ACA Implementation Lessons April 9, 2014

Transcription

1 ACA Implementation Lessons April 9, 2014 Heather Howard Lecturer in Public Affairs, Princeton University Director, RWJF State Health Reform Assistance Network

2 Overview Status of Implementation State Exchange Decisions State Exchange Funding Exchange Enrollment to Date Early Implementation lessons Exchange Governance Plan Management Consumer Assistance IT builds Transition to SBM Issues to Watch

3 3 INSERT LATEST SLIDE ON STATE EXCHANGE DECISIONS FROM KIDSWELL OR KAISER

4 ACA Exchange Grants to States (As of March 5, 2014)

5 Marketplace Enrollment as of March 1 Enrollment Metric 15 SBM States 36 FFM States Total Individuals who have Selected a Marketplace Plan Individuals Selecting a Marketplace Plan with Financial Assistance Individuals determined Medicaid/CHIP Eligible Age Distribution of Individuals Selecting Marketplace Plan < >55 Metal Level Distribution of Marketplace Plan Selection Bronze Silver Gold & Platinum 1,621,239 2,621,086 4,242,325 1,238,133 2,230,533 3,468,666 2,999,061 1,378,871 4,377,932 32% 39% 30% 23% 58% 18% 32% 38% 30% 16% 67% 16% 32% 39% 30% 18% 63% 17% Source: ASPE October February Marketplace Enrollment Report, March 2014

6 Enrollment Growing Steadily Source: SHADAC graphic using ASPE October February Marketplace Enrollment Report, March 2014

7 Early Observations: Governance Structure decisions have been based on political realities and capacity constraints Governance structure has impact on staffing and procurement flexibility Also think about: Legislative oversight Alignment with Governor s Office and state agencies Thus far, exchanges within state government have fared best

8 Early Observations: Plan Management Reviewing plans for compliance with ACA s new market rules requires new skills and training at DOI Policy making coordination between exchange and DOI is critical to ensure strong carrier relationships and participation rates Defining or redefining essential health benefits Plan standardization and/or limiting the number of plans offered (e.g., x plans per metal tier) Network adequacy Strong plan management relationships with carriers may: Lead to better operational relationships (e.g., enrollment and payment transactions) Result in increased participation Mitigate potential rate shock

9 Early Observations: Consumer Assistance Consumer assistance key to enrollment successes in the first OEP Many people wanted to talk to someone before signing up Issues with call center expertise, staffing, wait times and open hours Navigators and producers were vital Lead generation and follow-up (a more traditional sales approach) worked well in many places Enrollment fairs and in-person enrollment service centers generated large numbers - Some SBM s were better at being nimble and targeting efforts Providers and CACs can have strong impact too Difficult to maximize consumer assistance without a marketing campaign that lets individuals know the consumer assistance is available

10 Early Observations Systems Builds Importance of systems integrator The vendor matters Focus on core functionality avoid scope creep Integration with Medicaid is key Focus on consumer experience Clear lines of accountability, both internally and in vendor contracts Clear deliverables, testing schedules and performance-based reimbursement necessary to keep control over the build Universal workplans and timelines across different elements of the systems build are vital Assign an individual internally to be responsible for monitoring progress and identifying need for corrective action plans

11 Maslow s Hierarchy of Needs

12 Exchange Hierarchy of Goals Self - Actualization Esteem Belonging Security Physiological Enhance Quality of Care, Strengthen Delivery Systems and Improve Population Health Restrain Premium Trend and other Costs Near Universal Coverage Financially Self-Sustaining, Enhanced Consumer Experience and Decision Support Tools Accurate and Timely Functionality, Good Customer Service

13 Arkansas is Well Positioned Medicaid expansion model garnering significant attention in other states Board that is ready and willing to help staff make the tough policy and operational decisions Statutory authority provides ability to continue planning with core staff and infrastructure development Establishment grant funds in hand and the ability to ask for additional funding Proven leader to guide the ship

14 Transition to SBM Key Issues Timing Blueprint for 2016 SBM probably not due until June 2015 Final legislative authority required before blueprint submission Funding Level 1 s still available Deadlines upcoming in May, August, October and November Need to ask for final build and 1 st year operations funds by November 15, can spend in out years No guarantee there will be additional rounds of funding Other states NM transitions to an SBM for Jan 1, 2015 Illinois the only other state similarly situated, but others are showing interest (MI, VA, IA)

15 Issues to Watch Enrollment Overall numbers, but also mix by age, health status SEPs Churn Impact on broader insurance market New market entrants? Rise of narrow networks Private exchanges Affordability Further federal delays?

16 Heather Howard Director, RWJF State Health Reform Assistance Network Lecturer in Public Affairs, Princeton University Woodrow Wilson School of Public and International Affairs (609)