Release 2: Integrated Eligibility, Open Enrollment Self-Service

Title kynect: Kentucky s Healthcare Connection State Kentucky Category Digital Government: Government to Citizen (G to C) Contact Chris Clark, kynect Program Manager Commonwealth of Kentucky Cabinet for Health and Family Services Office of Administrative and Technology Services 12 Mill Creek, Frankfort, KY 40601 christopher.clark@ky.gov 502-564-0105 x.2848 Project initiation and completion dates Program initiation: October 8, 2012 Completion August 5, 2013 August 15, 2013 October 1, 2013 Release 1: Plan Management Contact Center Implementation Release 2: Integrated Eligibility, Open Enrollment Self-Service 1

Executive Summary Since its launch in October 2013, kynect, Kentucky s state-based health benefit exchange, has been hailed as a national model for its smooth operation and ease of use. With approximately 640,000 uninsured Kentuckians prior to open enrollment, kynect is providing access to quality, affordable healthcare for all Kentuckians. Through kynect, Kentucky residents can easily determine potential household eligibility for financial assistance and discounts, and browse and compare health insurance plans that meet the distinct needs of their family, all anonymously without pre-registration or providing private information. Additionally, insurance agents, assistors, and the kynect Contact Center are a click-away if an individual needs help. Now, because of kynect, one in every ten Kentuckians has secured affordable, quality health care for their families, many for the first time. kynect measurable outcomes as of December 2013 and April 2014 are reflected in the table below: kynect enrollment statistics December 2013 April 2014 Kentuckians enrollment in health coverage 116,152 413,410 Number enrolled in expanded Medicaid 84,480 330,615 Number enrolled in private insurance 31,672 82,795 Percentage of kynect enrollees under age 35 40% 52% Unique Visitors 747,359 1.5 million Page Views 24.3 million 58 million Preliminary eligibility screenings conducted 544,185 886,000 Call handled by the kynect Contact Center 304,000 839,398 The technology architecture of kynect establishes a service-oriented, rules-driven foundation, upon which Kentucky will build access to additional benefits, programs, and services; this work is already underway. More than a website, however, kynect is changing lives, outcomes, and the economic and health outlook of Kentuckians. The citizens of Kentucky benefit from the successful launch of kynect in two important ways. First, citizens now have access to affordable, quality health insurance; many for the very first time. Second, the established success of kynect translates into a more competitive health care marketplace with more choice of coverage options than previously existed. kynect is recognized as one of the nation s most successful new health insurance marketplaces. A unified vision, strong leadership and stakeholder collaboration, a straightforward web site design, and extensive testing contributed to a smooth launch and effective ongoing operations. 2

Business Problem and Solution In March 2010, President Obama signed the Affordable Care Act (ACA). Along with provisions that strengthened patient rights, removed copays for preventative care, and prevented insurers from denying coverage to individuals with pre-existing conditions, the ACA also created a marketplace for health insurance plans. States were given the option to create their own health care exchange or join the federally facilitated health exchange. Kentucky opted to create its own Kentucky Health Benefit Exchange, known as kynect, to meet the unique health care needs of Kentuckians. Each state was faced with this important decision; to either pursue a state-based health benefit exchange or to coordinate enrollment activities through a federally operated exchange. To succeed, states were required to apply and meet federal approval requirements by January 1, 2013, and be capable of providing open enrollment services by October 1, 2013. From the outset, Kentucky leadership, headed by Governor Steve Beshear, considered the ACA as an opportunity to make significant investments to improve the health of Kentuckians. Kentucky continues to rank at the bottom in most national health rankings. This includes 50th in smoking, 40th in obesity, 43rd in sedentary lifestyles, 41st in diabetes, 48th in poor mental health days, 49th in poor physical health days, 50th in cancer deaths, 49th in cardiac heart disease, 43rd in high cholesterol, 44th in annual dental visits and 48th in heart attacks. On July 17, 2012, Governor Beshear issued an Executive Order (EO) to establish the Office of the Kentucky Health Benefit Exchange (OKHBE) within the Cabinet for Health and Family Services (CHFS). As a state agency, OKBHE leveraged the Commonwealth's accounting, payment, and procurement systems and practices, and Kentucky was off to the races to implement kynect by October 1, 2013. The EO established a kynect Advisory Board comprised of the Kentucky Department of Insurance, insurance companies, agents, medical providers, administrators, and advocacy groups. The board worked quickly to advise the OKHBE on recommended policies, regulations, and decisions. The Office of the Kentucky Health Benefit Exchange (OKHBE), the Department of Medicaid Services (DMS), the Department of Community Based Services (DCBS), the Kentucky Department of Insurance (DOI) and others, worked quickly to identify requirements and functions for Kentucky s health benefit exchange. The CHFS Office of Administrative & Technology Services (OATS) within CHFS was responsible for managing the information technology implementation effort. The kynect design/build effort was organized under an "umbrella kynect Program Management Organization. The kynect program was comprised of eight component 3

