HBE BUSINESS PLANGoal # Category Objective Actionable Steps Timeframe
Late End
Progress Responsible
1. Define and Deliver Operational Excellence
1 Financial Replace current financial system
Process:-Procurement(RFC creation/publication, vendor selection, contract negotiation, signed contract) (Mar 2016)
-System Development Life Cycle(Analysis, design, configure, deployment, development complete) (May 2016)
-Testing(Data conversion, system testing, UAT, Abila parallel, testing complete) (Jun 2016)
-Production Implementation(Production installation, data conversion, finance system software go-live) (Jun 2016)
-Assess reports and adjust as necessary (Jun 2016)
1-2 Years 06/30/17 CaroleVincent
1. Define and Deliver Operational Excellence
2 Financial Develop five-year spending plan, including areas for efficiencies
-Update Medicaid allocation-Submit revised OAPD/IAPD-Propose reductions in IT, Call Center, staffing-Identify efficiencies/reduction in spending for 2017-2019 budget-Submit updated five-year spending plan
Track PMPM spending-Track QHP, SHOP, Dental
1 Year 9/30/2016
12/30/16
Carole
Not Started At Risk In Progress Completed
Goal # Category Objective Actionable Steps TimeframeLate End
Progress Responsible
1. Define and Deliver Operational Excellence
4 Financial Offer clear and standardized financial reporting to the Board and Legislature
-Implement key chart of accounts (Jun 2016)-Assess financial system report functionality to provide report to key internal/external stakeholders (Exchange Board, Legislature, OFM, etc.) (Sep 2016)-Improve revenue projections (Dec 2016)-Track actuarial forecast
1 Year 09/30/16 Carole
1. Define and Deliver Operational Excellence
7 Financial Establish a working definition of sustainability
-Meet with Leadership Team, Exchange Board, Legislature to develop agreed upon definition of sustainability-Identify and implement efficiencies-Research grant opportunities-Maintain HPF sustainability-Assess business development opportunities-develop process to assess the return on investment for system enhancements-Conduct financial audit (Sep 2016)-Conduct programmatic audit (Dec 2016)
1-2 Years 09/30/17 CaroleMolly
1. Define and Deliver Operational Excellence
9 External Relations
Create a stakeholder engagement plan to work directly with and hear from stakeholders and tribes
-Conduct TAC survey-Solicit feedback from one-on-one discussions with Legislators, Legislative staff and stakeholders (May-Oct 2016)-Analyze results (Nov 2016)
1-2 Years 12/31/16 Molly
1. Define and Deliver Operational Excellence
10 External Relations
Improve relations with the Legislature
-Schedule and hold meetings-Report to Exchange Board-Exchange Board follow-up with concerns-Schedule regular briefings with Legislators-Create timely briefing materials for Legislature meeting-Provide regular updates to Legislature and Legislative staff-Schedule appointments for Exchange Board members to brief democrat/republican caucus staff
1 Year 10/31/16 Molly
5
HBE BUSINESS PLAN
Not Started At Risk In Progress Completed
Goal # Category Objective Actionable Steps TimeframeLate End
Progress Responsible
1. Define and Deliver Operational Excellence
11 External Relations
Improve Committee and TACcommunications and input
-Develop questionnaire for TAC-Exchange Board Nominating Committee review/approve-Release survey (Apr 2016)-Compile results/categorize themes (May 2016)-Share results with Exchange Board Nominating Committee (Jun 2016)-Exchange Board Nominating Committee identify areas for improvements (Jun 2016)-Exchange staff work with Exchange Board Nominating Committee on next steps (Jun 2016)
1 Year 09/30/16 Molly
1. Define and Deliver Operational Excellence
19 Performance Improve communications and training to create customer service efficiencies
-Implement Content Management-Establish unified training plan-Identify resource to create cohesive training guide
Operations-Refine Call Center report to reflect current needs-Update IVR
HR-Assist with Lean training
IT-Implement the next versions of Edifecs which will include carrier access and SHOP file processing to improve carrier -O20 HBE operations-Improve SDLC policies & procedures as well as production control across all systems in the IT ecosystem-Automate plan loading and Federal 1095 reporting-Expand the CSA tool to better support call center resources and HE internal staff-Improve data quality through automated WAH renewal process and reduced manual data corrections
