Washington Health Benefit Exchange Hea Health th Equity ty T TAC - - PowerPoint PPT Presentation
Washington Health Benefit Exchange Hea Health th Equity ty T TAC M Mee eeting March 27, 27, 2018 2018 Welcome Agen enda Welcome and Introductions Preview Within Reach Equity Tool: Protocol for Culturally Responsive Organizations TAC
Welcome
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Welcome and Introductions Preview Within Reach Equity Tool: Protocol for Culturally Responsive Organizations TAC Discussion: − Equity Tool − Health Equity Definition Preview 2018 Equity Benchmark Public Comment
Making the connections Washington families need to be healthy.
WithinReach Healthy Equity Assessment Tool Annya Pintak, MSW
2004
WithinReach holds first cultural competency training.
2006
First organizational assessment is completed.
2007
A question about cultural competency is added to the staff evaluation form.
2009
All-staff retreat is held to collaboratively develop a cultural competency vision and goals for WithinReach.
2011
Staff cultural competency orientation process is developed.
2013
A strategic plan for cultural competency is developed as part of the agency’s
2012
The cultural competency committee develops a charter. Cultural competency questions are asked as part of the new executive director all-staff interviews.
2015
A qualitative assessment is done to gather feedback from staff about how they currently implement cultural competency in their work.
2016
Results of the qualitative assessment are analyzed and the process of an
assessment begins as a result. The mission, vision, and definition of cultural competency at WithinReach are re-written to be a clear and concise communication tool.
2000 2005 2010 2015 2020
ICC HISTORY TIMELINE
History of Intercultural Competency/Equity Work at WithinReach
Cultural Competence Statement: WithinReach recognizes, respects, and responds to diversity within
Vision Statement: WithinReach fosters awareness and appreciation of the diversity of our clients, our partners and ourselves. All policies and programs reflect WithinReach’s value of cultural responsiveness to promote health equity. Cultural Competence Definition: Cultural Competence at WithinReach is a commitment to promoting equity through culturally responsive evolution of behavior, policy and
This Protocol was created to assist organizations to improve their ability to serve communities of color. It is a deep dive- covering the full arena of
different domains, a set of 99 standards to establish the ideals for our work, and a set of 109 pieces of “evidence” that support an organization to assert it’s capacity to well-serve communities of color.
Protocol for Culturally Responsive Organizations
Committee of the Coalition of Community of Color
Racial Equity at Portland State University
Phase
“diagnose” one’s status
improvement plan
for a culturally responsive organization
experienced by clients speaking different languages
Board review services for relevance to communities of color
staff in “unlearning” racial bias
Some things to consider:
Who is going to drive the Equity Assessment process? And who will be involved? Identify appropriate Equity Assessment Tool, adapt as needed How will you implement and conduct the Equity Assessment across agency? Process to review equity assessment and integrate results programmatically and organizationally
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work (e.g., equity assessment process or tool)?
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among group members?
Exchange?
coordination at the state level?
strategies?
