Nevada Health Link
New Legislator Policy Briefing
December 3, 2014
Presentation Topics
• Transition to Supported State Based
Marketplace
• Open Enrollment Overview
• Consumer Case Resolution Initiative
• Exchange contact information
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SUPPORTED STATE
BASED
MARTKETPLACE
TRANSITION
What is an SSBM?
Supported State Based Marketplace
• Exchange provides health plan qualification
and certification services, oversees and
underwrites the cost of in-person assistance
programs, develops and funds marketing
and consumer outreach efforts, acts as
liaison between carriers and federal hub.
• Federal government provides technology:
the eligibility and enrollment operational
platform utilized by the Exchange.
• “Halbig-proof”, subsidies safe
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Part of Multi-Agency Team
The Exchange works with a multi-agency team
for project management
• Centers for Medicare and Medicaid Services
(CMS)
• Nevada Governor’s Office
• Division of Welfare and Supportive Services
(DWSS)
• Division of Insurance (DOI)
• Enterprise IT Services (EITS)
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Stakeholder Liaison
The Exchange also works with external
resources and stakeholders for the benefit of
Nevada’s consumers
• Consultants on technology integration and
messaging
• Insurance carriers
• Brokers and agents
• Exchange enrollment facilitators
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Technical Resource
• Developed a pathway to successful
transition
• Set benchmarks
• Configuration milestones
• Set up and transition milestones
• IT Security milestones
• Organization and resources milestones
• Managed carrier onboarding and
transitioning
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Operational Resource
• Plan certification
•
•
DOI, Exchange and carriers working together
New market entry – Time Insurance Company (PPO)
• Marketing and outreach
•
•
Educational and promotional campaigns
Sponsor events and enrollment stores
• Broker and agent education
•
•
Must register with CMS
Complete specified training
• Facilitator education
•
•
Navigator program required as SSBM
Complete specified training
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OPEN
ENROLLMENT
Goals
• Don’t burn the house down again, please
• Improve the consumer experience
• Mitigate/eliminate root causes of last
year’s issues
• Provide expanded access to in-person
assistance
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Strategies
• Adopt federal technology platform to:
•
•
•
Make signing up easier and faster
Assure data capture and transmission
Leverage federal technology infrastructure and resources
• Transfer premium billing and collection
activities to the insurance carriers
•
•
End the need for reconciliations
Minimize the potential for misallocation/errors
• Emulate successful outreach programs of
other states
•
•
Create brick and mortar enrollment assistance centers
Integrate community calendars, other tools
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The New Platform
Significant changes in Healthcare.gov from
2014
• Streamlined application form: 76 screens
reduced to 16
• Can handle 250,000 simultaneous users
• Ability to window shop for plans without
creating an account
• Back button
• Authorization/verification at conclusion of
the process rather than page by page
Does it work?
• Yes!
• Positive press
• “ Health exchange enrollment off to a smooth start” –
Las Vegas Sun
• “Health coverage enrollment gets good early reviews”
– Las Vegas Review Journal
• “Reviews good for Nevada Health Link enrollment” –
KLAS TV
• No substantial/widespread consumer
complaints
• No constituent services complaints
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In person assistance
• Enrollment stores in Las Vegas and Reno
opened November 15th
• Staffed with brokers, agents, navigators and
Medicaid enrollers
• Well received
• Positive consumer experiences
• Ability to get immediate assistance with
website, insurance related questions
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Initial Assessment
•
•
•
•
•
90 day race
Early results and impressions are positive
Messaging has been successful
Technology has been stable and robust
Demonstrating the value of the exchange as
a technical and operational resource, impact
of state specific marketing and outreach
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CONSUMER CASE
RESOLUTION
INITIATIVE
Overview
Issues surrounding 2014 Plan Year Open
Enrollment well documented
• Enrollment
• Eligibility
• Advanced Premium Tax Credit
• Billing
• Repeating data anomalies and
inconsistencies
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Remedial Actions
Committed, “all hands on deck” efforts as soon
as problems began to reveal themselves
• Constant communications with vendor
• Requested reporting by issue type to track
trends
• Development of vendor ‘Special Case
Resolution’ group
• A staff member and a representative of
Xerox are meeting with each carrier to
review open cases and identify opportunities
for resolution
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Added Resources
Strategic initiative to more quickly move
consumer issues toward resolution and closure
• Two existing vacant staff positions have
been filled and dedicated to resolving
consumer issues
• Public Consulting Group has been retained
and begun work on reconciling enrollment
and financial discrepancies
• Prioritized, continuous and full-time effort
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Root Causes Addressed
Enrollment will be through federal
platform, minimizing potential for
issues created by prior system failing
to properly capture and share data
Billing will be handled by the
carriers, ending the need for
financial reconciliations and payment
allocation errors
CONCLUSION
Progress
• Managed transition to an SSBM
successfully
• Navigated the first days of open
enrollment successfully
• Messaged the importance of
coverage and the availability of
local in-person assistance
successfully
• Resolved last year’s greatest
dissatisfiers successfully
Open items
• Consumer case resolution
• Termination of Xerox relationship
• Structural transformation to better
reflect the SSBM model
Contacting the Exchange
2014 Issues
Shawna DeRousse
sderousse@exchange.nv.gov
702.486.5262
Constituent Services
Matt Robinson
mrobinson@exchange.nv.gov
775.687.9936
Executive Director
Bruce Gilbert
bgilbert@exchange.nv.gov
775.687.9926