Washington Health Benefit Exchange

June 4, 2015All-Committee Group Meeting

Pam MacEwan, Chief of StaffBeth Walter, Director of Operations

Preparing for Open Enrollment

Overview of Topics

▪ Premium Aggregation Removal

▪ Medicaid Plan Selection

▪ Releases – Pre – open enrollment

▪ Auto-renewal

▪ Carrier participation

2

Premium Aggregation Removal

▪ Design and development are on track

▪ User testing has taken place to assure design is informed by users and that customers will understand new instructions and process

▪ First communications prepared for customers to encourage early switch to direct payment of carriers. Begin measurement in June.

▪ First demo on new screens, functionality, scenarios

▪ Testing will be very important – plans being developed for UAT, development of scenarios, integration testing, carrier testing

3

Premium Aggregation Removal

▪ Detailed work plan developed to meet organization and carriers needs

▪ Contingency plans being developed and shared with carriers

▪ Weekly carrier meetings – in person meeting planned for June

▪ Carriers are currently on track with readiness plans

▪ QA initiated with Bluecrane – first draft report discussed with Ops committee – final distributed to Board

4

Medicaid Plan Selection

▪ Release successfully launched May 11

▪ Smoke testing revealed no unexpected results – system performed as expected.

▪ Soft Launch Underway– Communications limited to member instructions, training, and stakeholder communications

▪ Monitoring Call Center, information from Navigators, brokers and HCA, initial use has been higher than expected

▪ Broader announcement and messaging to align with Open Enrollment 3

▪ Limited messaging to Legislature and interested audiences

5

Medicaid Plan Selection

▪ Lessons Learned from a Successful Joint Release▪ Right people from all organization

▪ Highest Priority

▪ Vigilant scope control

▪ Adequate Test Time

▪ Joint Test Preparation/Coordination

▪ Effective Governance Structure and Processes

▪ Integrated Project Management Team with senior level PM experience

▪ Integrated PM with global perspective – Cambria

▪ Effective and frequent communication

▪ Engaged project sponsor

▪ Higher quality of code from Deloitte

▪ Strong leadership from HBE PMO from end to end leading to accelerated risk identification, solution definition and implementation

▪ Collaborative, roll up your sleeves attitude

6

Release 2.2 - May

▪ In addition to Medicaid Plan Selection – defect corrections tested and released into production

▪ Currently undergoing validation

▪ Data Fix templates put into production – currently being tested – enables staff to correct problems for customers

▪ Successful deployment expected to result in improved performance and faster resolution of problems

▪ Remainder of known defects scheduled for correction in September Release

7

8

September Release (R3.0) – ScopeGo-Live: September 24, 2015

CR/RFC Name Track Total RFC Hours

1188

Premium Aggregation RemovalThe purpose of this Change Request is to remove premium aggregation functionality from HPF for the individual market. Carriers will be responsible for incorporating the premium aggregation functionality in their respective systems.

Executive 33,755

1192

Update APTC CalculationThe purpose of this Change Request is to make updates to the APTC calculation that is performed when (i) selecting a plan, and (ii) when the system computes APTC to be applied to an existing enrollment when no plan is confirmed.

Operations 6,725

1193SHOP Coverage Effective Date Enhancements + Regulations (requirements 1 and 2)The purpose of this Change Request is to allow HBE and end users of SHOP to remain compliant with new regulations for 2016. SHOP 6,277

1293

Web Services for Access to HPF DataThe purpose of this RFC is to enable the implementation of a library of HPF web services that will be exposed securely to the HBE environment.

Technology Services

10,457

1297 Correct Open Enrollment Dates in HPF Communications 49

1306

Primary Applicant Seeking CoverageThe purpose of this change request is to minimize occurrences of users changing their seeking/not seeking coverage selection once they have selected a plan by preventing them from changing the option of seeking coverage under certain scenarios.

Operations 797

1307UI EnhancementsThe purpose of this RFC is to update HPF with correct UI text and screen information. Communications 1000

1309Prototype: Usability Testing for Premium AggregationThe scope of this RFC is a clickable prototype of the draft customer-facing screens as defined. Communications 825

1309

Usability Testing for Premium AggregationThrough RFC 1188, premium aggregation functionality is being removed from HPF. With this change, the screen flow is being modified so that users apply, receive eligibility, and enroll through HPF but go directly to the issuers to make payments.

