Comparing Health Benefit. California and Maryland

Transcription

1 Comparing Health Benefit Exchange Models: Massachusetts, California and Maryland Jay Himmelstein MD, MPH, Director, New England Collaborative for Insurance Exchange Systems Greg Franklin, Assistant Secretary of Health Information Technology, California Technology Agency Pradeep Goel, Chief Executive Officer, Consumer Health Technologies

2 Panel Overview and Massachusetts Model Jay Himmelstein MD, MPH, Director New England Collaborative for Insurance Exchange Systems University of Massachusetts Medical School

3 Context: t Central Role of Health Benefit Exchanges (HIX) in Health Care Reform Health Benefit Exchanges (also known as Health Insurance Exchanges or HIX) are the key mechanism for implementation of coverage expansions and health insurance reforms adopted in the Patient Protection and Affordable Care Act (ACA) HIX have significant responsibilities in both the private and public markets, including determination of eligibility for Medicaid and tax subsidies, enrollment in qualified health plans, risk adjustment and re-insurance. The ACA provides States with significant flexibility in the design and operation of their Exchange to best meet the unique needs of their citizens and their market place

4 HIX: Flexible Options for States State-based State Federally- Exchange Partnership facilitated Model Exchange States may use Federal States operate: States may run: Services for: Plan Management Premium tax credit and/or determinations Consumer assistance Exemptions Risk Adjustment Reinsurance States may also run: Reinsurance Medicaid & CHIP eligibility determinations Reinsurance Medicaid & CHIP eligibility determinations 4

5 Tight Deadlines for Exchange Operations! Regulations implementing the Affordable Care Act require HHS to approve or conditionally approve Statebased Exchanges no later than January 1, 2013, for operation in Even if a State-based Exchange cannot be completed by October 2013, options for temporarily leveraging the FFE exist through State Partnership model The development lifecycle for updating and/or building Information Systems, including procurement, can be prolonged. Time is not our friend!

6 Key Challenge: Integration of HIX and Medicaid Eligibility and Enrollment Exchanges are required to determine eligibility for and coordinate enrollment e in Medicaid, d, CHIP, and state health subsidy programs using: (ACA 1413) A single, streamlined eligibility form for all programs A secure, electronic interface Multiple access points: internet, mail, phone, in person See Guidance for Exchange and Medicaid Information Technology (IT) Systems, Version 2.0 May

7 CCIIO Funded Early Innovator (EI) Cooperative Agreement Program EI states are charged with designing and implementing the information technology (IT) infrastructure needed to operate HIXs and to develop reusable and transferable technology components. The Massachusetts Early Innovator Grant (a.k.a. The New England Collaborative for Insurance Exchange Systems or NESCIES) builds upon the successful Massachusetts health reforms of 2006 which expanded the MassHealth program and established Health Connector Authority (also known as the Commonwealth Connector Authority or CCA). 7

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9 MA Single-Project Approach The Connector Authority and MassHealth (Medicaid) are coordinating on development, procurement and implementation of new technology infrastructure to meet ACA requirements and enhance customer service and program efficiency Scott Devonshire, CIO for CCA, Principal Functional Lead Manu Tandon, CIO for EOHHS, Principal Technical Lead The MA HIX-IES project will be funded through 3 sources: the Early Innovator Cooperative Agreement, the IT Component of Establishment Grant, and enhanced funding from CMSC for Integrated Eligibility Systems (IES) 9

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12 MA HIX-IES Single-Project Phases 12

13 MA HIX-IES Project Partners Executive Office of Health and Human Services (EOHHS) 13

14 The California i Health lthbenefit Exchange Gregory A. Franklin Assistant Secretary California Technology Agency

15 Visions for California s Health Benefit Exchange Pi Price Leader Change Agent The Exchange drives lower premiums; it is a cost-focused store and offers the most competitively priced health plans. The Exchange is catalyst of finance and delivery reform; establishing incentives to encourage innovation and improvement in the cost, quality, and efficiency in health care delivery. Service Center The Exchange is a consumer destination; it is a consumer-friendly, one-stop shop with broad choices on plan design, accessible information, and strong customer service. Public Partner The Exchange is closely aligned with Medi-Cal and Healthy Families partnering to adopt an array of policies that align to improve the health status and health care outcomes of low-income, high-need individuals. Source: California s Health Benefit Exchange: The Future Envisioned, California Healthcare Foundation, August 2011.

16 Issues before the California Health Benefit Exchange Business, Operations, and Financial Sustainability Enrollment & Information Technology Stakeholder Consultation Research and Analysis Communication Support; Research and Marketing, Outreach, and Education Assisters Strategy Health Plan Management and Delivery Reform Small Business Health Options Program (SHOP) Essential Benefits Basic Health Plan

17 Timeline for California Health Benefit Exchange

18 January 2014 Functionality Eligibility ibilit and Enrollment Plan Management Service Center Hardware, Software, Facilities Customer Service and Education via Web Portal Forms, Notifications, and IVR in Threshold Financial Management Case Data Management (two approaches solicited) Organizational Change Management

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20 Health Exchange enrollment activities will be about technology Source: UCLA 2009 CHIS Data

21 For consumers, understanding di the benefit will be key

22 Pradeep Goel Chief Executive Officer Consumer Health Technologies

23 Solution Overview COTS components integration using SOA framework Noridian, Consumer Health Technologies, Inc, Curam and Connecture Interface f with ihcares, MMIS, Oh Other state systems, Federal Data Hub, Carriers, TPAs Prime System Integrator COTS relationship

24 Implementation Team s Solution Technical Diagram 1/3/

25 Key Success Factors Stakeholder participation is critical Engage Carriers, consumers, employers and state agencies early Define interface requirements at the front end Data inputs by workflow spend the time to identify these upfront Create a Data Hierarchy HIX is a data aggregation problem First create a data hierarchy then system interfaces Getting to data is half the problem

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27 Integration ti Approach COTS model works if there is a strong integrator Align project planning with SDLC They cannot be built in isolation Non functional requirements are hard to define Engage the vendor to achieve specifics Timelines are tight Parallelize requirements, design & development (sprints) Stakeholder participation in acceptance

28 Wrap-up and Q&A Audience Questions Wrap W up from the panelists