Path to Success Presented to Maryland Health Benefit Exchange Board - - PowerPoint PPT Presentation

A service of Maryland Health Benefit Exchange

Path to Success

Presented to Maryland Health Benefit Exchange Board of Trustees Rebecca Pearce Executive Director

Tremendous interest

– Over 400,000 unique website visitors – Over 54,000 phone calls to our call center – Over 50,000 accounts created with verified identity – Over 30,000 applicants have had their eligibility determined

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Data Overview

Many Marylanders have been able to use website; but many have been frustrated by technical challenges We have made a number of changes

– Addressed user experience issues such as phone number and zip code formats – Updated overall capacity to support the volume of users – Created easier access to plan browsing for account holders – Improved eligibility for special populations (i.e. non-parent caretakers) – Improved plan shopping and check the cost of plans experiences

However, we are not satisfied with website or with pace of improvement

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Status

New resources on project We have worked to define path to greatest improvement and service to Marylanders over the next 6 months Key goals:

– Continue to improve user experience and functionality of the system – Assurance of eligibility determinations – Support enrollment transactions to & from carriers (834 file) and managed care organizations (8001 file)

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Path to Success

Additional resources now focused on addressing additional performance and software gaps in the system Examples of areas to be addressed include:

– Slow speeds during of peak usage – Difficulty for some users to see health plans – Consistent end-to-end experience for all supported browsers

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Focus: User Experience

When we launched, we gave all users examples of certain scenarios that might not be accurate. We have completed significant testing of existing eligibility determinations with a high level of confidence. Regular reviews, additional upgrades to the software, and

• ther steps underway

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Focus: Assuring Eligibility

An 834 file gets passed to carriers to confirm enrollment into a qualified health plan, and an 8001 file is passed to confirm enrollment into Medicaid. With support from carrier community modified 834 file format to be in line with CMS version 1.6 (Released September 2013) File to be sent to carriers mid-November

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Focus: Support enrollment transactions

To maximize our chances of success, we need to focus on these three issues. This means that we need to look at everything else in the project and find the right time frame for implementation. Principles for this review:

– Alternatives available to Marylanders – Impact on Marylanders – Ways we can support Marylanders in advance of a fully IT solution

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Path to Success

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SHOP

Background

• Small group market strong in MD
• Same prices inside and outside SHOP
• SHOP Exchange expected to start slow and grow slowly: Less than 10K enrollees

expected Support / Considerations

• Waiting until 4/1 would allow MHBE to properly test solution internally and externally
• Would allow TPAs time to build their solution to work with MHBE
• Feedback from Broker Advisory Committee is in full support of delay to allow proper

time for testing and training

• Tax credits will not be lost – available for 2 years from first receipt

Recommendation: Plan to launch SHOP 4/1

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Collection of First Payment

Background

• Not required of exchanges
• ACA requires ability for individuals to pay carrier directly
• Policy decision to take first payment was made by board in 2012 to complete “sale” for

individual Support / Considerations

• Carriers are expecting to collect first payment from individuals so minimal impact on

carriers

• Removes Maryland Health Connection from transaction
• Will require consumers to complete enrollment online a few days earlier

Recommendation

• Forego collection of first payment at this time; add when we can

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Provider File

Background

• Not required of state-based exchange
• Working with CRISP, we have developed a consolidated provider file to include in the

plan shopping process within MHC

• Due to some technical issues, not currently available on MHC
• CRISP created solution outside MHC with same information on separate site

Support / Considerations

• Allows people to search for their current provider to confirm he/she participates in a

plan

• File is only as good as the information received from carriers

Recommendation

• Have development team continue to work to implement on MHC, but behind the work

needed to complete required core functions

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Background

• MHC is intended to be in both English and Spanish
• Currently, site is in two components: (1) MHC Front End and (2) MHC Application
• Both are in English

Support / Considerations

• We can launch Spanish translation of front end within a couple of weeks, allowing them

to complete many pre-enrollment activities.

• We can translate application once changes are made and system is stable
• We can strengthen phone and in-person Spanish assistance to help Spanish speakers

until the full translation is available Recommendation

• Implement MHBE front end Spanish version as soon as possible
• Notify users as they move from (1) to (2) that the application is in English.
• Direct users to the call center (with Spanish speaking reps) or to CE’s with Spanish-

speaking navigators; supplement these resources as possible

Spanish Translation

We will stakeholders informed on key decisions and progress We will inform board of any major changes

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Next Steps