2015 OPSC Annual Convention. syllabus. February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California

Transcription

1 2015 OPSC Annual Convention syllabus February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California

2 THURSDAY, FEBRUARY 5, 2015: 2:00pm - 3:00pm Covered California: 2015 Update Presented by Alesia Wagner, DO, FACOFP * California Pain / End-of-Life Care

3 PRESENTATION Learning Objectives and Self ASSESSMENT questions LEARNING OBJECTIVES 1. Describe the goals and initial statistics for the second open enrollment period of Covered California. SELF ASSESSMENT QUESTIONS Self assessment questions not available at time of publication. 2. Describe current issues affecting Covered California consumers and providers. 3. Describe to patients how to explore their options with Covered California. OPSC s 54th Annual Convention and Exposition Syllabus 253

4 + Covered California: 2015 Update Alesia Wagner, DO, FACOFP February 5, 2015 OPSC s 54th Annual Convention and Exposition Syllabus 254

5 This initiative is supported by a grant from Covered California. + This activity is sponsored by the California Academy of Family Physicians. This initiative is a partnership of the California Academy of Family Physicians, California Academy of Physician Assistants, California Chapter of the American College of Physicians and Osteopathic Physicians and Surgeons of California. OPSC s 54th Annual Convention and Exposition Syllabus 255

6 + Learning Objectives At the end of the session, participants should be able to: Describe the goals and initial statistics for the second open enrollment period of Covered California. Describe current issues affecting Covered California consumers and providers. Describe to patients how to explore their options with Covered California. OPSC s 54th Annual Convention and Exposition Syllabus 256

7 + Open Enrollment Period November 15, 2014 to February 15, 2015 OPSC s 54th Annual Convention and Exposition Syllabus 257

8 + Covered California 2015 Health Plan Benefit Year January 1, 2015 to December 31, 2015 OPSC s 54th Annual Convention and Exposition Syllabus 258

9 + Open Enrollment Screen Shot of New Covered CA site OPSC s 54th Annual Convention and Exposition Syllabus 259

10 + Outreach Campaign Goals Covered California aims to: Increase enrollment from 1.2 million Californians to 1.7 million Californians; Fix problems consumers faced during the first open enrollment period; and Offer a streamlined renewal process. OPSC s 54th Annual Convention and Exposition Syllabus 260

11 + Headline: Covered California s Strong Start 1 In first four days of Open Enrollment: 314,100 unique visitors to CoveredCA.com. 69,245 consumers submitted applications. 35,877 consumers were determined eligible for coverage through Covered California and 11,357 picked a plan. 33,368 applicants were deemed eligible for Medi-Cal. OPSC s 54th Annual Convention and Exposition Syllabus 261

12 + Headline: Covered California s Strong Start An upgraded enrollment portal infrastructure allows for greater user capacity and faster page loads. The Service Center is open from 8 a.m. to 8 p.m. Monday through Friday and 8 a.m. to 6 p.m. on Saturday. Covered California added more than 200 storefront locations open evenings and weekends to enroll consumers or answer their questions. More than 12,000 Certified Insurance Agents, 10,000 county eligibility workers and 6,000 Certified Enrollment Counselors partnered with Covered California. OPSC s 54th Annual Convention and Exposition Syllabus 262

13 + Headline: Covered California Partnership with Providers 2 14 statewide provider organizations sent a joint letter to their members. American College of Physicians (California) Osteopathic Physicians and Surgeons of California CMA CHA American Academy of Pediatrics (California) California Pharmacists Association National Council of Asian Pacific Islander Physicians California Academy of Family Physicians California Academy of Physician Assistants CAPG National Medical Association National Hispanic Medical Association California Society of Health- System Pharmacists California Latino Medical Association OPSC s 54th Annual Convention and Exposition Syllabus 263

14 + Partnership with Providers Make your patients aware that enrollment for Covered California is open now and ends Feb. 15, Contact your association for ready-to-use information you can share with your patients: A simple one-page document that you can share with your staff and patients that describes open enrollment. A document that shows which plans are offered in each county. OPSC s 54th Annual Convention and Exposition Syllabus 264

15 + Partnership with Providers Confirm contracts with Covered California plans and display an I'm In placard prominently in your office so patients know you are participating. _placard.pdf OPSC s 54th Annual Convention and Exposition Syllabus 265

