Vermont Health Benefit Exchange

Advisory Group Meeting 4Monday, June 27, 2011

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Today’s Meeting

Updates on H.202 Implementation – Robin Lunge

Review of Basic Health Program Analysis Amy Lischko, Tufts University

Proposed Approach to Marketing/Outreach and Navigators Beth Waldman, Bailit Health Purchasing

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Today’s Meeting

Updates on H.202 Implementation – Robin Lunge

Review of Basic Health Program Analysis Amy Lischko, Tufts University

Proposed Approach to Marketing/Outreach and Navigators Beth Waldman, Bailit Health Purchasing

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ACA Basic Health Program

Option for states to implement a program for people 134-200% FPL (outside the Exchange)

Must include essential health benefits and consumers may not be charged more than what they would have been charged in the Exchange

State receives 95% of the premium tax credits and cost sharing subsidies for each person covered under the Basic Health program

Must establish a managed care system with care coordination, incentives for preventive services, etc.

What is the Basic Health Program?

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Options Analyzed for Vermont regarding Basic Health Program

Do not establish a Basic Health Program and move all adults above 133% FPL from VHAP and Catamount to Health Benefit Exchange

Transition VHAP, Catamount, and Dr. Dynasaur adults between 134-200%FPL to new Basic Health Program

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Steps to Estimate Costs of Implementing Basic Health Program Determine eligible population

Consider take-up rates

Estimate revenue state will receive: From 95% subsidy towards silver private

market premium, and Cost sharing subsidy amount

Estimate cost of Basic Health Program

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Assumptions Used

Take-up rates are 50% for uninsured and 90% for transitions from public programs

Catamount premiums are used for private market rates and adjusted to mirror actuarial value of plans in Exchange

Administrative costs are assumed to be 20% in private plans and 15% in Basic Health Program

All mandated benefits are in premiums and 2011 premium data are used

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Estimates of Adults Eligible for Basic Health Program in Vermont

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PPACA Provisions for Tax Subsidies

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Premium and Cost Sharing Revenue that Vermont would Receive for BHP

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Financial Impact of Moving People out of Exchange into Basic Health Program

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Policy Considerations

Continuity of care Financial protection for consumers Access to providers Preferences of consumers Safety net viability Effect on Exchange enrollment Risk selection Transition to single payer

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Today’s Meeting

Updates on H.202 Implementation – Robin Lunge

Review of Basic Health Program Analysis Amy Lischko, Tufts University

Proposed Approach to Marketing, Outreach and Navigators Beth Waldman, Bailit Health Purchasing

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Proposed Approach to Marketing, Outreach and Navigators: Developing Recommendations

Recommendations based on information gathered from variety of sources:

Market Decision reports (uninsured, underinsured, small business, brokers, and non-profit organizations)

Meetings held with brokers, insurers and non-profits in May/June Details from meetings included in

6/24 memo

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Proposed Approach to Marketing & Outreach

1. Develop comprehensive marketing and outreach plan, based on phases:

Pre-Implementation Implementation On-going as needed

Should leverage experience in Catamount Health but consider different populations.

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Proposed Approach to Marketing & Outreach

2. Develop overarching message and branding for Exchange

Consider when, to what extent, and how to weave in single payer goal

Must identify goals, audiences and messages

Convey messages through multiple means (media brochures, fact sheets, public forums, community events)

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Proposed Approach to Marketing & Outreach

3. Hire a marketing firm

Policy experts are not marketing experts

Conduct market research to shape strategies and messages

Potential Approach to Marketing & Outreach

4. Develop strategy for providing more detailed and targeted marketing as implementation nears.

Focus on who Exchange can cover immediately

Reduce fears about who is not impacted by Exchange

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Potential Approach to Marketing & Outreach5. Utilize a multi-pronged outreach and

educational strategy; including: State employees Social service agencies Schools Community-based organizations Private Employers Business Groups Health care providers (hospitals, CHCs, physicians) Health Insurers

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Potential Approach to Marketing & Outreach

6. Marketing must include a targeted focus on small businesses

This is essential to success of Exchange

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Potential Approach to Marketing & Outreach7. Targeted outreach and

comprehensive training are essential

Training must be widespread to ensure consistent messaging and understanding

Train the trainers have worked wellMust clearly define and delineate roles of

state staff, call center staff, Navigators and community advocacy staff

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Potential Approach to Marketing & Outreach

8. Where possible, tie education to enrollment

Will enhance access to the ExchangeAllows individuals to apply for program at

time being educated about it

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Proposed Approach to Navigators

1. Navigator Program should be central to education and outreach effort

Provide both general and specific information

One-on-one assistance available, as needed:

By phone By email By internet In person

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Proposed Approach to Navigators

2. State funds are needed for the Navigator program; enhanced funding should be made available up front

More robust navigation assistance will be required up front.

Need for Navigators will continue beyond initial enrollment

Proposed Approach to Navigators

3. Navigators should have capacity to serve clients over the phone, by mail and in person.

While in person service can be helpful, not all consumers will require face to face interactions

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Proposed Approach to Navigators

4. Navigator function must be well-coordinated with state and call-center staff

Clear role definition and training is essential

Consumers and employers need consistent messages

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Proposed Approach to Navigators

5. Navigators will need to utilize different approaches for different populations

Cannot have one size fits all approach for individuals and businesses

May need different entities to serve as Navigators for different populations

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Proposed Approach to Navigators

6. State has flexibility on how to contract for Navigator services Navigators must be paid through grants State can take a number approaches to

contracting: Hire staff directly Contract with individuals and/or organizations;

with state staff managing vendors Contract with individuals and/or organizations;

with single entity managing Navigator program

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Proposed Approach to Navigators

7. Navigators must receive significant training Either licensure or certificate of training

should be required to begin Continual training should also be

required Navigators should also provide

feedback to the State

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Proposed Approach to Navigators

8. State should not automatically include or exclude any particular type of entity as Navigators Focus should be on clearly defining role

in terms of specific skills and outcomes State should develop an RFP to hire

qualified individuals and agencies Serve individuals and/or small businesses Serve statewide or regions

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Proposed Approach to Navigators

9. Navigators should be measured based on performance and outcomes

Payment must be through grants, but some portion of payment should be tied to outcomes

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Questions/Input/Next Steps

Questions

Public Input

Next Steps in Process: Awaiting federal proposed regulations on Exchanges Draft full Exchange Design Draft Implementation Plan Draft Implementation Grant (Level 1)

Next Meeting: September 12, 2011