Health Equity TAC Meeting March 27, 2018 Joan Altman, Associate Director of Legislative and External Affairs
Review of Sept. 2017. v. Mar. 2018 Enrollment Report Data
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Report available at:
https://www.wahbexchange.org/wpcontent/uploads/2018/03/HBE_EN_180322_March_Enrollment_Report.pdf
2017 2018
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Report available at:
https://www.wahbexchange.org/wpcontent/uploads/2018/03/HBE_EN_180322_March_Enrollment_Report.pdf
2017 2018
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Report available at:
https://www.wahbexchange.org/wpcontent/uploads/2018/03/HBE_EN_180322_March_Enrollment_Report.pdf
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Report available at:
https://www.wahbexchange.org/wpcontent/uploads/2018/03/HBE_EN_180322_March_Enrollment_Report.pdf
▪ Enrollment by citizenship
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Report available at:
https://www.wahbexchange.org/wpcontent/uploads/2018/03/HBE_EN_180322_March_Enrollment_Report.pdf 2017 2018 2017 2018
enrollment
stakeholders to improve effectiveness in reaching groups at risk for barriers
reviewed to identify trends) [see appendix for last year’s data]
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– Total 2017 Enrollment (QHP and WAH) was obtained from the HBE March 2017 Enrollment report, includes Healthplanfinder enrollees who identify race in their application (optional field) – Proposed benchmarks are equal to the state non-ESI distribution provided by OFM – The TAC voiced support at the last meeting for using the state non-ESI distribution for the proposed Asian benchmark Metric 2017 Enrollment Enrollment % Proposed Benchmark American Indian/Alaska Native 50,235 3% 3% Asian 91,235 5% 7% African American 122,145 7% 7% Pacific Islander/ Hawaiian 52,318 3% 3%
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– Total 2017 Enrollment (QHP and WAH) was obtained from the HBE March 2017 Enrollment report, includes Healthplanfinder enrollees who identify as Hispanic in their application (optional field) – Hispanic enrollment through HPF (20%) is higher than the general statewide distribution (14%), and slightly lower than the state non-ESI distribution provided by OFM (21.5%) – The proposed benchmark was adjusted downward (from 20%) in response to TAC feedback. Members requested a lower benchmark based on concerns they are hearing from Hispanic residents (notably, that they may disenroll or fail to enroll due to concerns/fears about national immigration policies/providing citizenship information) Metric 2017 Enrollment Enrollment % Proposed Benchmark Hispanic 353,306 20% 18%
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– Total 2017 Enrollment (QHP and WAH) was obtained from the HBE March 2017 Enrollment report, includes Healthplanfinder enrollees who identify age in their application (required field) – Enrollment percent of ‘young invincibles’/under 35 (71%) is a higher percentage than the general statewide distribution (54%) and the state non-ESI distribution provided by OFM (60%) – The TAC supports an enrollment benchmark for enrollees aged 35-44 that aligns with the state non-ESI distribution population. – The enrollment benchmark for ages 45 – 64 (18%) is lower than the general statewide distribution (31%) and the state non-ESI distribution provided by OFM (27%) Metric 2017 Enrollment Enrollment % Proposed Benchmarks under 18 764,346 44% 44% 18-25 212,822 12% 12% 26-34 258,164 15% 15% 35-44 188,101 11% 13% 45-54 160,183 9% 9% 55-64 152,325 9% 9%
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– Total 2017 Enrollment (QHP and WAH) was obtained from the HBE March 2017 Enrollment report, includes Healthplanfinder enrollees who identify in their application that they do not read and/or speak English (required field) – LEP as a percent of total enrollment (6%) is the same as the state non-ESI distribution provided by OFM (6%), and slightly lower than the general statewide distribution (9%) – The benchmark was adjusted downward (from 9%) to account for the current enrollment percentage (6%) reflecting growth of over 5,600 LEP enrollees last year. Metric 2017 Enrollment Enrollment % Proposed Benchmarks LEP 112,524 6% 8%