projects, each led by a project manager and teams. The eight component projects were Business Transformation, Eligibility and Enrollment, Plan Maintenance and Billing, Contact Center, Identity Management, Document Management, Data Conversion, and Security and Privacy. Because of the aggressive implementation timeline, cross-project alignment and dependency management was crucial to program success. Kentucky secured Deloitte as the primary systems integrator in October of 2012; kynect was operational in less than one year. Navigating the landscape of options for obtaining health coverage can be cumbersome. kynect simplified the process for Kentuckians to determine program eligibility, review options, and enroll in coverage. The innovation of kynect lies in its easy-to-use interface, which provides a comprehensive array of intuitive, user-friendly modules and applications without overwhelming the user or overburdening the system. The solution incorporated a number of custom and COTS applications and was fully integrated with existing systems to provide a seamless user experience. kynect has an uncomplicated website design that adapts to its diverse consumers. The site simplifies the process for Kentuckians to compare and select private insurance plans and determine eligibility for programs like Medicaid and the Kentucky Children s Health Insurance Program (KCHIP). One critical feature of kynect is the ability of visitors to anonymously browse plans and conduct a preliminary determination of eligibility with minimal information. Citizens are not required to create an account on kynect until they are ready to buy thereby avoiding a source of bottlenecks in other exchange implementations. Not content to simply standup an exchange, Kentucky embarked on a daring undertaking to also build and implement a complete, integrated eligibility system. Because of this, kynect determines the differing individual eligibilities (health plans, financial assistance, Medicaid, KCHIP) in real-time for an entire household from one single application. kynect then allows the family to shop for coverage to meet their individual (eligibility) needs. In a year, kynect implemented an integrated, a rules-based, service oriented solution, laying the foundation for the Commonwealth to add future programs, benefits, and services within a web-based, real-time eligibility system. Other key technologies and components include integrated identity and access with multi-factor authentication, and master data management (MDM) to catalog benefit recipients across multiple state programs. To say it succinctly, kynect has established a modern, service-oriented, rules-driven integrated eligibility foundation upon which Kentucky will migrate additional eligibility driven benefits programs. 4

Education and Outreach kynect embarked upon a holistic branding, public education and outreach campaign, preceded by planning and development of advertising, marketing and outreach materials for radio, television, print, web, social media, direct mail and outdoor advertising. The kynect brand utilizes consumer oriented characters representing Kentucky s diverse population in terms of ethnicity, age, gender, profession, community, income, and health. Additionally, the kynect character types include individuals, families, small business employers and employees, young invincibles, assisters, and contact center representatives. kynect s marketing campaign included: 30 television spots on targeted cable networks Radio spots in 2 metropolitan areas (Lexington & Louisville) and 120 counties Full-page ads in 28 Tier 1 and 14 Tier 2 newspapers Full-page ads in statewide magazines Posters, billboards, and truck/bus advertising Participation in 39 festivals, fairs, and other events prior to open enrollment Over 100 speaking engagements from 1/1/13 11/8/13 kynect has a continued social media presence on Yammer, Facebook, LinkedIn, and Twitter with dedicated on-site staff to manage content. Significance The economic impact of chronic and widespread ill health is well known. Children miss school and their education suffers, ultimately lowering the skill level of the available employee pool. Workers are unable to work causing businesses to suffer. Lost work days means reduced family income, resulting in fewer dollars going back into the economy as people look for ways to cut expenses and make up the difference. Uninsured and underinsured individuals avoid seeking care until illnesses become emergencies, ultimately causing medical costs to escalate for everyone. All of those factors contribute to making states less attractive to profitable businesses, further damaging the economy and depleting the tax base. With nearly 14% of Kentucky s citizens uninsured when this project started, the Commonwealth was in need of assistance in all of these areas. Governor Steve Beshear has spoken plainly about Kentucky s need for the help offered by the Affordable Care Act. Noting Kentucky s low standing in the health ratings at or near the bottom in almost every measurable health category, including smoking, cancer deaths, preventable hospitalizations, obesity, and many others he still did due 5

