MARYLAND HEALTH BENEFIT EXCHANGE Exchange Implementatin Advisry Cmmittee Kick-Off Meeting February 23, 2012
Agenda Welcme Kevin Yang, Maryland Health Benefit Exchange, Chief Infrmatin Officer Tequila Terry, Maryland Health Benefit Exchange, Directr, Plan & Partner Management Opening Remarks Dena Puskin, ScD, CCIIO Cmmittee Charter, Rles & Respnsibilities Backgrund n Exchange Key Activities Infrmatin Technlgy (IT) Vendr Selectin SHOP Strategy Exchange Implementatin Timeline Cmmittee Member Input Apprach Jint Applicatin Develpment (JAD) Sessins Plicy & Operatins Questinnaires and Discussins Cmmittee Questin & Answer Public Cmments Next Steps - 2 -
Exchange Guiding Principles The fllwing principles guide the Maryland Health Benefit Exchange (the Exchange) in its decisin making prcess and n plicy tpics s that we can serve the health care needs f individuals, families, and emplyers in Maryland. Accessibility Reduce the number f Marylanders withut health insurance Affrdability Make cverage affrdable within the Exchange Sustainability Ensure that the Exchange succeeds and endures Stability Pursue a step-by-step apprach that builds n existing strengths in the system Health Equity Address disparities in health care Flexibility Adjust Exchange plicy as the changing market requires Transparency Activities shuld be transparent and services easily available - 3 -
Implementatin Advisry Cmmittee Charter Purpse: Frum fr the Maryland Health Benefit Exchange (the Exchange) t engage with industry partners t discuss and receive advice n matters pertaining t the implementatin f key peratinal and technical integratin pints between the Exchange and health plans Objectives: Establish and maintain a dialg between the Exchange and industry t discuss key decisin pints, timelines, issues, and risks, btaining the advice f industry experts n these matters Ensure that cmmn interfaces and integrated business prcesses between the Exchange and industry are: Transparent Standards-driven Supprtive f maximum autmatin and reuse Efficient and equitable Serve as cnduit fr the identificatin f specific subject matter expertise within industry t wrk in cllabratin with the Exchange n detailed requirements and design sessins - 4 -
Rles / Respnsibilities The Exchange: Chair cmmittee meetings (at least nce a mnth thrugh January 2013) Develp meeting schedule and agendas Dcument minutes, actin plans, etc. Organize jint applicatin design (JAD) sessins with industry partners State Liaisns: DHMH, DHR, MIA, DOIT Participate in cmmittee meetings and help priritize discussins Represent state stakehlders fr insurance regulatins, Medicaid, CHIP Cmmittee Members: Insurance Carriers, TPA s, MCO s, Other Stakehlders Participate in cmmittee meetings and help priritize discussins Review Exchange plans, appraches, and timelines t prvide best practices Raise any issues and risks assciated with cmmittee tpics and/r suggest additinal tpics fr discussin Identify subject matter experts within their rganizatins t participate in Exchange design sessins - 5 -
Cmmittee Meeting Frmat Meetings are Public Meetings d nt cnflict with existing advisry cmmittee meetings in terms f seeking plicy advice frm stakehlders, but serve t supplement these meetings with additinal technical and peratinal details. Timing and technlgy fr plan data exchanges The extent f integratin fr transfer f existing membership data t the Exchange Design and technlgy fr SHOP Operatins Other Advisry Cmmittee meetings will be set up fr ther stakehlder grups and intrduced pending Bard recmmendatins. Tpics discussed within this advisry cmmittee may als be discussed within ther stakehlder grup advisry cmmittee meetings. User experience fr plan cmparisn functinality Management f pen and special enrllment perids Technlgy t supprt Navigatrs and Brkers - 6 -
Exchange Status Update Maryland Health Benefit Exchange established by legislature April, 2011 Funded by cmbinatin f federal funds with state match thrugh 2015 Planning Grant Early Innvatr Grant Level 1 Establishment Grant Level 2 Establishment Grant (Applicatin by June 30, 2012) Significant Milestnes Exchange management team: Executive Directr: Rebecca Pearce Directr f Operatins: Leslie Lyles Smith Directr f Cmmunicatins and Outreach: Danielle Davis Directr f Plan & Partner Management: Tequila Terry Chief Infrmatin Officer: Kevin Yang Assistant Attrney General: Kristine Hffman IT vendr award recmmendatin adpted thrugh reslutin by Exchange Bard pending CMS apprval - 7 -
