EXECUTIVE DIRECTOR S REPORT Peter V. Lee, Executive Director February 21, 2019 Board Meeting

Transcription

1 EXECUTIVE DIRECTOR S REPORT Peter V. Lee, Executive Director February 21, 2019 Board Meeting

2 ANNOUNCEMENT OF CLOSED SESSION 1

3 EXECUTIVE DIRECTOR S UPDATE 2

4 AFFORDABILITY REPORT SUBMITTED TO GOVERNOR AND LEGISLATURE 3

5 OPTIONS TO IMPROVE AFFORDABILITY IN CALIFORNIA S INDIVIDUAL HEALTH INSURANCE MARKET Developed pursuant to AB 1810 (Committee on Budget, Chapter 34, Statutes of 2018), to develop and present options to improve affordability for low- and middle-income Californians to the Governor, Legislature, and Council on Health Care Delivery Systems. Five-month engagement of academic experts and Covered California s Policy Division with a workgroup of stakeholders, legislative staff and broad community input. Report presents multiple options to improve affordability in the individual market building on tools of the Affordable Care Act. Report available at: 4

6 UPDATE ON OPEN ENROLLMENT 5

7 COVERED CALIFORNIA OPEN ENROLLMENT 2019 Covered California 2019 Open Enrollment Early Analysis 6

8 WHILE COVERED CALIFORNIA S TOTAL ENROLLMENT HELD STEADY, THE DROP IN NEW ENROLLEES IS A CONCERN AT THE STATE AND FEDERAL LEVEL Covered California s drop in new enrollees of 24 percent surpassed the 16 percent decline in the 39 states represented by the federal marketplace. The decline in those states was on top of a 39 percent decrease in new enrollees between 2016 and 2018, while California has maintained more new enrollees each year and a 200 percent healthier risk mix. Comparing New Enrollment, Covered California and FFM, , in millions Covered California 2019 Open Enrollment Early Analysis 7

9 UPDATE ON FEDERAL COMMENTS SBM Comment Letter on Automatic Re-enrollment and Stability in Cost-Sharing Reduction Funding Covered California s comments on the Proposed User Fee Covered California s comments on the Proposed Changes to the Risk Adjustment Data Validation, Premium Adjustment, and Prescription Drug Formulary Changes 8

10 APPENDICES 9

11 APPENDICES: TABLE OF CONTENTS Covered California for Small Business Update Service Channel Update CalHEERS Update Service Center Update 10

12 COVERED CALIFORNIA FOR SMALL BUSINESS End of Year Group & Membership Update (1/29/19) Groups: 6,255 Members: 52,609 * Retention: 86% Average Group Size: 8.4 members Net Membership Growth over 1/1/18-21% *membership reconciled to 1/29/19 Operations Update (2/15/19) On-line Self Renewal Available to All Customers 1/1/2019 ACH Customer Payment Option Launched to all customers 2/8/

13 OUTREACH & SALES ENROLLMENT SUPPORT: KEY METRICS 1 of 2 Uncompensated partners supporting enrollment assistance efforts. ENROLLMENT ASSISTANCE PROGRAM ENTITIES COUNSELORS Certified Application Counselor 240 1,504 Certified Plan-Based Enroller 11 Plans 418 Certified Medi-Cal Managed Care Plan 2 Plans 23 Certified 12

14 OUTREACH & SALES ENROLLMENT SUPPORT: KEY METRICS 2 of 2 Data as of February 21, ,742 Certified Insurance Agents 17% Spanish 7% Cantonese 7% Mandarin 4% Korean 4% Vietnamese 885 Navigator: Certified Enrollment Counselors 63% Spanish 4% Cantonese 3% Mandarin 3% Vietnamese 2% Korean 1,504 Certified Application Counselors 59% Spanish 5% Cantonese 4% Mandarin 1% Vietnamese 1% Korean 418 Certified Plan Based Enrollers 45% Spanish 10% Cantonese 2% Mandarin 7.5% Vietnamese 7.3% Korean 23 Certified Medi-Cal Managed Care Plan Enrollers 44% Spanish 36% Cantonese 31% Mandarin 1% Russian 13

15 CALHEERS UPDATES 1 of 3 CalHEERS Release 19.2 was deployed on February 11, 2019, which included the following features: Updated consumer facing pages as part of ongoing User-Centered Design to improve consumer experience. Moved Notices to the Cloud to improve operational efficiency and costs of storage. Implemented Federal Data Services Hub services for Verification of Lawful Presence to comply with federal regulations. 14

16 CALHEERS UPDATES 2 of 3 The next CalHEERS release, Release 19.3, is planned for March 25, 2019, and will include: Updating documents and correspondence pages as part of User- Centered Design to ensure a consistent consumer experience. CalHEERS also has Release 19.4 planned for April 22, This release will include: Focus on implementing a federal integration standard known as Account Transfer that will provide a separation of eligibility determinations and enrollments in health plans. This will reduce data duplication and reconciliation needs, as well as enable CalHEERS to take advantage of standards in use across the country. 15

17 CALHEERS UPDATES 3 of 3 The CalHEERS June release will focus on improving the integration and data exchange between the CalHEERS system and the Statewide Automated Welfare Systems (SAWS) an ongoing effort associated with the Business Rules Exposure project within CalHEERS. 16

18 OTHER TECHNOLOGY UPDATES CoveredCA.com: Apply Section Redesigned to provide a simplified path that consumers can follow to enroll in health coverage. The Apply Page now has three paths including enroll online, enroll at a StoreFront, and enroll by phone. Financial Help Redesigned to provide consumers with a simple overview of what plan tiers are and the benefits each provides. It also gives consumers an idea of their subsidy eligibility to entice them to apply. Analytics Implemented analytics for the Apply Section and Financial Help Section to understand where users may drop off in the journey and additional improvements may be helpful. HBEX.CoveredCA.com Redesign Collecting Top Tasks for Toolkit Section to understand how Agents are currently using the Toolkit and where information architecture improvements can be made. 17

19 SERVICE CENTER UPDATE Improving Customer Service Voluntary and Mandatory OT were in place to reduce hold time and assist more consumers Generation of all 1.15 million forms was completed by 1/8/19, printing and mailing was completed on 1/17/19 Increased Appeals Informal Resolution Rate CiCi (Chatbot) had 20,586 conversations with our consumers in the month of January Staffing Updates Vacancy rate of 10.8 percent (2019) increase to prior year of 8.6 percent (2018) 18

20 SERVICE CENTER PERFORMANCE UPDATE 1 of 2 Year Calls to IVR Comparing January 2019 vs Call Statistics Calls Offered to SCR Abandoned % Calls Handled ASA AHT Service Level % , , % 285,755 0:02:43 0:18: % , , % 322,076 0:04:35 0:18: % Percent Change 21% decrease 16% decrease 51% decrease 11% decrease 41% decrease* 2% decrease* 84% increase *Time formats (H:MM:SS) are not equal to decimals. Time formats must be converted to decimal before performing calculations. (Example 0:15:45 = 15.75) 19

21 SERVICE CENTER PERFORMANCE UPDATE 2 of 2 The total Calls to the IVR decreased from 2018 by 21% The total Calls Offered decreased from 2018 by 16% Calls Handled decreased only by 11% The Abandoned % decreased by 51% Service Level increased by 84% 20

22 QUICK SORT VOLUMES Quick Sort refers to the calculator tool used to determine if a consumer is eligible for CoveredCA or should be referred to Medi-Cal. The tool also determines which consortia the consumer should be referred. This volume represents the total of those transfers. 21