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November Exchange Board Meeting: Contract Timeline, New Senior Staff, and User IT Experience

The November Exchange Board meeting (agenda) was held a little earlier in the month than usual (presumably to avoid Thanksgiving travel conflicts). The highlights of the meeting included an approved resolution intended to commend Pat Powers on her work as Acting Administrator, an inspirational and innovative presentation on an interface for the Exchange, and (my personal favorite) a new rule that limits each public comment to two minutes.

Peter Lee encouraged stakeholders to submit their comments via written letters rather than verbal comment at meetings, explaining that the written letters receive serious and timely consideration and verbal comments are merely noted.

Click here to see the Exchange Board’s final vision, mission and values statements.


Peter Lee provided a presentation that outlined the Exchange Board’s plan over the next year.

Nine contracts will be provided as a result of the Level I Establishment Grant. The below chart outlines contracts, estimated solicitation release dates, and when the vendor will begin service. Additional information on each contract can be found below.

Business and Operations: A firm has been chosen to create the B&O plan and will be financed through the end of 2014, at which point no federal funds can be used to operate the Exchange.

Eligibility, Enrollment and IT: The firm ClearBest was selected to create an RFP in October 2011. They will release a solicitation on January 18, 2012 and a firm will be selected by April 17, 2012. The RFP will be available for public comment between December 20 and December 31, 2011 (stakeholders asked that the deadline be pushed back to January 6 to avoid holiday conflicts).

Stakeholder Consultation: To date, Cal State University has been helping with media and note taking. Every aspect of the Exchange will include stakeholder engagement. It is an integral part of the process.

Research and Analysis: Many organizations have come up with numbers and estimates related to the Exchange. The goal of the Board is to engage the best researchers to get the most accurate numbers.

During the day’s closed session, the Board moved ahead with contracts in six areas, including research and analysis, stakeholder engagement, community support and outreach, health plan management, SHOP, and support for Board meetings. At the next meeting, they will present the standard procurement process. Because IT is such a large, complex issue, the contract process will be open for public comment. Peter Lee emphasized that enrollment and IT is a complex initiative with a tight time frame.


A number of background materials will be developed, including a legal scope (Setting the “guard rails” from the feds. What is federally mandated and what do we want in the state?),“just the facts” (Where are we today? Determine relevant California-level data to assist with reform efforts), stakeholder perspectives (help create a detailed, structured plan for the Level II Grant ask), options and recommendations, and a detailed budget and timeline for the Level II Establishment Grant.


Over the next 6 weeks, the Exchange board will hold 6-8 person meetings throughout the state to generate input. Lee provided three areas as examples of where stakeholders will be engaged: (1) Marketing, promotion and outreach; (2) Navigators, agents and brokers; and (3) Enrollment and information technology.


The Level I Establishment Grant allows for 76 full-time positions. To date, the Exchange has been “ably served by consultants”.

The state legislation allowed for some flexibility with executive-level positions. The Board has the power to “appoint” these positions. The Board therefore adopted resolutions for a number of positions, including a Chief Medical Officer (part-time or consultant), an IT project director, an assistant COO, a Director of Government Relations, a Director of Marketing in Communications, General Counsel, a Director of Sales and Marketing for SHOP an Actuary, etc. Many people will come from other state departments as a part of civil services requirements (for example, many people from the department of corrections have been laid off and will receive priority for these positions).

The following executive-level positions have already been appointed: Katie Marcellus (Assistant Secretary of HHS) has been appointed the senior position on Eligibility and Enrollment. David Maxwell-Jolly (Undersecretary of HHS) was appointed as the Chief Operations Officer. Sharon Stevenson (Chief Administrative Law Judge and Deputy Director of DHCS) was appointed General Counsel and David Panush (Health Policy Advisor to Senator Steinberg) was appointed Director of Government Relations.

Below is the proposed organizational structure:

UX 2014

Terri Shaw, UX 2014 Project Director, delivered a presentation on developing a first-class user experience for enrollment in the Exchange. UX 2014 is a public/private partnership across eleven states (including a collaborative in New England that was part of the Exchange/IT innovator grant) with the goal of designing an interface based on consumer needs. UX 2014 brought on the design firm “IDEO” who are known for their innovative ideas. UX 2014 will focus on the design of the IT, not the actual software.

UX 2014 has engaged a variety of consumers and stakeholders to create the initial design.

Below are snapshots of the preliminary visual designs:

When inputting information, consumers can easily switch between family members (see top) and receive real-time support (see left). The design also includes a definition box. In the above example, PPO is being defined for the consumer.

The design includes a link to provider networks and estimated monthly premiums and copays for each plan. Stakeholders commented that providing estimates of monthly premiums might not accurately inform the consumer of the estimated total annual out-of-pocket costs.

UX 2014 has proposed multiple enrollment channels (mobile phone, paper, computer, tablet/kiosk, telephone/in-person) and a single uniform application process. They have also included a detailed mobile enrollment design (below) that alerts users of renewals, prompts them to submit missing information, allows voice/text/location-based support, and tracks enrollment via text/e-mail

Note: A recent report by the Greenlining Institute indicated that mobile smart phones could be the best way to reach underserved populations.