Washington Health Benefit Exchange

HEALTH EQUITY TECHNICAL ADVISORY COMMITTEEFEBRUARY 25, 2014

Agenda

▪ Welcome and Introductions (5 min.)

▪ Exchange and Operations Status Updates (20 min.)

▪ Navigator Update (15 min.)

▪ Tribal Outreach Update (15 min.)

▪ Immigration Webinar Follow Up (10 min.)

▪ Language Access Update (10 min.)

▪ Public Questions and Comments (5 min.)

▪ Next Meeting and Adjourn

Washington Health Benefit Exchange

Status UpdateFebruary 25, 2014

Pam MacEwan, Chief of Staff

Status Updates

▪ Trends and Developments

▪ Enrollment

▪ Call Center

▪ Application issues

▪ Transfer of Data to Carriers

▪ Marketing and Outreach

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Trends/Developments

▪ Enrollment continues to climb, especially Medicaid

▪ System functionality improved

▪ Dealing with application errors and eligibility and enrollment problems. Triage system includes individual assistance, escalation, data fixes, and creative manual workarounds.

▪ Retroactive coverage implementation underway

▪ EDI file system improvements and transfer of information to carriers.

▪ Preparation for March 31

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Enrollment Update (as of 2/25/2014)▪ Web and Call Center Data

▪ Unique Visitors – 1,504,077

▪ Accounts Created – 449,935

▪ Call Center Volume – 110,362

▪ Average Wait Times after menu selection – 37 min.

▪ Enrollments Complete

▪ Qualified Health Plans – 101,857

▪ Medicaid Newly Eligible/Coverage Jan 1. – 202,168

▪ Medicaid Previously Eligible but not Enrolled – 102,238

▪ Medicaid redeterminations – 311,670

▪ In-Process Applications

▪ Qualified Health Plans Application (need to pay) – 82,249

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January Call Center Volumes and Staffing▪ Staffing:

▪ 409 CSRs

▪ Attrition rate of 7.1%

▪ Call Volumes:

▪ Approximately 741,000 calls received during operating hours

▪ 623,000 high volume messages played

▪ 107,000 handled

▪ 11,000 abandoned

▪ Daily totals average over 40,000

▪ Wait times are measured at two queues

▪ Initial wait times average less than 2 minutes

▪ Specialty queue wait times average 40 minutes

▪ Duplicate call rate was 68%

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Preliminary February Call Volumes

▪ 525 CSRs

▪ Overall volume of calls is holding at 8,000 to 9,000 a day

▪ The majority of calls are being answered

▪ Duplicate call rate is decreasing

▪ A total of 230 additional network circuits were installed to help decrease the number of calls that can’t get through

▪ Triage system is working well

▪ Calls are handled more efficiently

▪ Abandoned call rate is decreasing from 50% to 8%

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Where We Are - Enrollment DetailsAs of 02/18

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15,315Applications eSigned

but no Enrollment

391,000eSigned and Enrolled

Total QHP :

99,946

15,315

Total Washington

Apple Health :

291,054*

Note: An additional 297,780 individuals had previous Medicaid coverage and completed their

Washington Apple Health enrollment through HPF

Tracking Application Throughput

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100 applications

submitted on 2/14

1 Encountered an HPF

technical error

4 Encountered an

ES Eligibility

Determination Error

95 Receive Eligibility

and Can Enroll

When tracking a set of 100 applications submitted on Friday 2/14:

Client Specialist Team: View from the Front Lines

Role/Responsibilities of Client Specialist team:

1. Complicated and emotionally sensitive enrollment and eligibility issues. Improving the customer experience

2. Governors Office and Legislative Staff RequestsOther High Priority Requests

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Client Specialist Team: Cases Reviewed▪ Shift in Role/Responsibility for Client Specialist Team

▪ Mid November

▪ High Priority Cases

▪ Number of cases resolved:

▪ Internal Staff requests = 2,000 requests

▪ Issues received from call center/IPAs/brokers = 1,500

▪ Governor’s Office = 500

▪ Legislative staff = 250

▪ Partnering state agencies (HCA/OIC) = 300

▪ Leadership/Board = 150

▪ Over 8,000 calls to customers

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Transfer of Data to Carriers▪ The Healthplanfinder sends daily 834 enrollment files and

monthly 820 payment files to QHPs

▪ Over 30 different errors have been identified in the enrollment and payment files since December