16 + Partnership with Providers Help identify specific patients who have been helped already by gaining coverage through Covered California and are receiving care in your practice. Covered California collects these real-world stories, which are the best way to tell the story of coverage and care. Send information about stories you and patients are willing to share to OPSC s 54th Annual Convention and Exposition Syllabus 266

17 + Partnership with Providers Confirm your network status WITH HEALTH PLANS. No Covered California Physician Directory is planned for Confirm contract status with PLANs. OPSC s 54th Annual Convention and Exposition Syllabus 267

18 + Partnership with Providers OPSC s 54th Annual Convention and Exposition Syllabus 268

19 + OPSC s 54th Annual Convention and Exposition Syllabus 269

20 + Physician Directory Reference Guide Covered California produced a Provider Directory Reference Guide, which details: Provider directory links for each plan Plan name on CoveredCA.com Plan name on ID card Plan name on health plan website Available here: mesidcardproviderdirectoryre ferenceguide.pdf OPSC s 54th Annual Convention and Exposition Syllabus 270

21 + Headline: DMHC Rebukes Anthem and Blue Shield 3 In November, the Department of Managed Care (DMHC) released the results of its investigation into the accuracy of Anthem Blue Cross and Blue Shield of California's provider lists for their Covered California and individual market products. Physician organizations urged and strongly supported this investigation. OPSC s 54th Annual Convention and Exposition Syllabus 271

22 + DMHC Rebukes Anthem and Blue Shield DMHC found that more than 25 percent of the listed providers were not accepting Covered California patients or were no longer at the location listed in the directory. OPSC s 54th Annual Convention and Exposition Syllabus 272

23 + DMHC Rebukes Anthem and Blue Shield DMHC referred the case to the Office of Enforcement. It is not yet clear whether the plans will face penalties. DMHC plans to conduct follow-up surveys in six months to determine whether the violations have been corrected. OPSC s 54th Annual Convention and Exposition Syllabus 273

24 + Headline: HealthNet Joins the Narrow Network Trend 4 For the 2015 plan benefit year, HealthNet plans to transition from a PPO network to a network with 54 percent fewer physicians and no coverage for out-ofnetwork care in certain regions. OPSC s 54th Annual Convention and Exposition Syllabus 274

25 + HealthNet: Joins the Narrow Network Trend The slimmed-down plan will cost up to nine percent more than the PPO coverage, however. HealthNet said the change was necessary to keep rates affordable. OPSC s 54th Annual Convention and Exposition Syllabus 275

26 + Networks/Access in 2015 Remember: Covered California does not change how existing state health care problems are administered. Covered California does NOT regulate plan networks. Covered California does not contract directly with physicians, hospitals or other providers. Health insurance plans contract directly with providers and the terms of those contracts (financial and nonfinancial) are proprietary to each plan. OPSC s 54th Annual Convention and Exposition Syllabus 276

27 + Networks/Access in 2015 Report problems to your respective association. Encourage patients who cannot access health care to report problems to state regulators. California Department of Managed Health Care (DMHC): oversees HMOs and some PPOs or California Department of Insurance (CDI): handles complaints against PPOs or OPSC s 54th Annual Convention and Exposition Syllabus 277

28 + Our Advocacy Makes Change OPSC s 54th Annual Convention and Exposition Syllabus 278

29 + Headline: Obama s Executive Order on Immigration 5 In November, Obama announced a plan to allow up to five million undocumented immigrants who have lived in the U.S. for at least five years and who have no record of felony offenses or serious misdemeanors to apply for a program to avoid deportation. Under federal law, such undocumented immigrants still are not eligible for health benefits under the Affordable Care Act. OPSC s 54th Annual Convention and Exposition Syllabus 279

30 + Executive Order on Immigration Gov. Brown s administration is considering expanding Medi-Cal to undocumented immigrants in California who are protected from deportation under President Obama s recent executive action on immigration. No answers yet. OPSC s 54th Annual Convention and Exposition Syllabus 280

31 + Headline: Covered California on Undocumented Immigrants 6 Covered California Announced (early December): We want everyone to know that when you apply for health insurance through a health insurance marketplace like Covered California, all of your information is kept private and secure, said Covered California Executive Director Peter V. Lee. It will not be shared with or used by any immigration agency to enforce immigration laws. All information you submit is used strictly to determine your eligibility for health insurance programs available under the Affordable Care Act. OPSC s 54th Annual Convention and Exposition Syllabus 281

