Health Insurance Exchanges
Payers & Providers convened a webinar on Aug. 15 focusing on the California Health Benefits Exchange. It featured presentations from Jon Gabel, a Senior Fellow from NORC at the University of Chicago, Anthony Wright, the Executive Director of Health Access California, and David Panush, director of government relations for the California Health Benefits Exchange.
Panush’s presentation was delivered by Payers & Providers Publisher Ron Shinkman.
Now that the U.S. Supreme Court has upheld the constitutionality of the Affordable Care Act, the focus has begun to shift in the next logical step in implementing reform: the construction of the state health benefit exchanges.
The Affordable Care Act stipulates detailed provisions regarding the establishment, development and operation of Health Insurance Exchanges. The exchanges are slated to commence operations in 2014.
States have the option of operating an Exchange for their state, to combine an exchange with one or more other states, or to defer and allow the federal government to operate an exchange in their state on their behalf. States are at various stages of decision or development in this regard. For example, for many months now, California has steadily been ramping up its own health benefits exchange, adding staff, and beginning the tremendous task of building an infrastructure capable of enrolling millions of its residents into multiple insurance plans.
Gabel provided the following graphic from the Kaiser Family Foundation in his presentation to illustrate the various stages states are in, in preparing for the exchanges (see this graphic in Vitals).
“I have the sense that the nation is looking to Massachusetts, Maryland, and California for leadership,” Gabel said. In reference to California, he observed ”the view is you are further along than others and that hopefully many of the solutions that you will find will be able to be exported to other states in the country.”
To better assess California’s progress toward building an exchange, Panush’s presentation listed six primary values, adopted by the exchange board, which will guide its construction and operation:
• Consumer-focused: At the center of the Exchange’s efforts are the people it serves, including patients and their families, and small business owners and their employees. The Exchange will offer a consumer-friendly experience that is accessible to all Californians, recognizing the diverse cultural, language, economic, educational and health status needs of those we serve.” “Affordability: The Exchange will provide affordable health insurance while assuring quality and access.”
• Catalyst: The Exchange will be a catalyst for change in California’s health care system, using its market role to stimulate new strategies for providing high-quality, affordable health care, promoting prevention and wellness, and reducing health disparities.
• Integrity: The Exchange will earn the public’s trust through its commitment to accountability, responsiveness, transparency, speed, agility, reliability, and cooperation.
• Partnership: The Exchange welcomes partnerships, and its efforts will be guided by working with consumers, providers, health plans, employers and other purchasers, government partners, and other stakeholders.
• Results: The impact of the Exchange will be measured by its contributions to expanding coverage and access, improving health care quality, promoting better health and health equity, and lowering costs for all Californians.
Panush also provided a timeline of events leading up to the exchange being financially self-sustaining by 2015.
Wright discussed fulfilling the promise of the exchange and the challenges ahead in getting it ready.
He emphasized that the “Day One Challenge” is maximizing enrollment. The California Health Benefit Exchange must do as much as it can to get as many people pre-enrolled as possible during early enrollment so that on January 1, 2014 it can prevent adverse selection with the biggest and broadest pool of possible enrollees.
“At the end of the day the biggest challenge is just being operational,” Wright said. “Nothing matters if it doesn’t work.”
Wright also talked about the change fulfilling the promise of “active purchasing.” This is described in California government code as an exchange that will “selectively contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality, and service.” He highlighted five topics which are important to this conversation:
• Qualified Health Plans (QHP) discussion crucial. Not a “let the buyer beware flea market,” but making the market manageable and consumer-friendly.
• Creating apples-to-apples comparisons in purchasing decisions, as opposed to the complexity and confusion of the current market. The standardization of dozens of benefit variables is also a plus.
• Vetting products and given them a Good Housekeeping-style seal that promotes confidence in coverage.
• Maintaining/building capacity to help maintain the safety net for lower-income exchange enrollees
• Quality and Cost: A increasing focus on encouraging value and delivery system reform for cost, quality, safety & equity
You can order a copy of the webinar: The California Healthcare Exchange: A Progress Report for $129 from Healthcare Web Summit. The CD-ROM version (or flash drive, when indicated) of this event is available for purchase by phone at 209.577.4888 or online at www.managedcarestore.com/ymcol/defcrscd.htm.
Past Events include an event menu with event information and faculty bios; a full-length webinar audio recording, and all faculty slide presentations.
For an overview of this webinar as well as its learning objectives and biography information for the speakers please visit www.healthwebsummit.com/pp081512.htm.