1-2 Years 09/30/17 MichaelBethVincentBrian
6
HBE BUSINESS PLAN
Not Started At Risk In Progress Completed
7
HBE BUSINESS PLANGoal # Category Objective Actionable Steps Timeframe
Late End
Progress Responsible
1. Define and Deliver Operational Excellence
21 Performance Single, streamlined ticketing and complaint system
Phase 1 - 2016-Assess current ticketing system to improve efficiency and effectiveness-Research single streamlined ticketing and complaint system (OIC, corporate website, Zendesk)-Seek CEO/Leadership Team approval-Assemble project team (Ops IT, Communications, Policy, Legal, Finance)-Collaborate with IT under return on investment proposition-Assess single streamlined ticketing and complaint system impact
Phase 2 - 2017-Determine system changes-Develop communications plan-Develop training-Build knowledge base
Phase 3 - 2018-Implement system changes-Implement communications plan-Provide training
2-3 Years 9/31/18 BethVincent
Not Started At Risk In Progress Completed
Goal # Category Objective Actionable Steps TimeframeLate End
Progress Responsible
1. Define and Deliver Operational Excellence
24 Performance Develop key metrics of Exchange performance
-Research state-based Exchange metrics-Right size organization-Eliminate duplication-Use State services-Research SBE benchmarks-Exchange Board and CEO identified 2016 goals-Exchange Board mapped Strategic Plan priorities and CEO goalsDeliverable: Revised Executive Dashboard; Analysis of state services (forecasting, OCIO, etc.)
HR-Assist with benchmarking staffing in other state Exchanges-Partner with Exec/departments to identify necessary competencies-Perform gap analysis to project future manpower and competency needs. This can include checking current organizational structures for functional redundancies, and using this data to assess/evaluate current compensation structure.
1-2 Years 09/30/17 PamMollyCaroleBrian
1. Define and Deliver Operational Excellence
26 Performance Coordinate efforts across the Exchange and state agencies
IT-Review and revise change requests for 2016-2017 releases to include enhancements & defects (Apr 2016)-Implement CRM tool for greater change control and visibility (April 2016)-Ensure approval by HPF Gov. Committee (May 2016)-Review and improve CIO workgroup-Review EMT for updates-Improve SDLC policies & procedures as well as production control across all systems in the IT ecosystem -Launch cross functional innovations team-Implement data warehouse to better understand current customer decisions
1 Year 12/31/16 PamVincent
8
HBE BUSINESS PLAN
Not Started At Risk In Progress Completed
9
HBE BUSINESS PLANGoal # Category Objective Actionable Steps Timeframe
Late End
Progress Responsible
2. Increase the Number of Insured and Access
to Affordable Coverage
29 Navigator & Brokers
Configure navigator program appropriately for the changing needs of Exchange enrollees
-Develop opportunities for Navigators/Brokers to collaborate-Determine return on investment for training-Assess Navigators/Brokers performance activities-Solicit feedback from Lead Organizations to restructure RFP (May 2016)-Evaluate opportunities to incentivize Navigators/Brokers-Identify needs based on population/geographic area to establish awareness and enrollment channel-Assess/Adapt strategies to meet needs for population/geographic area-Work with partners to identify opportunities to maximize enrollments
3 Years 09/31/18 MichaelKelly
2. Increase the Number of Insured and Access
to Affordable Coverage
30 Navigator & Brokers
Pursue broker-specific activities to encourage Exchange enrollments and renewals
-Deepen partnerships with Navigators/Brokers associations-Identify other measures that lead to establish best return for the Exchange-Assess Navigators/Brokers performance for specific geographic area-Work closely with Navigators and Brokers to reach hard to reach population-Sponsor broker events as appropriate-Assess return on investment-Analysis of uninsured, hard to reach population
1-2 Years 12/31/17 MichaelKelly
Not Started At Risk In Progress Completed
10
HBE BUSINESS PLANGoal # Category Objective Actionable Steps Timeframe
Late End
Progress Responsible
2. Increase the Number of Insured and Access
to Affordable Coverage
31 Navigator & Brokers
Create more opportunities and facilitate joint events for navigators and brokers
