Eastern Washington Outreach Coalition February 5, 2013

1. Eastern Washington Outreach CoalitionFebruary 5, 2013 Michael Marchand Communications Director

2. Today’s Agenda • Overview of ACA and Exchange • Exchange Governance and Build • Key Challenges and Upcoming Milestones • Navigator Program Update

3. Impact of the Affordable Care Act • Changes to private insurance, e.g., • Young adults on parent’s policies to age 26 • Prohibit lifetime monetary caps • Minimum spending on medical care (medical loss ratio) • Closes the prescription “doughnut hole” • Expands coverage • Expands Medicaid to 138%* of Federal Poverty Level (FPL) • Exchanges *ACA 133% = 138% due to across the board income disregards

4. Washington HealthPlan Finder Vision: Redefining People's Experience with Health Care Mission: Radically improving how Washingtonian’s secure health insurance through • innovative and practical solutions • easy-to-use customer experience • our values of integrity, respect, equity and transparency • providing undeniable value to the healthcare community (patients, providers, plans)

5. Exchange Basics • Individuals >138% of FPL and small groups (2-50) • Tax credits available for individuals 138%-400% of FPL • Cost sharing reductions available for <250% of FPL • “Qualified health plan” (QHP) offerings • Metallic tiers of actuarial value • Apples-to-apples comparisons for consumers, one-stop shop • 10 essential health benefits • Navigators, agents/brokers, call center

6. Building The Exchange 2013 2012 • Exchange must be certified by HHS • Additional legislative action taken as needed • Open Enrollment begins (October 1) • Board begins governing authority • ESSHB 2319 passed • Deloitte Consulting, signs on as system integrator • Exchange names first CEO and moves into new building • Washington becomes second Level 2 establishment grant recipient, $128 million • Exchange moves onto own payroll and accounting systems • Sustainability plan submitted to Legislature • WA HBE receives conditional approval from HHS/CCIIO to operate the state exchange 2011 2014 • Coverage purchased in the Exchange begins • Open enrollment ends March 31. • Year 2 open enrollment in Oct. • HCA receives one-year $22.9 million grant to design and develop Exchange • SSB 5445 passed creating Exchange as “public private partnership” • Governor names Exchange Board members

7. Who is represented? Employee benefits specialists Health care finance specialists and economists Health consumer advocates Small business representatives Administrators from public and private health care Consumer advocates Health insurance carriers Health insurance brokers Health care providers Tribal representatives Technical experts Consumers Consumer advocates Health insurance carriers Exchange Governance Structure

8. Exchange Board Members Eleven member, bi-partisan board assumed authority on March 15, 2012 Margaret Stanley – Chair, Retired Executive Director, Puget Sound Health Alliance Steve Appel – Farmer, Past President of the Washington Farm Bureau William Baldwin – Partner, The Partners Group Donald Conant – General Manager, Valley Nut & Bolt, Assistant Professor Doug Conrad – Professor, University of Washington Melanie Curtice – Partner, Stoel Rives Ben Danielson – Medical Director, Odessa Brown Phil Dyer – Senior VP, Kibble & Prentice, and Former Legislator Teresa Mosqueda – Legislative & Policy Director, Washington Labor Council *Commissioner Mike Kreidler – Insurance Commissioner *MaryAnne Lindeblad – HCA Director * non voting, ex officio

9. Important Board Policy Decisions Completed • Branding • Criteria for qualified health plans (QHPs) • Premium aggregation • Consumer Rating System • Pediatric Dental Benefits • Sustainability report provided to Legislature • Navigator program Upcoming • Role of agents/brokers

10. Exchange Functions & Services

11. What is a Navigator? • Conducts public education and awareness of QHPs • Distributes fair and impartial information • Facilitates with enrollment • Provides referrals to any applicable assistance, ombudsman or like activity • Delivers information in a manner that is culturally and linguistically appropriate • Executes in a fair and impartial manner • May not be funded with federal grant dollars

12. Who Can Be A Navigator? • At least one community and consumer-focused nonprofit • At least one other: • Trade, industry and professional association • Commercial fishing industry organizations, ranching and farming organizations • Chambers of Commerce • Unions • Resource partners of the Small Business Administration • Licensed agents and brokers • Other public or private entities (including Tribal organizations) and human service agencies

13. Consumer Entry Points

14. Program Development Status • Board approved the Proposed Navigator Implementation Plan • Network Structure • Compensation • Performance measures • Plan posted for public input • Moving forward with RFP Development

15. Navigator Network Tribal Program Individual Navigator

16. Lead Organization Key Responsibilities • Build local Navigator Network • Coordinate outreach and education efforts • Train Navigator Organization staff • Monitor performance and service quality • Submit required Exchange data and reports • Funding agent

17. Navigator Key Responsibilities • Outreach • Community Awareness and Education Activities • Application-Enrollment Assistance • Service Coordination

18. Qualifications • Complete Required Exchange Training • Knowledge and competency-based • Under development • Pass Certification Exam • Ongoing training and recertification

19. Target Population • Broad public education – awareness efforts • Outreach Plan for each service area • Application-Enrollment support to those who need one-on-one assistance • Populations who experience barriers to access

20. Navigator Limitations • Impartial, objective information • Cannot offer QHPs outside open enrollment

21. Compensation Approach • Grant funds for first 18 months (In-Person Assistance - pending) • Exchange compensates Lead Organizations • 50% Performance (Activity) Based and 50% Outcome-Based • Example (next slide)

22. Navigator Contract Example *Add tiers for proportion of target 2 or 3 goal met – not “all or nothing”

23. Navigator Program Timeline

24. Key Challenges • Tight timeline – Oct. 1, 2013 • Federal dependencies and guidance • IT flight path – scope, schedule and budget • Delivery environment • Critical inter-agency interdependencies • Managing expectations • Options deferred to 2.0 • Complex authorizing environment

25. What to look for • New Exchange website, email addresses: wahbexchange.org • Legislative debate on sustainability plan • Late winter/early spring: • RFPs, applications for Navigators, in person assisters, and QHPs • Marketing, outreach to ramp up • System testing to begin, first with other systems (integration testing), then user testing

26. The Future? • The exchange’s role in the marketplace • Data gathering, and business intelligence • Supporting delivery system and other reforms through a QHP rating system • Supporting continuing consumer engagement • Performance reporting

27. More on the Exchange www.wahbexchange.org Includes information about: • Exchange Board • Legislation and grants • Policy discussion • TAC and stakeholder involvement • IT systems development • HHS guidance • Listserv registration • info@wahbexchange.org