Contracting Update California Health Benefit Exchange Peter V. Lee January 17, 2012
The Exchange’s Process for “Evidence-Based Policy Making” Legal Scope 1. Regulatory requirements Prohibited approaches Allowable alternatives “ Just the Facts ” 2. Current California activities California and National relevant data Stakeholder Perspectives 3. Options and Recommendations 4. Detailed budget and timeline for Level II grant 5. 1 California Health Benefit Exchange
Major Issues before the California Health Benefit Exchange Business, Operations, and Financial Sustainability Enrollment & Information Technology Stakeholder Consultation Research and Analysis Communication Support; Research and Marketing, Outreach, and Education Assisters Strategy Health Plan Management and Delivery Reform Small Business Health Options Program (SHOP) Essential Benefits Basic Health Plan …and many more 2 California Health Benefit Exchange
Communications Support for Outreach and Education Plan and Assisters Program The Board approved Solicitation and Delegated Award in November 2011, valued at $900,000 Joint solicitation in partnership of Exchange, the Department of Health Care Services and Managed Risk Medical Insurance Board Solicitation was informed by input gained in multiple in- person discussions across California and early input on outreach and enrollment 3 3 California Health Benefit Exchange
Communication Project Scope Development of a statewide marketing, outreach and education strategy and plan to reduce the number of uninsured Californians by: Ensuring eligible individuals are aware of their options for subsidized and unsubsidized coverage through the Exchange, Medi-Cal and Healthy Families; Assisting individuals with applying for and retaining coverage through appropriate and eligible program options; and As part of a comprehensive plan, developing outreach and communication strategies that are consumer-friendly, culturally and linguistically appropriate, and use targeted media and other strategies to reach the large and diverse population of Californians. Initial marketing and communications support, branding and design for the California Health Benefit Exchange and its programs to be coordinated with the overall outreach theme. Development of a plan for implementation of an Assisters Program. 4 4 California Health Benefit Exchange
Communications Project Update Released on December 27, 2011 on Website, Bid-Sync and to 12 potential vendors Thirteen additional vendors have also indicated interest Proposals due on January 30, 2012 Planned start date is March 1, 2012 5 5 California Health Benefit Exchange
Solicitation for Health Plan Management and Delivery System Improvement The Board approved Solicitation and Delegated Award on November 2011, valued at $600,000 Statement of Work was developed with input from state partners including Department of Health Care Services, Department of Managed Health Care and CalPERS 6 6 California Health Benefit Exchange
Health Plan Management and Delivery Reform Scope Develop standards and process for certification and selection of Qualified Health Plans for Exchange Programs Develop ongoing program for certification, performance measurement, quality monitoring and compliance for participating QHP’s Develop implementation timeline, process & solicitation packages for Qualified Health Plan selection Recommend strategies for using Exchange programs to improve broader health delivery systems in California 7 7 California Health Benefit Exchange
Potential Delivery System Reform Strategies Developing standards and criteria for qualified health plans (QHPs) that promote quality improvement and desirable delivery system characteristics Aligning quality improvement and reimbursement strategies with other state and/or private purchasers 8 8 California Health Benefit Exchange
Health Plan Management and Delivery Reform Project Update Released on December 22, 2011 on Exchange Website, Bid-Sync and to 11 potential vendors Three additional vendors have been added since the release Proposals due on January 30, 2012 Planned start date is March 1, 2012 9 9 California Health Benefit Exchange
Input into Health Plan and Delivery Reform Planning Exchange to develop questions for stakholder discussions Exchange to hold stakeholder meetings across California Vendor will share draft recommendations through Exchange for public comment 10 10 California Health Benefit Exchange
Health Plan Strategy and Delivery Reform Working Timeline Health Plan Procurement Tentative Timeline Deliverable Date Draft Contractor report with detailed task, timeline and resources that will be needed to support health plan selection and procurement as background to the level II grant application April 15, 2012 Final timeline and tasks provided two weeks after Exchange has delivered input • Draft Contractor combined report and recommendations for health plan certification standards, selection process and for delivery system improvements June 1, 2012 Final reports provided two weeks after Exchange has delivered input • Draft Contractor developed health plan solicitation document and model health plan contract September 1, 2012 Final documents provided two weeks after Exchange has delivered input • Health plan solicitation released October 1, 2012 Health plan solicitation responses are due January 1, 2013 Exchange preliminary health plan selection April 1, 2013 Final selection of Health plans and adjustment of rates July 2013 (TBD) Coverage begins in the Exchange January 1, 2014 11 California Health Benefit Exchange
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