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– Total 2017 Enrollment (QHP and WAH) was obtained from the HBE March 2017 Enrollment report, includes Healthplanfinder enrollees who identify income in their application (required field for those who choose to be screened for WAH and tax credits) – Enrollment percentage for the WAH eligible population (up to 138% FPL) is much higher (81%) than the state non-ESI distribution provided by OFM (37%) and the general statewide distribution (19%) – Enrollment percentage for 138%+ FPL population is much smaller (18%) than the state non-ESI distribution provided by OFM (60%) and the general statewide distribution (79%)
Metric 2017 Enrollment Enrollment % Proposed Benchmarks Less than 100% 1,144,812 66% 60% 100-137% 252,449 15% 16% 138-199% 159,476 9% 11% 200-299% 106,199 6% 8% 300-399% 27,653 2% 3% 400% or higher 20,445 1% 2%
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Geography Enrollment Enrollment % Population
Population
Non-ESI Population
Non-ESI Population of WA % Proposed Benchmarks Rural 294,854 17% 925,587 15% 437,365 17% 20% Urban 1,439,919 83% 5,211,924 85% 2,122,853 83% 80%
– Total 2017 Enrollment (QHP and WAH) was obtained from running enrollment data through an algorithm provided by OFM that segregates zip codes into rural and urban areas
▪ Background: TAC members reviewed key findings of HBE Disenrollment Report (available here) ▪ Individuals who sign-up but disenroll during the plan year are more likely to (1) have selected a bronze plan, (2) be unsubsidized and (3) be under age 35 ▪ No notable differences by race; ethnicity; gender; citizenship; county; or FPL ▪ Background: TAC members reviewed recent disenrollment data including reasons for termination/disenrollment ▪ The following proposed benchmarks were discussed: ▪ Increase silver plan enrollments for enrollees below 250% FPL ▪ Explore development of a survey specifically for the dis-enrolled population ▪ Continue affordability related health-literacy efforts to educate enrollees about metal tiers and available subsidies
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2017 QHP Enrollment <250% FPL 2017 Silver Plan Enrollment <250% FPL Percent of enrollees <250% FPL who selected a silver plan Proposed Benchmark 94,110 73,579 78% 82%
– Maximizing enrollment of enrollees under 250% FPL in silver plans is expected to decrease disenrollment, because disenrollees are more likely to be in bronze plans and unsubsidized (those in silver plans at this FPL level are currently eligible for a tax credit and cost-sharing reduction) – Percentage of enrollees <250% FPL who selected a silver plan increased from 74% in 2016 to 78% in 2017 – Assumes continued provision of cost-sharing reductions from the federal government
Increase silver plan enrollments for enrollees below 250% FPL
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Month Plan Selection Plan Payment Percent of plans selected for which a payment was made
Nov-2016 162,542 155,354 96% Dec-2016 154,885 147,248 95% Jan-2017 175,157 167,163 95% Feb-2017 188,204 179,778 96% Mar-2017 197,470 187,472 95%
▪ Churn occurs when:
▪ QHP enrollees become eligible for WAH auto-enrolled into a WAH plan if no plan selected ▪ WAH enrollees become eligible for QHP not enrolled in a QHP unless a plan is selected and payment submitted
▪ In depth churn study conducted in January 2016 (available here) ▪ Churn to and from QHP/WAH is tracked on a monthly basis, and included in bi- annual enrollment report
▪ Churn affects small portions of the enrolled population ▪ Average monthly churn from WAH (Medicaid) to QHP, is higher than from QHP to WAH ▪ Highest churn from WAH to QHP occurs at the beginning of the plan year
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Month
3/1/2016 4/1/2016 5/1/2016 6/1/2016 7/1/2016 8/1/2016 9/1/2016 10/1/2016 11/1/2016 12/1/2016 1/1/2017 2/1/2017 3/1/2017
QHP - Medicaid
1,265 1,204 981 1,042 869 1,083 1,056 1,196 3,904 4,261 1,758 826 589
Medicaid - QHP
2,444 2,150 2,026 1,821 1,785 1,728 1,829 1,782 1,727 1,857 5,010 3,676 2,289 Month 3/1/2016 4/1/2016 5/1/2016 6/1/2016 7/1/2016 8/1/2016 9/1/2016 10/1/2016 11/1/2016 12/1/2016 1/1/2017 2/1/2017 3/1/2017 QHP -Medicaid 0.69% 0.69% 0.57% 0.61% 0.51% 0.65% 0.63% 0.71% 2.33% 2.62% 1.14% 0.47% 0.31% Medicaid - QHP 0.16% 0.14% 0.13% 0.12% 0.12% 0.11% 0.12% 0.11% 0.11% 0.12% 0.32% 0.24% 0.15%