Exchange Infrmatin Technlgy Landscape The prcurement fr Phase 1A f the Prgram t Supprt the Maryland Health Benefit Exchange and the Affrdable Care Act prvides the cre functinality fr the Individual Exchange and Medicaid Expansin alng with key interfaces. Internal State Integratin DHMH/DHR CARES MMIS Other State Systems MVA Cmmn Services Ph1A Exchange and ACA Infrmatin Technlgy Phase 1A Eligibility & Enrllment Plan Management Plan Cmparisn Custmer Relatinship Management Financial Mgmt Phase 1B SHOP Management Exchange Hsting Phase 2 Nn-MAGI Phase 3 SNAP and TANF Other IT Public Website Admin. Systems PC s, Desktps, SW Data Management Netwrk Management Security / Firewalls Ph1A External Integratin Insurance Carriers Third Party Administratrs Managed Care Organizatins HR/Pay Ph1A Federal Gvernment Integratin - 8 -
Small Business Health Optin Prgram (SHOP) The SHOP was separated int Phase 1B t give the Health Benefit Exchange maximum flexibility t select a slutin that is best fr the State f Maryland Existing Maryland small business market place utilizes Third Party Administratrs (TPAs) Initial study dne in 2011 shwed interest and prmising capabilities t supprt SHOP Custmer friendly slutin that meets everyne s needs in market with minimal disruptin Internal State Integratin DHMH/DHR CARES MMIS Other State Systems MVA Cmmn Services Exchange and ACA Infrmatin Technlgy Phase 1A Eligibility & Enrllment Plan Management Plan Cmparisn Custmer Relatinship Management Financial Mgmt Phase 1B SHOP Management Exchange Hsting Phase 2 Nn-MAGI Phase 3 Other Scial Service Prgrams Other IT Public Website Admin. Systems PC s, Desktps, SW Data Management Netwrk Management Security / Firewalls Ph1B External Integratin Insurance Carriers Third Party Administratrs Managed Care Organizatins HR/Pay Ph1B Federal Gvernment Integratin - 9 -
SHOP Operatins Strategy Develpment The Exchange is currently wrking n an initial cncept fr SHOP technlgy and peratins Initial SHOP cncept will be discussed ver the next several weeks with: Implementatin Advisry Cmmittee (IT / Operatins) Phase 1A IT Vendr Other stakehlders: SHOP Advisry Cmmittee (Plicy) Decisin fr SHOP Implementatin will be made by March 30, 2012 Target fr Phase 1B prcurement decisin by May 1, 2012-10 -
Maryland Health Benefit Exchange Act f 2012 Based n the 2011 study prcess and the Exchange Bard s recmmendatins, SB 238/HB 443 have been created and will determine key functins f the Exchange including: Operating Mdel Insurance Rules & Risk Mitigatin SHOP Exchange Set Up Navigatr Prgram Multi-State & Reginal Cntracting Plan fr Fraud, Waste & Abuse Financing The Gvernr s Office f Health Care Refrm is leading the prcess t accept and review requested stakehlder amendments t the bill. The final public sessin t review amendments is n March 2,2012. - 11 -
Timeline The Exchange implementatin timeline is being develped based n the fllwing: Federal legislatin and requirements State legislatin and requirements Stakehlder input Insurance Carriers Managed Care Organizatins TPAs Brkers Cnsumers State Agencies - 12 -
Prductin Integrated Testing Design & Develpment Timeline QTR 1-2 2012 QTR 3 2012 QTR 4 2012 QTR 1 2013 QTR 2 2013 QTR 3 2013 QTR 4 2013 QTR 1 2014 Stakehlder input n design Stakehlder input n design EHB benchmark cmpleted CMS certifies the MD exchange Operatins technlgy plan fr the SHOP defined QHP certificatin prcess designed Testing enrllment transactins begins (Medicaid, CHIP, Cmmercial) Test financial transactins (billing, cllectins, payment) Applicatin, rate & frm review prcess starts Certify QHPs and ppulate QHP data n prtal Oct 1 begin pen enrllment Jan 1 begin exchange benefit year - 13 -
Timeline Cmmittee members will be asked t help establish the timeline fr additinal implementatin steps that are needed: Specificatins fr plan data exchanges Enrllment data feeds Billing/cllectins prcesses Plan presentment fr the Exchange website Optins t link t the Exchange website Call center and CRM functins CRM integratin Appeals and grievances prcesses Terminatins and ther eligibility changes - 14 -
Timeline - Discussin What are yur thughts n the preliminary timeline? Des the timeline give yur rganizatin enugh time fr plan creatin and filing with the Maryland Insurance Administratin? Are there areas that yu are particularly cncerned abut? What additinal tasks shuld we cnsider as we plan implementatin activities? - 15 -