diligence to make sure the state could afford to invest in expanded Medicaid and a healthcare exchange. The outcome of the study he commissioned from PricewaterhouseCoopers and the Urban Studies Institute at the University of Louisville was that Kentucky couldn t afford not to do it. Detailed economic impact information is available here: (http://governor.ky.gov/healthierky/medicaid/pages/default.aspx) Under the ACA, kynect provides access to quality healthcare coverage to newly eligible populations, provides an organized marketplace to help to Kentucky residents shop, compare and buy affordable, quality health insurance, and provides small-group employers new options for providing quality health care coverage to their employees. In the individual exchange market, individuals or families earning less than 400% of the federal poverty level (FPL) are potentially eligible for either Medicaid under the expansion program or special discounts on Qualified Health Plans (QHP s). Customers can browse plans without registering or submitting an application, which allows users more flexibility and reduces the initial application burden on the system. kynect features a preliminary anonymous screening feature that provides an initial household benefit eligibility assessment within five minutes. Customers complete a single application to determine eligibility for all members of a household and purchase health plans. kynect serves a diversity of customers including families, small business employers, case workers, insurers, and other stakeholders, with uninsured individuals representing the greatest proportion of users. According to the U.S. Census Bureau, there are an estimated 4.4 million people who live in Kentucky, almost all of whom are eligible to use kynect. Of those 4.4 million, approximately 640,000 did not have health insurance prior to the kynect launch. As a starting point, the Commonwealth aimed to have 350,000 newly insured citizens (out of the 640,000 uninsured) by 2015. Since the launch of kynect, there are already over 413,000 newly insured Kentuckians. Benefit kynect is the enabling foundation of the overall Medicaid expansion effort in Kentucky. The kynect system facilitated timely enrollment of newly-eligible individuals and provided the infrastructure needed for improved coordination between insurers, case workers, and others to support the influx of Medicaid enrollees. The Commonwealth estimates that Medicaid expansion will result in: 17,000 new jobs $15.6 billion injected into the KY economy $802.4 million positive budget impact 6

Kentucky now has more citizens registered for private insurance and Medicaid per capita than any other state. (http://www.pewstates.org/projects/stateline/headlines/whysome-state-run-health-exchanges-worked-85899525479) The web-based interface is designed for access to kynect via computer, smartphone, or other device. The balanced design of kynect allows citizens to easily navigate their eligibility and coverage options, while also requesting help online to be assisted by 1 of over 1,800 licensed insurance agents or over 1,000 kynector (assisters) who are trained, certified, and authorized to operate on the exchange. Compliance testing for usability and accessibility were conducted to ensure that the language of the application (grade 5 reading level) was appropriate for the target audience. Additionally, Kentucky has implemented kynect branded kiosks in multiple counties across the state offering public (free) access to kynect and to the Contact Center via chat. The kynect website leverages security standards and controls to protect the privacy of Kentucky s citizens, in compliance with NIST 800-53. For example, to establish a system account, users must first complete an online, real-time identity proofing process to validate their identity. Insurance agents, kynectors, and other privileged users must utilize multi-factor authentication to safeguard this important level of elevated access. Encryption technologies protect citizen information during transmission and while atrest within kynect. Notice, choice, and consent are integrated into the registration process in a way that is easily understood by citizens and complies with legal requirements. Only information essential to an application for coverage is accessible. As an important example, income verification information from the IRS never displays on and application screen nor is it accessible by kynect workers. Kentucky s design to protect federal tax information (FTI) was acknowledge and replicated to other state exchanges as a best-practice. The success of kynect required the careful balance of stakeholders core values, while ensuring compliance with federal and state law and regulation. Well before Kentucky applied to pursue the establishment of a state-based exchange, Kentucky met with many stakeholder groups and sought their input into key decisions regarding the Affordable Care Act. Probably the most crucial decision facing Kentucky was whether the Commonwealth should pursue its own state-based exchange, or operate on the Federally Facilitated Marketplace. Working with insurance companies, medical providers, advocacy groups, and others the decision became clear; Kentucky would design, build, and operate its own state-based exchange. Thus began the journey and success story of kynect, a story that will continue to be told to improve the health and economic futures for the citizens of the Commonwealth of Kentucky. 7