Building an Integrated State Health Insurance Exchange

Transcription

1 Building an Integrated State Health Insurance Exchange Health Insurance Exchanges Presented to: State of Kansas 03/15/2011

2 About CHOICE Administrators Providing innovative and seamlessly integrated health care Exchange solutions & services for over 15 years Leading online Individual & Family Plan Quote Enrollment system Provided over 4.2 million quotes individual and families in 2010 Currently operating 5 Health Insurance Exchanges Small group and mid-sized market More than 10,000 contracted employers More than 150,000 health Exchange members

3 About CHOICE Administrators Continued. Dedicated member services support Phone, online, electronic and paper support tools Support centers for assisting new enrollees through enrollment 15 years experience in broker and employer outreach Trained over 10,000 brokers Hosted more than 2,500 broker/employer Exchange seminars Conducted 1,250 Continuing Education training classes Spoken, sponsored or exhibited at over 850 national tradeshows Proven systems and flexible architecture Consolidated billing and remittance for groups HIPAA compliant encrypted EDI 820 & 834 file feeds

4 Three Critical Success Factors for a Successful Exchange 1. Outreach 2. Enrollment 3. Integration

5 Success Factor #1: Outreach Strategic Planning Define key outreach objectives & success metrics Target % of uninsured population enrolled in Exchange Target % population awareness of Exchange Education / Training Brokers, Community Advocates, Navigators Kansas State Agencies, Key Legislators and Mayors / City Leaders Marketing Multi-year communication and outreach plans targeting multiple audiences including commercial and public programs Partnerships with Corporate and Civic Organizations Kansas Jayhawks, Kansas State Wildcats, Kansas City Royals /Chiefs Health Care Foundation of Greater Kansas City Kansas City Interfaith Council St. Lukes - Shawnee Mission Health System Topeka Independent Business Association Paid advertising and on-line marketing

6 Success Factor #2: Enrollment A single entry portal for consumers and small business to access all available healthcare solutions Assisted and Non-Assisted enrollment support Local support center in helping K-Med, SCHIP, Individual/Family and Small Group enroll Navigator assistance at community organizations Support the role of the Broker and Agent as defined by the State of Kansas First-class on-line consumer experience: Online Enrollment Online Renewal Online changes during the coverage life cycle Seamless coordination between K-Med/SCHIP, Public Programs, health plans, brokers and navigators; a single solution for successful state exchanges.

7 Success Factor #3: Integration K-Med & SCHIP Subsidy Program Integration Individual & Family Plan Coverage Group Coverage

8 No Wrong Door With the Exchange

9 Exchange Process Overview: Unassisted Web Portal Individual Consumer Applicant Assisted Web Portal (Co-Browsing) Assisted Call Center Small Group

10 Exchange Process Overview: Continued Individual Individual Online Income Qualifier Calculator K-Med Other State Programs Subsidized Coverage (ACA) Non-Subsidized Commercial Coverage (ACA) Proposal/ Enrollment Systems Small Group Small Group Online Tax Subsidy Calculator Tax Credit Qualified Non-Tax Qualified

11 12 months later Exchange Process Overview: Continued Individual Online plan comparisons by price, health plan, plan type and deductible range Underwriting Approval Renewal Proposal/ Enrollment Systems Enrollment Fulfillment Billing Small Group Employer Defined Contribution Employee Worksheets Operations Terminations Additions Life Events Call Center EDI Transmissions To Carriers

12 Ways to Improve the Value of the Exchange Provide real-time analytics Enrollment statistics Consumer satisfaction ratings Population health management Access to care Regardless of income Differentiated Physician Networks Offer value add products, such as: Vision, Dental, Hearing, Chiropractic and Acupuncture Integrated payroll and HR support

13 Providing innovative and seamlessly integrated health care Exchange solutions and services for over 15 years Things to consider Experience vs. Risk Encourage all carriers to embrace the exchange Engage all brokers and public agencies to be involved in outreach Exchange to handle all financial transactions

14 Health Insurance Exchanges

15 Demo links Exchange Demo