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September California Exchange Board Meeting: SHOP, Consumer Assistance, Stakeholder Engagement Options

The California Health Benefits Exchange Board will meet in Sacramento tomorrow, September 18, 2012. The agenda includes action on the Exchange’s stakeholder engagement plan, the qualified health plan (QHP) solicitation process, and the operations of the Small Business Health Options Program (SHOP). In addition, the Board will discuss ombudsman and consumer assistance options.

The stakeholder engagement plan seeks to incorporate input through three advisory groups focusing on (1) plan management; (2) marketing, outreach, and assistance; and (3) the SHOP. The staff also notes that ad hoc advisory groups can be convened as needed going forward.

The Exchange staff recommends a consumer assistance plan in which the Exchange would both provide consumer support services and partner with the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) to provide access to independent consumer support. The Exchange would also join with DMHC to incorporate the help of community-based organizations to provide customer support and report difficulties that Exchange consumers encounter, allowing for a rapid response and quality improvement.

Regarding the SHOP options, the Board will discuss whether to perform many administrative options internally or to contract with vendors to perform those functions. The Exchange staff has recommended that the Exchange contract with outside vendors to perform several operations in the SHOP’s first years. The rationale for this course of action is that the Exchange lacks sufficient time to implement the SHOP without contracting with vendors to provide certain services, and the staff predicts that vendors will have the capability to easily adapt their services to suit the needs of the SHOP. Further, the staff notes that other Exchange priorities demand their attention. The list of functions that the staff proposes to contract for includes information and technology services, eligibility and enrollment, agent management, sales, customer service, grievances and appeals, and financial management.

While we understand the need to contract with vendors to perform certain functions for the SHOP, the list of proposed functions is long, and we need much more information about the rationale for this decision. We feel that it will be important for the Exchange to be very closely engaged in eligibility and enrollment, as well as grievances and appeals processes, particularly in the initial years of operation. Monitoring the volume and nature of issues that consumers experience and seek to address through these processes will be critical because this information will allow the Exchange to stay in touch with the consumer experience and to quickly rectify problems as they arise.


All meeting materials are available on the Exchange website:


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