Nevada Health Link

December 3, 2014

New Legislator Policy Briefing

Presentation Topics

• Transition to Supported State Based Marketplace

• Open Enrollment Overview• Consumer Case Resolution Initiative• Exchange contact information

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SUPPORTED STATE BASED

MARTKETPLACE TRANSITION

What is an SSBM?

Supported State Based Marketplace • Exchange provides health plan

qualification and certification services, oversees and underwrites the cost of in-person assistance programs, develops and funds marketing and consumer outreach efforts, acts as liaison between carriers and federal hub.

• Federal government provides technology: the eligibility and enrollment operational platform utilized by the Exchange.

• “Halbig-proof”, subsidies safe

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Part of Multi-Agency Team

The Exchange works with a multi-agency team for project management• Centers for Medicare and Medicaid

Services (CMS)• Nevada Governor’s Office• Division of Welfare and Supportive

Services (DWSS)• Division of Insurance (DOI)• Enterprise IT Services (EITS)

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Stakeholder Liaison

The Exchange also works with external resources and stakeholders for the benefit of Nevada’s consumers• Consultants on technology integration

and messaging• Insurance carriers• Brokers and agents• Exchange enrollment facilitators

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Technical Resource

• Developed a pathway to successful transition

• Set benchmarks• Configuration milestones• Set up and transition milestones• IT Security milestones• Organization and resources milestones

• Managed carrier onboarding and transitioning

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Operational Resource• Plan certification

• DOI, Exchange and carriers working together• New market entry – Time Insurance Company (PPO)

• Marketing and outreach• Educational and promotional campaigns• Sponsor events and enrollment stores

• Broker and agent education• Must register with CMS• Complete specified training

• Facilitator education• Navigator program required as SSBM• Complete specified training

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OPEN ENROLLMENT

Goals

• Don’t burn the house down again, please

• Improve the consumer experience• Mitigate/eliminate root causes of last

year’s issues• Provide expanded access to in-person

assistance

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Strategies• Adopt federal technology platform to:

• Make signing up easier and faster• Assure data capture and transmission• Leverage federal technology infrastructure and resources

• Transfer premium billing and collection activities to the insurance carriers• End the need for reconciliations• Minimize the potential for misallocation/errors

• Emulate successful outreach programs of other states• Create brick and mortar enrollment assistance centers• Integrate community calendars, other tools

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The New Platform

Significant changes in Healthcare.gov from 2014• Streamlined application form: 76

screens reduced to 16• Can handle 250,000 simultaneous users• Ability to window shop for plans without

creating an account• Back button• Authorization/verification at conclusion

of the process rather than page by page

Does it work?• Yes!• Positive press• “ Health exchange enrollment off to a smooth

start” – Las Vegas Sun• “Health coverage enrollment gets good early

reviews” – Las Vegas Review Journal• “Reviews good for Nevada Health Link

enrollment” – KLAS TV

• No substantial/widespread consumer complaints

• No constituent services complaints

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In person assistance• Enrollment stores in Las Vegas and

Reno opened November 15th

• Staffed with brokers, agents, navigators and Medicaid enrollers

• Well received• Positive consumer experiences• Ability to get immediate assistance

with website, insurance related questions

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Initial Assessment• 90 day race• Early results and impressions are

positive• Messaging has been successful• Technology has been stable and robust• Demonstrating the value of the

exchange as a technical and operational resource, impact of state specific marketing and outreach

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CONSUMER CASE RESOLUTION

INITIATIVE

Overview

Issues surrounding 2014 Plan Year Open Enrollment well documented• Enrollment • Eligibility• Advanced Premium Tax Credit• Billing• Repeating data anomalies and

inconsistencies

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Remedial Actions Committed, “all hands on deck” efforts as soon as problems began to reveal themselves• Constant communications with vendor• Requested reporting by issue type to

track trends• Development of vendor ‘Special Case

Resolution’ group• A staff member and a representative

of Xerox are meeting with each carrier to review open cases and identify opportunities for resolution

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Added Resources

Strategic initiative to more quickly move consumer issues toward resolution and closure• Two existing vacant staff positions

have been filled and dedicated to resolving consumer issues

• Public Consulting Group has been retained and begun work on reconciling enrollment and financial discrepancies

• Prioritized, continuous and full-time effort 19

Root Causes Addressed

Enrollment will be through federal platform, minimizing potential for issues created by prior system failing to properly capture and share data

Billing will be handled by the carriers, ending the need for financial reconciliations and payment allocation errors

CONCLUSION

Progress• Managed transition to an

SSBM successfully• Navigated the first days of

open enrollment successfully• Messaged the importance of

coverage and the availability of local in-person assistance successfully

• Resolved last year’s greatest dissatisfiers successfully

Open items• Consumer case resolution• Termination of Xerox

relationship• Structural transformation to

better reflect the SSBM model

Contacting the Exchange2014 Issues

Shawna DeRoussesderousse@exchange.nv.gov702.486.5262

Constituent ServicesMatt Robinsonmrobinson@exchange.nv.gov775.687.9936

Executive DirectorBruce Gilbertbgilbert@exchange.nv.gov775.687.9926