Washington Health Benefit Exchange

Exchange Board MeetingOctober 20, 2016

Health Equity Update

Molly Voris, Policy DirectorLibby Weisdepp, Access & Education Specialist

Health Equity TAC Membership

Member Organization

Jesus Bervis NeighborCare Health

Laura Flores Cantrell Washington Dental Service Foundation

Adrian Dominguez Spokane Regional Health District

Patricia Gepert Washington Association of Community and Migrant Health Centers

Daniel Gross Northwest Health Law Advocates

Tatsuko Go Hallo Children’s Alliance

Annya Pintak WithinReach

Shirley Prasad Community Health Plan of Washington

Eva Wong Public Health-Seattle King County

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*ACA 133%=138% due to across the board income disregards

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TAC Areas of Interest

Language Access

Health Literacy

Improving the Customer Experience: Reaching potential new enrollees

System Enhancements

Data Metrics and Collection

Churn

Disability Access

Staff Training

Recent Equity Efforts

▪ Development of Equity Metrics

▪ Health Literacy Campaign

▪ Outreach to Urban AI/AN Populations

▪ Updated Language Access Plan

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Development of Equity Metrics

▪ In collaboration with the Health Equity TAC, equity metrics have been developed to measure progress toward incorporating equity work across Exchange functions

▪ Information gathered from Healthplanfinder, survey results, and feedback from consumer assisters, TACs/workgroups, and other stakeholders

▪ Next Steps: work with Equity TAC to develop benchmarks that align with prioritized equity metrics

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Health Insurance Literacy Campaign ▪ Based on several surveys with consumer touchpoints, we

prioritized several topics for health literacy focus:

▪ How a Deductible Works

▪ Insurance Costs Through the Year

▪ Lower Out-of-Pocket Costs (Cost-Sharing Reductions)

▪ How to Report a Change

▪ 1095 Process

▪ Why Insurance is Important

▪ October begins monthly email marketing campaign tied to health insurance literacy theme

▪ New translated materials

▪ ABCs of Health Insurance (Spanish)

▪ New closed-captioned videos

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Outreach to Urban AI/AN Populations

▪ Urban AI/AN populations often lack access to tribal assisters and IHS options.

▪ HBE is providing additional training through King County Public Health for Navigators who want to provide assistance to Urban Indians in that service area. Training will focus on AI/AN policy and application issues.

▪ Goal to build AI/AN expertise in counties with high Urban Indian population.

▪ Also partnering with statewide organizations offering assistance to Urban Indian families seeking health coverage.

▪ E.g., Providing training to staff at PAVE/Washington Family to Family Health Information Center, who provide help to Urban Indian families with health needs in support groups across the state.

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Updated Language Access Plan (LAP)

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Background

▪ LAP initially implemented in September, 2014

▪ Updated every two years, in collaboration with the Health Equity TAC

▪ Updates take into account:

▪ Regulatory developments

▪ Emerging technologies/best practices

▪ Program/assessment/survey findings – including self-assessment

▪ Consumer & Stakeholder Feedback

▪ Extensive stakeholdering

Updated Language Access Plan

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2016 Updates

▪ Recent federal non-discrimination regulations incorporated

▪ Incorporated self-assessment findings which include:

▪ Develop additional ”How to” materials/training for staff

▪ Create multilingual signs or posters highlighting availability of language assistance services

▪ Establish regular reporting on LEP metrics

▪ Stakeholder feedback incorporated, including:

▪ Additional information about consumer assister training

▪ Additional information about non-discrimination rules and clarification about family interpreter requirements

▪ Additional information about assessments

Updated Language Access Plan

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Key Areas for Improvement

▪ Staff Training

▪ Developing new “Language Access Procedures Manual” for staff

▪ Exploring broader cultural competency/humility training for Exchange staff

▪ Language Metrics & Reporting

▪ Including additional language specific data in next Enrollment Report

▪ Accessibility of information

▪ Exploring further website enhancements (HPF homepage)

▪ Plain talking correspondences

▪ Navigator training – revisiting contract requirements

▪ Improving access to 1-1 assistance in preferred language (search feature)

Upcoming Equity Efforts: Implementation of Strategic Plan

▪ In collaboration with Equity TAC, develop equity benchmarks (Winter)

▪ Survey Navigators during OE to assess obstacles to access (Winter)

▪ Annual survey to identify additional tools/materials/messaging that could assist with enrollment

▪ Board engagement on rural issues (Winter)

▪ Geographic access barriers ; Exchange role

▪ Carrier engagement (Winter/Spring)

▪ Quality Measures

▪ Data sharing

▪ Best Practices (language access; health literacy; cultural sensitivity)

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Upcoming Equity Efforts: Implementation of Strategic Plan

▪ Develop survey for LEP stakeholders to capture qualitative data on language barriers (Spring)

▪ Develop Disability Access Plan (Spring/Summer)

▪ Assistance from 3 masters students at iSchool at UW – capstone project will identify best practices/models/resources and make recommendations about how to improve access

▪ Ongoing: Staff training on cultural competency

▪ Key area for improvement (self-assessment; stakeholder feedback)

▪ Distributed e-learning modules endorsed by Gov.’s Interagency Council on Health Disparities related to Culturally and Linguistically Appropriate Services (CLAS).

