California Health Benefit Exchange Vision and Mission The vision of the California Health Benefit Exchange is to improve the health of all Californians by assuring their access to affordable, high quality care. The mission of the California Health Benefit Exchange is to increase the number of insured Californians, improve health care quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value. California Health Benefit Exchange 1
California Health Benefit Exchange Values Consumer-focused Integrity At the center of the Exchange ’ s efforts are The Exchange will earn the public ’ s trust the people it serves, including patients and through its commitment to accountability, their families, and small business owners and responsiveness, transparency, speed, agility, their employees. The Exchange will offer a reliability, and cooperation. consumer-friendly experience that is accessible to all Californians, recognizing the Partnership diverse cultural, language, economic, educational and health status needs of those The Exchange welcomes partnerships, and its we serve. efforts will be guided by working with consumers, providers, health plans, employers and other purchasers, government Affordability partners, and other stakeholders. The Exchange will provider affordable health insurance while assuring quality and access. Results The impact of the Exchange will be measured Catalyst by its contributions to expanding coverage and access, improving health care quality, The Exchange will be a catalyst for change in promoting better health and health equity, and California ’ s health care system, using its lowering costs for all Californians. market role to stimulate new strategies for providing high-quality, affordable health care, promoting prevention and wellness, and reducing health disparities . California Health Benefit Exchange 2
Timeline for California Health Benefit Exchange California Health Benefit Exchange 3
Major Issues before the California Health Benefit Exchange Major Issues: • Business, Operations, and Financial Sustainability • Enrollment & Information Technology • 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 All supported by: • Alignment and coordination with State partners • Stakeholder Consultation • Research and Analysis California Health Benefit Exchange 4
The Exchange’s Process for “Evidence-Based Policy Making” 1. Legal Scope • Regulatory requirements • Prohibited approaches • Allowable alternatives 2. “ Just the Facts ” • Current California activities • California and National relevant data 3. Stakeholder Perspectives 4. Options and Recommendations 5. Detailed budget and timeline for Level II grant California Health Benefit Exchange 5
California Health Benefit Exchange 2012 Working Discussion and Decision Calendar February March April Information & Discussion: Information & Discussion: Information & Discussion: Quality Health Plan and Outreach and Assistance Basic Health Program Delivery Reform Landscape Landscape Options and Implications • Plan Designs • Report on outreach input • Benefit Designs • Eligibility and enrollment Service Center Options • Provider Contracting estimates • Delivery Reform • Outreach Models SHOP Landscape • Assistance Models Working Timeline California Health Benefit Exchange 6
California Health Benefit Exchange 2012 Working Discussion and Decision Calendar May June July and future months Information and Discussion: Decision: Decision: 1. Scope/options for outreach 1. Outreach and 1. QHP and Ben. and communications communications plan Design Policies 2. Options for Assisters scope/nature 2. Assister/ Navigator 3. Options for 2. Assisters and broker scope, Training and branding/campaign policies and budget Oversight 4. Options for SHOP 3. SHOP Policies (as needed Solicitation 5. Options for Qualified Health for Level II Grant and Plan strategies that impact Alignment with QHP Level II policies) 6. Rough of Level II Grant 4. Level II Grant (2013-2015 (2013-2015 Budgets and Budgets and operations plans with completed Draft plans) Components) Working Timeline: the Exchange Board to consider need for multiple meetings for option presentation/discussion in May or early June. California Health Benefit Exchange 7
Communications, Outreach and Assistance: Major Decisions 1. Scope and Nature of Outreach and Marketing 2. Targeted Outreach and Enrollment Support (public program “transfer” and capturing change of life circumstance) 3. Scope and Nature of Individual Assistance a. Service Center b. Navigator / Assisters c. Brokers 4. Ongoing Stakeholder Engagement Structures and Processes 5. IT and CalHEERS a. Assuring first class consumer experience b. Provider Directory California Health Benefit Exchange 8
SHOP: Major Decisions 1. Benefit Designs 2. Employer Benefits Administration 3. Plan Selection, Participation and Management 4. Marketing and Promotion 5. Employer / Employee Rules 6. Business Model 7. Manage or Contract Out California Health Benefit Exchange 9
Plan and Benefit Designs: Major Decisions 1. Benefit Designs 2. Plan Selection and Performance Standards 3. Reinsurance, Risk Adjustment, Risk Assessment and Consistency of Offering Rules 4. Plan selection and contracting standards to promote enrollment, effective delivery of needed care, reduction in disparities and affordability 5. Building blocks for delivery system reform 6. Plan assessment fee structure See “Stakeholder Questions: Developing Qualified Health Plan, Benefit Design and Delivery System Reform” at www.hbex.ca.gov. California Health Benefit Exchange 10
Plan, Benefit Design and Delivery Reform Landscape Sessions Panel 1: Overview of the California Market, Regulatory Structure and Major Purchasing Strategies • Marian Mulkey, California HealthCare Foundation • Deborah Kelch, Consultant/CHCF • James Robinson, UC Berkeley Panel 2: Purchasing In Action: Examples of Major Purchasing Strategies and Consumer Reactor • Suzanne Delbanco, Catalyst for Payment Reform • Anne Boynton, CalPERS • Betsy Gilbertson, Hotel Employees and Restaurant Employees International Union (HEREIU) Welfare Fund • Jon Kingsdale, Wakely Consulting (former Director Mass. Connector) • Elizabeth Abbott, Health Access Panel 3: Plan, Provider and Consumer Reactors • Charles Baachi, California Association of Health Plans • Duane Dauner, California Hospital Association • Dustin Corcoran, California Medical Association • Donald Crane, California Association of Physician Groups • John Arensmeyer, Small Business Majority • Ellen Wu, California Pan-Ethnic Health Network Public Comment California Health Benefit Exchange 11
For More Information: Visit our website at http://www.hbex.ca.gov And join our listserv California Health Benefit Exchange 12
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