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Former WAH consumers with QHP eligibility Former WAH consumers enrolled in QHP Percent Benchmark 6,295 1,930 31% 33%
▪ Annual Navigator survey ▪ Annual Health Literacy Survey ▪ Annual Tribal Assister survey ▪ Bi-Annual LEP survey ▪ Annual TAC survey ▪ CMS Carrier Customer Service Survey
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Survey Audience Topics How Results Improved Effectiveness Navigators – Assistance provided to vulnerable or hard-to-reach populations – Service gaps (immigrants; low-income; LEP; homeless; AI/AN; etc.) – Language barriers – Health literacy – Enrollment barriers – Healthplanfinder – Assister training and support – Implemented Healthplanfinder changes in April that give Navigators the ability to manage partnerships without assistance – Improved Navigator support (e.g., New Lead Org RFP includes a provision that enhanced user support will be available to navigators in real time) – Improved/streamlined training – System improvements (e.g., shopping tips) – Budget request for increased outreach and marketing Health Literacy – Health literacy challenges – Eligibility and enrollment process – Insurance concepts – Plan selection – Post OE challenges – Customer resrouces – Improved plan selection tools being implemented in next release (tools to narrow options, search for multiple providers, drug look-up) – Improved marketing of in-person help and new mobile feature to find in-person assistance using geolocation services – Continued focus on simplifying language on HPF and notices Tribal Assisters – AI/AN materials/information – Healthplanfinder – Assister training and support – Improved Call Center support services for AI/AN enrollees and assisters – Improved application support – Recommendations for improved tools and resources
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Survey Audience Topics How Results Improved Effectiveness Dental Survey – Barriers to payment – TBD Limited English Proficient (LEP) Customers & Community Partners – How often language assistance services are being used – Should be changes in the way services are provided
– Are the language assistance services in place meeting the needs of LEP communities – TBD TACs and Workgroups – Role of Committee and sharing HBE policies – Exchange priorities – Committee/workgroup support – Areas for improvement – TBD CMS QHP Enrollee Experience Survey – Carrier customer service – Access to care (clinical measures; language access) – Customer demographics (race; ethnicity) – Informs Quality Rating System (QRS) displayed in Healthplanfinder
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8 9 21 17 13 18 22 53 43 38 36 40 22 42 63 58 42 68 30 62 54 93 59 32 20 40 60 80 100 Oc t-16 No v-16 De c -16 Ja n-17 F e b -17 Ma r-17 Offic e o f the I nsura nc e Co mmissio ne r (OI C) Re c e ive d WAHBE Co rpo ra te We b site Re c e ive d OI C/ WAHBE Clo se d OI C/ WAHBE Ope n
Custome r Complaints – OIC / WAHBE Cor por ate We bsite
Sour c e 1 2 3
Co rpo rate We b site – Custo me r Co mpla ints E nro llme nt Pla n Ca nc e lla tio n Pa yme nt/ Invo ic e OIC – Custo me r Co mpla ints E nro llme nt T a x Cre dit/ E lig ib ility 1095-A Co rpo rate We b site – Se a rc h* 1095-A Sig n In De nta l
Custome r Se r vic e Ke y Issue s
*Of the # 3,441 (3% o f to tal visito rs) who use the se arc h func tio n o n the c o rpo rate we b site – ke y te rms b e ing se arc he d.
reviewed to identify trends)
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Reason Code Jan Feb Mar Apr May 1095-A Issues 1 3 5 2 Eligibility/Tax Credit Issues 7 8 10 5 2 Enrollment Issues 16 14 11 5 Other/Feedback 6 3 3 3 1 Payment/Invoice Issues 1 1 Plan Cancellation/EDI Issues Tax Credit Reconciliation 1 Technical Issues Password/Outage 2 3 3 1 Reason Code Jan Feb Mar Apr May 1095-A Issues 1 2 2 Eligibility/Tax Credit Issues 3 5 1 5 1 Enrollment Issues 10 1 8 5 3 Other/Feedback 1 2 1 Payment/Invoice Issues 1 2 3 1 1 Plan Cancellation/EDI Issues 4 7 Tax Credit Reconciliation 2 Technical Issues Password/Outage 1
WAHBE Received Complaints OIC Received Complaints (referred to WAHBE)
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