▪ Many of these are the result of upstream defects

▪ Some carriers have also had difficulty processing files

▪ Conducted nearly 40 data and manual fixes to correct the data being set to carriers

▪ Correct system to prevent these issues (2/13 and scheduled 2/23)

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Communications▪ Lead Organization Meeting

▪ Improved performance

▪ Additional enhancements

▪ Programmatic future

▪ Advertising and Marketing for the Homestretch

▪ Ads start airing last week

▪ Other events, vehicles in play

▪ Readying for the final push

▪ Assessing Effectiveness

▪ Engaged Weekly

▪ Review of outreach and marketing efforts

▪ Analyses to drive future activity

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System Releases

▪ Summer Release: Focus on auto-renewals for fall open enrollment

▪ Fall Release: Focus on fall open enrollment and user enhancements

▪ User Enhancements prioritized based on what we’ve heard from stakeholders and what we’ve seen in usability testing

▪ Will be discussing approach with Committees

▪ January release: Medicaid shopping

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Washington Health Benefit Exchange

Health Equity Technical Advisory CommitteeNavigator UpdateFebruary 25, 2014

Certified In-Person Assisters

Certified

IPA Lead Organizations and network partners

1,725

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Exchange Update Applications/Enrollments

October through January 31, 2013*

Target

12-31-14

Actual

1-31-13

Total Enrollments (all types) 344,000

IPA Assisted Enrollments – 1/31/14 70,000 106,100

Percent of Enrollments Assisted by an

IPA

25% 31%

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*Preliminary data on Navigator/IPA Program

Lead Organization Enrollments (*preliminary data)

Total Target (12/31/14)

Enrollmentsas of 1-31-14*

Percent of Target Met

Whatcom Alliance for Health Advancement *QHP = 1,880/WA Apple Health = 10,065

11,316 11,950* 106%

Public Health Seattle-King County*QHP = 3,320/WA Apple Health = 20,930

19,180 24,250* 126%

Tacoma-Pierce County Health Department*QHP = 750/WA Apple Health = 6,250

8,050 7,000* 87%

Kitsap Health Department*QHP = 400/WA Apple Health = 1,750

2,520 2,150* 85%

CHOICE*QHP = 1,010/WA Apple Health = 6,090

6,520 7,100* 109%

Cowlitz Family Health Services*QHP = 230/WA Apple Health = 1,820

1,306 2,050* 157%

Clark County Public Health*QHP = 330/WA Apple Health = 1,795

4,596 2,125* 46%

Yakima Neighborhood Services*QHP = 1,025/WA Apple Health = 13,900

3,500 14,925* 426%

Benton-Franklin Community Action Connections

*QHP = 460/WA Apple Health = 5,240

3,036 5,700* 188%

Better Health Together*QHP = 1,950/WA Apple Health = 20,050

10,026 22,000* 219%

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Implementation Update

▪ System issues and our actions

▪ Troubleshooting Guide

▪ Webinars

▪ Weekly update (new issues, resources, HCA)

▪ Lead Org Meetings

▪ Navigator team troubleshooting cases/urgent cases

▪ System enhancements

▪ Navigator “Admin Role” in Healthplanfinder

Lead Organization Update

▪ Performance/reporting data

▪ Limited availability

▪ System limitations – user/organization types

▪ Issues impacting enrollment targets

▪ User access in October-November

▪ System availability/paper applications

▪ Application errors/stuck applications

▪ Unplanned Medicaid renewals

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Board Decision

▪ Retain Navigator TAC

▪ Topics for future work – Navigator program outcomes, consumer satisfaction, transition to 2015

▪ Membership turnover

▪ Establish new Outreach TAC

▪ Recruiting for Outreach TAC - Listserve

▪ Broad scope and membership

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NTAC Accomplishments

▪ Stakeholder Engagement

▪ Guiding principles

▪ Navigator/IPA core competencies

▪ Statewide network structure

▪ Lead Organization responsibilities

▪ Navigator Organization Selection Criteria

▪ Compensation structure

▪ Training

▪ Testing and certification

▪ Data collection

▪ Performance monitoring

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Upcoming Priorities

▪ Reports

▪ Implement New Outreach TAC

▪ IPA/Navigator Recertification Process

▪ Navigator Program post-2014

▪ Compliance Monitoring

▪ Evaluation of 2013-14 open enrollment

▪ Training for 2014-15 open enrollment/system changes

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Washington Health Benefit Exchange