▪ Exploring additional cultural humility training options for Exchange staff recommended by the Governor’s Interagency Council on Health Disparities

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APPENDIX

TAC Efforts to Establish Metrics and Equity Benchmarks

Goal:

Develop measurable indicators using available data, which includes HPF data, call center data, website statistics, consumer feedback, program assessment findings, and other external data sources.

Specific Engagement:

• Develop equity metrics & benchmarks

Workplan:

March: Review draft equity metrics

April: Provide additional feedback on draft equity metrics

May: Review equity metrics & available data

July: Review final equity metrics & available data and discuss reporting frequency and where the data should be published

August: Share recommendation with Board Data and Metrics Committee

September: Discuss Board Data and Metrics Committee feedback, update recommended metrics as needed

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TAC Efforts to Establish Metrics and Equity Benchmarks

Progress to date:

Board Data and Metrics Committee reviewed the TAC recommended equity metrics [included 70 metrics (35 new) in 19 categories]. Led to a robust Committee discussion about equity data, that informed development of the Strategic Plan and the Language Access Plan

Given the breadth of the list, the TAC was asked to further prioritize the recommended items

TAC members prioritized the following key metrics (broken down by race, ethnicity, age, language, LEP, citizenship, disability, FPL, metal level, geography):

• Current QHP and Medicaid enrollment

• Number and Percentage of churn between QHP and Medicaid

• Number of Disenrollment's

• Reasons for termination/disenrollment

• Number of cancellations

• Use of survey results from TACs, Navigators and other stakeholders to improve effectiveness in reaching groups at risk for barriers

• Consumer complaints, broken down by reason code (and reviewed to identify trends)

Next Steps: Develop benchmarks that align with the equity metrics

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Language Access Plan (LAP) Development

Progress to date:

March: TAC discussion of OE3 analysis results, and low-literacy efforts

April: Review strategies in current LAP

May: TAC review and discussion of staff proposed LAP updates

June: Update LAP based on TAC feedback

July: Continued TAC discussion of proposed changes and discussion of strategy for soliciting feedback

August: Solicit stakeholder feedback

September: Final TAC review, updated LAP posted

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Background: • LAP implemented in September 2014, updated every two years• LAP available at: www.wahbexchange.org/about-the-

exchange/what-is-the-exchange/policies/• Access and Education Specialist oversees implementation of LAP

LAP Stakeholder Engagement

• LAP broadly distributed to:• Health Equity TAC

• Governor’s Interagency Council on Health Disparities

• Washington State Commission on Hispanic Affairs

• Washington State Commission on Asian Pacific American Affairs

• Washington State Coalition for Language Access (WASCLA)

• Members of the Washington Association of Community and Migrant Health Centers (WACMHC)

• International Community Health Services (ICHS)

• Community Health Network of Washington (CHNWA)

• Navigator Lead Organizations

• Consumer Advocates (includes: Children’s Alliance; Northwest Health Law Advocates- NoHLA; Washington State Labor Council –WSLC; Northwest Justice Project –NJP)

• State agency partners

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Recent Language Access Activities

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• Language Access Plan (LAP) updates • Development of Language Resources page • Implementation of new 1557 requirements • Development of Language Access Procedures staff resource• Distribution of CLAS staff training • Health literacy activities (new homepage layout, partner materials,

videos)• Website updates • Workgroup activities

• Notices Workgroup• Interagency LEP Workgroup• Meetings on cross-IT system coordination of language coding• Presentation to WASCLA members

• Correspondence updates• New correspondence to groups at risk for obstacles to access (age,

Citizenship/lawful presence)• Re-alignment of correspondence management and translation to Access and

Education Specialist • Comprehensive correspondence review (goal to streamline & plain talk)

Upcoming Language Access Activities

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• Review of Board member findings from LEP stakeholder engagement• Include of additional language access metrics included in next

Enrollment Report• Present at WASCLA summit • Work with TAC to develop equity benchmarks • Develop survey to gather qualitative information on access barriers for

LEP individuals• Solicit feedback on language access services post OE• Ongoing participation in relevant workgroups, including DSHS/HCA/HBE

effort to align language coding in shared systems