Cmmittee Member Input Apprach We will be emplying a tw track apprach t sliciting requirements and further defining the Exchange s methdlgies in prviding the required health insurance t citizens within the State f Maryland Jint Applicatin Develpment (JAD) Sessins The Prject Management Office fr the State f Maryland Healthcare Refrm Prject will cnduct several JAD sessins n behalf f the Exchange. JAD is a prcess that accelerates the design f infrmatin technlgy slutins. JAD uses custmer invlvement and grup dynamics t accurately depict the user's view f the business need and t jintly develp the requirements necessary t successfully design, develp, and implement the IT slutin. Plicy & Operatins Discussins High-Level plicy and peratins questins will be distributed t the apprpriate stakehlders via email t slicit feedback and respnses n a number f tpics. Infrmatin gleaned frm these questins will be incrprated int subsequent JAD sessins t help fill in any gaps within the assciated prcesses. Fllw-up meetings will be scheduled t discuss feedback frm the questinnaires and surveys t ensure the Exchange has an accurate interpretatin f the results. - 16 -
Jint Applicatin Develpment (JAD) Sessins Several JAD Sessins have been scheduled t address the needs f the Exchange. These sessins are fcused n functinality areas that directly map t the requirements cntained within the Affrdable Care Act (ACA). Sme key cmpnents f each have been identified belw: Eligibility and Enrllment (February 27, 2012) Plan Enrllment Accunt / Case Management SHOP Functins & Small Business Management Plan Management (March 2, 2012) Plan Presentment ecmmerce HUB Billing and Payment (March 7, 2012) Premium Payment Tracking Insurance Carrier / TPA Management Custmer Supprt (March 12, 2012) Agent / Navigatr Management Call Centers Reprting, Transparency, & Ntificatins (March 26, 2012) - 17 -
JAD Sessin Benefits The fllwing are the benefits f the JAD apprach: Benefits: JAD decreases time and csts assciated with requirements elicitatin prcess. JAD brings experts tgether giving them a chance t share their views, understand views f thers, and develp the sense f prject wnership. JAD implementatin are well knwn, as it is "the first accelerated design technique available n the market and prbably best knwn", and can easily be applied by any rganizatin. Easy integratin f CASE tls int JAD wrkshps imprves sessin prductivity and prvides systems analysts with discussed and ready t use mdels. Enhances quality Prmtes teamwrk with the custmer Creates a design frm the custmer's perspective Lwers develpment and maintenance csts JAD achieves these benefits because f the fllwing factrs: The decisin makers are all present. The facilitatr keeps the grup fcused n the gals. Differing views are handled immediately. The system design reflects the user's desires. Issues are reslved quickly. Assumptins are dcumented and understd. The prcess tends t gain mmentum, nt lse it. - 18 -
Plicy & Operatinal Discussins High-Level Plicy and Operatins questins will be distributed fr each functinal area and will prvide additinal perspective n the requirements f the Exchange. These questins will be less technical in nature than the JAD sessins and will likely require input frm different stakehlders within yur rganizatins The purpse is t aid the Exchange in defining critical plicy and peratins cmpnents that drive the technical slutin and ur management strategy Fllw-Up discussins will be scheduled t ensure the Exchange prperly interprets the feedback and has a clearly defined apprach fr integratin with the technical slutin Cmmittee members will receive a list f questins befre the sessin t be discussed in the meeting. Meetings will be cnducted mnthly - 19 -
Plicy & Operatinal Discussins The mnthly Plicy & Operatinal discussins will include tpics such as: Current prcess flws (i.e. MIA) Plan Cntracting Plan Certificatin Medical Dental Visin Plan Management Accreditatin Prcess Netwrk Adequacy Measurement Discriminatry Benefit Design Risk Mitigatin Open Enrllment Premium Billing Prcesses YOUR TOPICS - 20 -
Questins / Cmments
Next Steps Each rganizatin shuld prvide additinal cntacts fr the Eligibility and Enrllment JAD Sessin scheduled fr February 27, 2012. Cntacts shuld be identified n later than February 24, 2012 Cmplete the handut tday if yu knw the cntact Fllw Up Plicy/Operatins Questinnaires will be distributed Turn arund timelines will be included within the specific questinnaires and surveys Review these with yur internal resurces t develp answers Next Exchange Implementatin Advisry Cmmittee Meeting Schedule t be annunced - 22 -