TRIBAL UPDATE

SHERYL LOWE, TRIBAL LIAISON

PAM COWLEY, OUTREACH MANAGER

Overview

▪ Tribal Consultation Meeting Outcomes

▪ The Value of Sponsorship

▪ American Indian Health Commission Tribal Assister Program

▪ The Data We Know

▪ 2014 Outreach Strategies

TRIBAL CONSULTATION OUTCOMES

▪ Clear and shared understanding of

‘consultation’ meaning

▪ Tribal Advisory Workgroup

engagement with leadership

▪ Annual Tribal Consultation

meetings

▪ Use of Tribal Liaison at Policy Level

▪ Tribal engagement in:

▪ 2014 Strategic Policy Issues

▪ Tribal Input into Legislative Issues

▪ Operational issues that impact

Tribes and AI/AN enrollment

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THE VALUE OF SPONSORSHIP

“The preservation of our dreams and our people is deeply

rooted in our health”

• Indian people have the worst health

outcomes overall in WA State

• Insurance is a new concept for some

AI/ANs

• Outreach messages different

• Revenue for underfunded Tribal

clinics/health programs

• Healthy people, healthy systems,

healthy communities

The WHBE Premium Sponsorship Program will allow Tribes to enroll hundreds of AI/AN members in QHPs who would not otherwise take advantage of the opportunity

American Indian Health CommissionTribal Assister Program

▪ Tribal Assister Certification Process

▪ Exam Preparation

▪ 85 Certified Assisters – 23 of 29 Tribes, 2 urban Indian health programs

▪ Tribal Get Covered Workgroup

▪ Weekly Webinars

▪ Average Participation: 30 - 40

▪ Application Technical Support

▪ Zen Desk Ticketing/Troubleshooting Applications

▪ Average Participation: 30 – 40

▪ On-going Training▪ In-Person training for Tribal Assisters

▪ Regional Tribal Trainings

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Preserving

▪ Medicaid Enrollment1

▪ Newly Eligibles: 5,468

▪ Renewals: 6,799

▪ QHP Enrollment (Preliminary)▪ Determined Eligible for QHPs: 2,903

▪ Enrolled in QHPs: 30

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AI/AN ENROLLMENT: DATA WE KNOW

Our Health

1 Washington Apple Health (Medicaid) Enrollment Update Karol Dixon, Health Care Authority; February 14, 2013

2014 Outreach Strategies

▪ Culturally, spiritually appropriate outreach material

▪ Targeting the urban Indian population

▪ Webinars

▪ Tribal Assister Retreat

▪ Regional Tribal Trainings

▪ Increasing Tribal Sponsorship

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Washington Health Benefit Exchange

IMMIGRATION WEBINAR FOLLOW UP

JOAN ALTMAN, SENIOR POLICY ANALYST

Webinar Summary

▪ Target audience:

▪ Any type of community partner or assister working with refugees and lawfully present immigrants.

▪ Participation:

▪ HCA staff co-presented

▪ Over 600 registered participants

▪ Content:

▪ Recent updates to the Healthplanfinder, application tips, common error codes and current workarounds.

▪ To receive the link to the recording please send an email to Kathy.krulich@wahbexchange.org

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Webinar Summary: Main Topics

▪ Immigrant Eligibility under the ACA

▪ Recurring Myths

▪ Lawfully Present Immigrants

▪ System Requirements/Online Application Flow

▪ SSNs

▪ Partnering/Linking

▪ Naming Conventions

▪ Common Error Codes/Challenges

▪ Person ID Matching

▪ Identity Proofing

▪ Other (e.g., SEVIS ID Error)

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Washington Health Benefit Exchange

LANGUAGE ACCESS PLAN UPDATE

JOAN ALTMAN, SENIOR POLICY ANALYST

Language Access Plan Timeline

▪ December

▪ Create working draft that builds both on HEqTAC recommendations and staff feedback

▪ January

▪ Staff review

▪ Manager review

▪ February

▪ Leadership review

▪ Health Equity TAC review

▪ March

▪ Health Equity TAC discussion

▪ External Stakeholder review