Communications 1,000

1312 Update Carrier Related Information for Plan Year 2016 Plan Mgmt. 0

1311

Release 3.0 Training SupportThe purpose of this Change Request is to develop training materials, provide training and provide consulting support for Release3.0 of the Washington Healthplanfinder.

Operations 4,485

1299

EasyStreet VPN Access to HPF Monitoring ToolsThe purpose of this Change Request is to allow Easy Street to have access in Healthplanfinder (HPF) Production environment inorder to access monitoring data, and to escalate issues to HBE when an exceptional event occurs.

Infrastructure 20

1310

WA HPF Network Capacity UpgradeThe purpose of this change request is to upgrade the firewall devices for the WA Healthplanfinder (HPF) environments including Production environment at the Data Center Delta (DCD) data center from the current configuration.

Production/Infra 65

Total: 65,455

Auto-Renewal

2014▪ Numerous technical issues

encountered with the Trial Eligibility batch

▪ Enrollees received confusing messaging about action required to renew coverage

▪ Enrollees were required to actively pay for 2015 coverage

▪ Invoice errors, guaranteed renewability caused delays in enrollment

▪ Some carrier systems could not process EDI transactions in the sequence we sent them

2015▪ Updated processing flow will

streamline the Trial Eligibility batch and allow for better processing time

▪ Communications plan is being developed with carriers to avoid mixed messaging

▪ Premium aggregation removal allows enrollees to passively renew and pay carriers directly(carrier preferred)

▪ Updated design to align EDI sequence with carrier systems

9

Call Center Improvements and Efficiency Gains

▪ Implemented a broker and In Person Assister help desk and provided them the ability to schedule appointments

▪ Staffed client specialists in the call center to assist with complex cases which decreased the time to resolve customer issues

▪ Set up and conducted several auto dialer campaigns to better communicate with the customers allowing more CSRs to take incoming calls

▪ Bilingual CSRs for Spanish, Russian, Vietnamese, and Mandarin calls to decrease call length and better serve the customers

▪ Implemented several improvements in monitoring the quality of the customer interactions:

▪ More calls being monitored per CSR

▪ Improvement in the process for feedback

▪ Monitoring how well CSRs effectively use Healthplanfinder

10

Call Center Ongoing Improvements▪ Implemented full voice prompts on the Interactive Voice Response System

(IVR) for the eight Medicaid languages

▪ Training Improvements:

▪ Enhancements to core training modules and curriculum which have increased agent knowledge and skill set

▪ Revamped on the job training to include more hands-on and real-life scenarios

▪ Reduced call handle times by 20% (from 16 minutes to 12 minutes 45 seconds

▪ Reduced handle time to process Email by 28.6% (from 7 minutes to 5 minutes

▪ Reduced handle time to upload documents and process paper applications by 19% (from 8 minutes to 6 minutes 30 seconds

11

Call Center Technology Upgrades

▪ New customer interaction system which will increase knowledge of the customer experience by having better tools to retrieve call recordings as well as interaction analytics

▪ Increase the capacity of the Interactive Voice Response System and allow more flexibility in improving the customer experience

▪ Increased functionality in the work force management system to better deploy staff in peak traffic periods

▪ More robust historical data to determine long-term staffing needs

12

2016 Proposed Individual Market Summary

▪ 13 issuers submitted plans

▪ 3 new issuers

▪ 188 proposed QHPs

▪ 90 approved QHPs in 2015

▪ Includes five multi-state plans

13

2016 Proposed Healthplanfinder Business Market Summary

▪ 3 issuers

▪ 1 new issuer

▪ 47 proposed QHPs

▪ No platinum plans

▪ Increase from the 19 plans offered in 2015

14

2016 Proposed Pediatric/Family Dental Market Summary

▪ 6 Issuers

▪ 1 New Issuer

▪ 13 plans

▪ 10 Low

▪ 3 High

▪ Three carriers submitted family dental plans

15

High= Plan Value of at least 85%Low= Plan Value of at least 70%

Proposed 2016 Plan Rates Carrier 2014 Rate 2015 Rate 2016 Rate

UnitedHealthcare* N/A N/A $312

Columbia United Providersᶧ N/A $331 $317

Moda Health Plan N/A $297 $369

Health Alliance Northwest Health Plan* N/A N/A $323

Molina Healthcare of WA $311 $292 $270

Kaiser Foundation Health Plan of the NWᶧ $321 $324 $316

BridgeSpan Health Company $300 $263 $286

Premera Blue Cross $305 $308 $320

Community Health Plan of WAᶧ $335 $356 $414

LifeWise Health Plan of WA $305 $310 $309

Coordinated Care Corp. $245 $246 $228

Group Health Cooperative $281 $313 $258

Regence BlueShield* N/A N/A $284

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Rates reflect the preliminary rate requested of a Silver plan for a 40 year old non-smoking King County resident in the individual Exchange. *Indicates new carrier entering the Exchange in 2016. ᶧIndicates carrier that is not offering plans in King County; plan rates reflect another county pricing.