32 + Covered California on Undocumented Immigrants With the President s recent executive order, there is renewed attention on undocumented residents. Covered California wants consumers to feel confident that they can apply for coverage for legal family members without any consequences for undocumented family members. Any US citizen or person who is lawfully present in California is eligible for health insurance through Covered California even if they have family members in their household who are undocumented. OPSC s 54th Annual Convention and Exposition Syllabus 282

33 + Headline: December 15 Deadline Passed 7 Plans AUTOMATICALLY renewed consumers unless they (the consumers) made a plan change by December 15. Consumers previously enrolled had to select a new plan by December 15 to be insured by January 1, 2015 if they wished to change their plan. OPSC s 54th Annual Convention and Exposition Syllabus 283

34 + Renewal Notices: Late December Notice Late December: an invoice from the health insurance plan the member selected. a. The member s 2015 monthly net premium. b. Instructions for making the premium payments to the health insurance plan, not Covered California. OPSC s 54th Annual Convention and Exposition Syllabus 284

35 + Reminder: How to Help with Open Enrollment 8 During Open Enrollment, consumers have multiple avenues to purchase health insurance. OPSC s 54th Annual Convention and Exposition Syllabus 285

36 + Reminder: How Patients Can Enroll CC Service Center Certified Enrollment Counselors is the ONLY official website! Certified Insurance Agents Mail or Fax Local county human or social services office OPSC s 54th Annual Convention and Exposition Syllabus 286

37 + Reminder: Three Paths to Health Insurance Path 1 At or below 138% of the Federal Poverty Level (FPL) Medi-Cal Path 2 Between % FPL Eligible for a CC Health Plan with premium assistance and improved benefits Between % FPL Eligible for a CC Health Plan with premium assistance but not improved benefits Path 3 Over 400% FPL Eligible for a CC Health Plan OPSC s 54th Annual Convention and Exposition Syllabus 287

38 + Who Got Covered? Medi-Cal 29% 13% 6% 25% 12% 9% 5% Covered California Other non-group Employer-Sponsored Insurance Somewhere else/unknown Remaining Undocumented Uninsured Remaining Eligible Uninsured Remaining Uninsured 42% Newly Insured 58% Kaiser Family Foundation OPSC s 54th Annual Convention and Exposition Syllabus 288

39 + The Remaining Uninsured Length of Time Uninsured 37% Never insured 45% 2 years + 12% 1-<2 years 6% 2 months-<1 year Income/Eligibility 30% Undocumented 30% Medi-Cal target group 24% Exchange subsidized target group 4% 400% FPL 4% Don t know/refused to Answer Race/Ethnicity 24% White 32% Eligible Hispanics 29% Undocumented Hispanics 5% Blacks 8% Other Age 17% % % % Total Hispanics: 62% OPSC s 54th Annual Convention and Exposition Syllabus 289

40 The Remaining Uninsured in Their Own Words Among California s remaining uninsured: What is the main reason you have not gotten health insurance this year? 34% -- Can t afford it/too expensive. 15% -- Don t qualify for coverage/financial help. 9% -- Haven t tried/too busy. 9% -- Lack of information/ Don t know how to get it. I still cannot afford health insurance. It s a total rip-off, it s extremely expensive. I don t have enough income. Can t apply for it because of my legal status. My husband s income is too high. Don t think I qualify. Working so much I haven t had time. I m limited with my time and the applications are too long. I don t have time. I find it too difficult to understand and there s no support from anybody to help me. Confused about the system. Kaiser Family Foundation OPSC s 54th Annual Convention and Exposition Syllabus 290

41 + The Remaining Uninsured An opportunity exists: 57 percent of the uninsured think they will enroll later this year; only 31 percent think they will continue without health insurance. 36 percent of the uninsured say they tried unsuccessfully to get insurance in the first open enrollment period. OPSC s 54th Annual Convention and Exposition Syllabus 291

42 Thank you! + Questions? OPSC s 54th Annual Convention and Exposition Syllabus 292

43 RETURN TO TABLE OF CONTENTS OPSC s 54th Annual Convention and Exposition Syllabus 293