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18 Νοε 2013 (πριν από 3 χρόνια και 8 μήνες)

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“Commonwealth Choice” & the
Health Connector Exchange:


Design Issues & Lessons Learned




Kevin Counihan

Chief Marketing Officer


MA Conference on National Reform

and State Exchanges

January 21, 2010


2

Agenda

1.
Overview

2.
Enrollment in Health Connector Exchange

3.
Preliminary Design Issues for Exchanges

4.
Lessons Learned

3


Commonwealth Choice


Roles of Health Connector

Regulator
Procurement
Distributor
4

Commonwealth Choice

Role of Health Connector

Complex Roles:


Regulator


Minimum Creditable Coverage (MCC)


Affordability Schedule


Section 125 Regulations


Procurement


Health Plans


Seal of Approval Benefit Plan Designs


“Subconnector” administration


Distributor


On
-
line Distribution and Enrollment


Broker support

5

Commonwealth Choice


Role of Health Connector



Establish and administer
Commonwealth Choice™
, a
commercial insurance “exchange:”


Evaluate and recommend health plan offerings


Standardized benefit plans & provide Seal of Approval


Provide more affordable coverage options (small
group/non
-
group market merger)



Facilitate access to unsubsidized access to coverage for:


Individuals earning above 300% of FPL


Part
-
time employees


Young adults (age 18


26)


Small groups (1


50 ees)




6


Make Policy Decisions as Authorized by Health
Reform law



Educate individuals, employers, brokers/
consultants about law and Connector products



Digital Marketing


Search Engine Marketing


Pay
-
per
-
Click


Social Networks


Commonwealth Choice


Role of Health Connector (cont.)


7

Subsidized Uninsured

Small Employers

Other?

Non
-
Group


Commonwealth Choice


Exchange and Target Markets

8


Commonwealth Choice: Unsubsidized
Marketplace for Non
-

& Small
-
group

9

Enrollment Process

Vince


Age 37


Lives in Shrewsbury


Uninsured


Wants Non
-
Group, Single Coverage


Wants Good Value in Insurance Purchase


Sensitive to Monthly Costs


Wants MD Choice


Wants Easy Access to Information

10


What benefits do I
want?



How much do I
want to spend?



Location of
MDs/hospitals


Plan A


Plan B


Plan C


Plan D


Selects Health
Plan A


Completes
Online
Enrollment


Picks a PCP


Pays 1
st

Month
Premium



Collects Premium



Sends Vince’s
Enrollment
Information to
Health Plan A



Online Vince:

Sub
-
Connector

Vince

Decision Support Tools:

Health Plan Choices:


Processes
Vince’s
Enrollment


Issues Vince ID
Card to EOC


Prepared to Pay
Claims

Health Plan A

11



Starting List of Design Issues

1. Carrier Bidding & Selection




-

“Managed Competition”




-

Transparency




-

Long
-
term Relationships

12



Starting List of Design Issues

2. Benefits Specification



-

Market Research




-

Encourage Innovation




-

Standardize for Easy Comparison






-

Manage Change

13



Starting List of Design Issues

3.
Remember Customer Needs:


-

Comprehensive coverage


-

Understandable benefits (“I bought what?”)


-

“Affordable” cost


-

Reduce insurance jargon, (where possible)





14



Starting List of Design Issues

4.

Administrative Functions






-

Outreach & Marketing




-

Eligibility Determination




-

Enrollment & Premium Billing




-

Customer Service




-

Appeals





15




Likely Functions of Exchanges


1. Offer Coverage for Target Market Segments (non
-
group, small group,
other?)


2. Specify Plan Designs & Coverage Tiers for unsubsidized coverage


3. Contract with & Sell Health Plans


4. Education, Outreach & Marketing


5. Oversee/Ensure Risk Adjustment


6. Ensure Compliance with Benefit Offering Rules and Requirements


-

Benefits determined by Feds (MCC?)


-

States must reimburse Feds for extra costs due to mandates

beyond MCC



16


Potential Value of Exchanges



1.
Protecting/representing enrollees


2.
Prudent purchasing of health insurance


3.
Choice & “managed competition”


4.
Scale economies in distribution






17

Lessons Learned


Hire Staff who Know Health Insurance Business



Communication Never Ends



Minimum Coverage / Affordability



For Consumers, Keep it Simple

Less = More



Nurture Stakeholder Relationships



Leverage Public/Private Practices