-Look into strategies to best serve geographic area-Create better network of super users-Provide more opportunity for more dialogue between Navigators and Brokers-Help clarify Navigators/Brokers role and responsibility-Assess "store front" for outreach efforts-Work with Navigators/Brokers to assess skills
1-2 Years 09/30/17 MichaelKelly
2. Increase the Number of Insured and Access
to Affordable Coverage
32 Exchange Market
Develop a comprehensive understanding of the Exchange’s potential customer market
-Continue to be involved in other national surveys (RWJ)-Work with GMMB on market survey-Develop firm understanding of study/report from OFM, Wakely, forecast council -Leverage existing resources to determine customer market
1-2 Years 09/30/17 Michael
Not Started At Risk In Progress Completed
11
HBE BUSINESS PLANGoal # Category Objective Actionable Steps Timeframe
Late End
Progress Responsible
3. Advance Consumer Choice and
Decision Making
48 Future Choice & Affordability Tools
Identify funding sources for decision support tools
Phase 1 - 2016-Research decision-support tools-Work with Finance/IT to identify cost allocation-Identify/Prioritize decision-support tools-Obtain Exchange Board approval on decision-support tools
Phase 2 - 2017-Potentially submit to Legislature for biennium budget request-Explore grant funding
Phase 3 - 2018-Implement decision-support tool
2-3 Years 09/30/18 MollyVincent
3. Advance Consumer Choice and
Decision Making
56 Short-Term Consumer Tools
Optimize health literacy efforts and develop an effective feedback loop to understand consumers’ issues and gaps in knowledge
-Review/Assess health literacy content-Engage Lead Organizations/stakeholders to discuss opportunities for improvement-Solicit feedback from TAC on messaging-Investigate other channels that could lend support (Pharma- formulary awareness)-Build larger partnerships-Implement dental program-Assess impact of dental (pilot dental program)
IT-Implement content management system to provide customers more relevant and timely information-Implement family dental services on HPF
1-2 Years 09/30/17 MichaelNellyVincent
Not Started At Risk In Progress Completed
12
HBE BUSINESS PLANGoal # Category Objective Actionable Steps Timeframe
Late End
Progress Responsible
3. Advance Consumer Choice and
Decision Making
60 Future Choice & Affordability Tools
Track affordability and choice issues as they affect enrollment retention and growth
-Secure funding for focus groups to address questions about affordability (Dec 2016)-Use consumer survey feedback to track progress (2017)-Analyze HPF data to develop action plan-Explore ways to capture information internally (2018)
IT-Implement data warehouse to better understand current customer decisions
3 Years 09/30/18 MollyVincent
3. Advance Consumer Choice and
Decision Making
62 Short-Term Consumer Tools
Implement quality rating system
-Develop request for change-Prioritize request for change-Implement QRS as part of Release 3.2 (Jul 2016)-Track use of data-Phased in implementation into HPF (2-3 Years)
IT-Implement HPF quality rating system to help customers make more informed health insurance purchasing decisions-Implement data warehouse to better understand current customer decisions
Next Year 12/31/17 MollyVincentMichael
Not Started At Risk In Progress Completed
13
HBE BUSINESS PLANGoal # Category Objective Actionable Steps Timeframe
Late End
Progress Responsible
4. Promote Equity Across System
68 Establishing Metrics & Utilizing Expert Committees
Establish equity-focused metrics
March (month 1): Review timeline and proposed metrics with TACApril (month 2): Revised proposed metrics based on TACfeedbackMay (month 3): Discuss updated metrics with TACJune (month 4): Share recommended metrics with Board Data and Metrics CommitteeJuly (month 5) - October (month 8): Develop benchmarks that align with approved metrics using similar process to above.
IT-Implement data warehouse to support equity analysis and policy development
1 Year 12/31/16 MollyJoanVincent
4. Promote Equity Across System
71 Establishing Metrics & Utilizing Expert Committees
Develop and review audience-specific messaging and materials
-Set up dedicated meetings with committees to review messaging-Develop survey on messaging framework-Work with network of providers to identify message instruments to improve communication
IT-Implement content management system to improve and simplify UI for at risk population
3 Years 09/30/18 MichaelNellyVincent
Not Started At Risk In Progress Completed
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