Draft Timeline for Certification Process

▪ April 24– Begin Certification and Regulatory Review of QHP/QDP

▪ July 24 – Issuers Submit Participation Agreement to WAHBE

▪ August 27 –Date for Board to Review Certification of QHP/QDP

▪ November 1 – Open Enrollment Begins

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Appendix

Proposed Individual QHP Submissions

19

New Renew Platinum Gold Silver Bronze Catastrophic

Bridgespan 36 0 6 7 14 9 0

CHPW 2 0 0 1 1 0 0

CoordinatedCare

12 0 0 1 7 4 0

Columbia United Providers

2 3 0 1 2 2 0

Group Health 5 1 0 1 2 2 1

Health Alliance Northwest

5 0 0 1 1 2 1

Kaiser Foundation Health Plan

2 5 0 1 2 3 1

Lifewise 5 0 0 1 2 2 0

Moda Health Plan

3 2 0 1 2 2 0

Molina 3 0 0 1 1 1 0

Premera Blue Cross 3 10 0 3 5 5 0

Regence Blue Shield 25 0 5 5 10 5 0

United Healthcare of WA

64 0 0 20 28 16 0

TOTAL 167 21 11 44 77 54 3

Proposed Healthplanfinder BusinessQHP Submissions

20

New Renew Gold Silver Bronze

Kaiser Foundation of the Northwest

6 6 3 5 4

Moda Health Plan

9 8 3 10 4

UnitedHealthCare of Washington

18 0 6 8 4

TOTAL 33 14 12 23 12

Proposed Dental Market

21

Renew/New High/Low

High= Plan Value of at least 85%Low= Plan Value of at least 70%

Dental Carrier New Renew High Low Pediatric Family

Delta Dental 1 1 0 2 1 1

Dental Health Services 3 2 2 3 2 3

Dentegra 2 0 0 2 1 1

Kaiser Foundation of the Northwest

1 1 1 1 2 0

Lifewise 0 1 0 1 1 0

Premera Blue Cross 0 1 0 1 1 0

IT Update

Architecture and Code Review

Progress continues in the following focus areas:

▪ System Performance improvements to create a more responsive Customer Experience

▪ Code Quality and Maintainability improvements to reduce development time & cost

Data Quality improvement is a focused effort

Emphasis on analyzing and fixing enrollment and eligibility data anomalies

• New online data update tools being implemented that enable account workers update capabilities which will reduce the number of higher cost back-end data updates

• Majority of these tools will be implemented prior to Release 3.0 (Sept 2015)

• Developing on-going data integrity validations to identify & fix issues

• Data fix queries are also being developed to clean-up historical data

22

IT Improvement Projects

System Stability Enhancements for Release 3.0 (Sept 2015)

▪ OE3 Release includes tools & services that improve the way HBE manages and support HealthPlanFinder to improve the customer experience

▪ Customer Service Admin Tools

▪ Improved EDI Tools & processes to reduce manual work & increase automation

▪ Improved Eligibility Tools to streamline data sync between systems

Software Quality Initiative

▪ Improving HealthPlanFinder quality throughout the Software Development Life Cycle (SDLC) from requirements gathering to implementation

▪ Software Quality Board established - cross-functional team meets weekly

▪ Development of Roles & Responsibilities

▪ Enhancing our Prioritization process to focus on critical changes that align with our strategic goals / vision

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Call History

Month Average Calls per Day

Average Wait Time

Average Abandon Rate (%)

QHP Calls (%)

QHP /WAHCalls (%)

WAH Calls(%)

# of CSRs

April 5,300 32 seconds 2.86 32.9 41.1% 26% 291

March 6,000 13 seconds 1.16 35.7 25.2 39.1 363

February 9,000 1 min 30 sec

8.66 31.95 30.05 38 415

January 9,000 1 min 39 sec

7.96 31 27.9 41.1 397

December 10,000 6 min 30 sec

24.54 31.5 37.5 31 433

November 5,000 2 min 47 sec

11.39 30 26.7 43.3 311

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