Home » Blog » September Exchange Board Meeting: Stakeholder Consultation, Consumer Assistance, SHOP and Service Center Models

September Exchange Board Meeting: Stakeholder Consultation, Consumer Assistance, SHOP and Service Center Models

Executive Director’s Report

Exchange staff provided legislative and CalHEERS updates, as well as a naming/tagline exploration board status update.  Chris Kelly summarized findings from a preliminary focus group of 66 people, who liked the names “Covered, CA,” “CaliHealth,” “Avocado,” “Ursa” and “Eureka.”  Interestingly, Spanish names did not test well with the Latino members of the focus groups.  Staff will narrow down the options to 1-3 names/taglines by the end of September, conduct quantitative/qualitative focus group testing in October, and complete the process in November.

Exchange staff also summarized the outreach and education grant program’s preliminary concepts.  Goals and objectives of the program are:

  • ensure participation of non-profits with trusted relationships with uninsured markets
  • establish linguistically/culturally diverse statewide network to target regions and market segments
  • deliver cost-effective program that promotes/maximizes enrollment
  • ensures grantees will perform: target outreach/resources to counties, employment sectors and organizations with access to market segments with most opportunity to enroll; access populations with variety of health statuses who are eligible for Medi-Cal, Healthy Families, Exchange (with or without subsidies); deliver culturally/linguistically competent outreach; employ techniques likely to increase awareness; ensure that grantees disseminate clear, accurate and consistent messages to eliminate barriers, increase interest and motivate enrollment

Issues being considered are:

  • Funding allocation: Exchange to consider both geographic and non-geographic (specific sectors with disproportionately high rates of uninsured, cultural/linguistic groups, newly eligible groups) options
  • Grant award size/period: Exchange to offer a variety of small, medium and large awards ($15,000, $50,000, $100,000, $175,000 and $250,000)
  • Required grant activities and statement of work: Exchange to provide broad guidelines, minimum deliverables and allow organizations to propose own specific creative approaches/tactics for reaching their target audience
  • Eligible entities and organizations: 501(c)(3) and non-profit organizations, school districts and community colleges, trade/industry/professional organizations, public agencies.  Is considering the inclusion of specific for-profit companies (pharmacies, for-profit urgent care clinics)

Board members discussed the idea of utilizing existing community/regional foundations as re-granting institutions; the board voted to adopt the staff’s recommendations.

Stakeholder Engagement Plan

Exchange staff recommended that the board continue with their public meetings, solicitation of topic-specific written stakeholder input, and topic-specific webinars.  In 2013, however, the Exchange may revise its current advisory groups by disbanding the two standing advisory groups (individual and small business workgroups) to create three advisory groups (plan management; marketing, outreach and enrollment assistance; Small Employer Health Options).  The staff recommended that the advisory group meetings be open to the public, with opportunities for public comment at designated times during the meeting.

Consumer Assistance/Ombudsman Options

Currently, consumer assistance is provided by health plans, plan sponsors (e.g. employers), regulatory  agencies (California Department of Insurance; Department of Managed Health Care) and independent non-regulatory agencies (Health Consumer Alliance/Legal Services).  When the Exchange is operational, there is the expectation that exchanges should support their enrollees in receiving necessary services.  Exchange staff proposed four options:

  • Option 1 – refer to existing regulatory entities (CDI/DMHC): Exchange would have a minimal role in consumer assistance, and thus would require no Exchange resources.  It would not, however, promote the Exchange’s core values of partnership and a focus on the consumer, or allow the Exchange to directly obtain information from enrollees.
  • Option 2 – establish internal non-regulatory assistance capacity within the Exchange.  The Exchange would have the most engaged process, and would allow for easy monitoring of customer services quality and performance metrics; it would also be the most costly option and may not be realistic by the October 2013 deadline.
  • Option 3 – partner with regulatory agencies (CDI/DMHC) and provide interim support for non-regulatory independent assistance (HCA).  The combination of both types of assistance makes it a cost-effective option that leverages existing infrastructure, resources, and knowledge.  It would require the Exchange to coordinate with other programs for monitoring and developing common metrics to evaluate quality.
  • Option 4 – contract directly with non-regulatory independent consumer assistance programs (HCA).  This option would lessen the administrative burden to the Exchange, while providing a unique “on the ground” assistance to low-income consumers.  The funding, however, is uncertain, and the workload may be too much for the HCA to absorb.  Additionally, there is no existing “consumer services center” but instead is a partnership of community-based legal services only available in 13 counties.  The staff is only accustomed to dealing with low-income populations.

Exchange staff recommended Option 3.

Small Business Health Options Program (SHOP) Administration

The Exchange is considering contracting for SHOP operations for the following reasons:

  • time required to build an internal operational capability is significant, and may not be ready for enrollment by 2013
  • external vendors have existing functionality that already serves the small business market that could be easily adapted to Exchange functions
  • other competing, high priority items with tight timelines facing Exchange staff, particularly in the individual exchange

With these considerations and stakeholder feedback, the Exchange staff recommends issuing a solicitation for the administration of SHOP operations through two options:

  • Option A: vendor uses CalHEERS technology and provides operational staff to support eligibility and enrollment, financial management, sales, agent management, customer services and appeals/grievances
  • Option B: vendor provides both operational staff to support services in Option A, plus the technology to support these functions.  Exchange will develop integration requirements between CalHEERS and the vendor’s IT solution.

Qualified Health Plan Solicitation: Content, Timeline and Stakeholder Input

Andrea Rosen presented the staff’s QHP timeline, as well as content and approach to QHP solicitation.

Service Center Status Update

Exchange CTO Juli Baker and Eventus’ Craig Tobin presented on options to refer Medi-Cal eligible consumers to county offices:

  • Approach 1 – quick sort: customer service agent asks consumer for minimun information necessary to use the Smart Calculator, and then executes a “warm handoff” to a county eligibility worker, along with the transfer of Smart Calculator data.  If not transferred, appropriate cases will be handled by the Exchange
  • Approach 2 – partial assessment: customer service agent asks for limited information for a more accurate referral of Medi-Cal cases to their county of residence, and then executes a “warm handoff” to a county eligibility worker, along with the transfer of Smart Calculator data.  If not transferred, appropriate cases will be handled by the Exchange
  • Approach 3 – full assessment completed: customer service agent uses single streamlined CalHEERS application by entering data required to assess whether consumer is Exchange or MAGI Medi-Cal and/or potentially non-MAGI Medi-Cal eligible.  Potential MAGI Medi-Cal cases are transferred to the county with the appropriate data to an eligibility worker’s queue.  May or may not have warm handoff.

Exchange staff welcomes comments on the 3 approaches by September 25, 2012.

The next board meeting will be held on October 16 in Sacramento.  All meeting materials, including written comments to the board, are available online.

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