CoveredCA_PromotingQualitySlide

Covered California Board Meeting: Highlights from August 20, 2015

This Covered California board meeting featured a discussion of a vision benefit proposal and agents’ payments and responsibilities, both for action next month; the release of rates for 2016, an update on the redesigned navigator program; and a hearty welcome to new Board member and former Senator and Democratic Party Chair Art Torres (see his bio).

Executive Director’s Report

  • New rates for 2016 calendar year: Preliminary rate filings show an average rate increase of around 4%, which is lower than historical norms. Where there is greater market competition, as in Los Angeles, we find a smaller increase in rates (1.8%).  Covered CA Executive Director Peter Lee urged consumers to shop for better rates and network access in 2016–folks switching to the lowest cost plan could see a decrease of 5 or even 10% in premiums. Our Beth Capell noted that while previously these rates were opaque and unknowable, Covered CA is now publishing the “Kelly Blue Book” of preliminary rates (subject to regulatory review). This good news (see extensive press coverage) affirms Covered CA’s leadership as an active purchaser exchange that maximizes value for consumers through standardized benefits.  All told, Covered CA’s says its negotiations with the plans saved consumers $200 million for the 2016 plan year. State regulators (mostly at the Department of Managed Health Care (DMHC) are reviewing the rate filings. Consumers Union and other consumer advocates will submit comments on the rates.
  • Health Care Quality Reporting: The 2016 plan year will be the first where consumers will be able to weigh quality ratings on a 5-point scale (not 4-points) based on satisfaction scores of actual Covered CA enrollees. After that, quality ratings will be based on both satisfaction scores and clinical measures of quality—though the latter will be calculated by CMS. Covered CA looks at a number of quality measures when it selects plan for participation (see this blog’s featured slide), including integration and coordination of care, managing chronic diseases, addressing health disparities, and prevention and wellness programs. In the comments portion, several advocates highlighted the importance of oversampling and other approaches to improving health equity. California LGBT HHS Network Director Kate Burch urged Covered CA to look at how the Office of Patient Advocate handles reporting quality measures: If consumers want more detail they can dig deeper on a given measure.
  • Navigator Grant Program Update Post-Redesign: Lee described a much redesigned navigator grants program as federal funding for it is replaced by funding based on premium assessments. Of the more than 100 organizations that applied for the $10 million in funding set aside for targeted enrollment and retention activities, 69 navigator entities (supporting 1,755 certified enrollment counselors)) have been selected.
  • Difficulties with enrollment processes and timely response to hearing decisions: Lee responded to a comment letter from Health Consumer Alliance outlining the many lingering issues faced by consumers, including difficulties with enrollment, too many open or unresolved tickets, implementation of ALJ (Administrative Law Judge’s) decisions, and errors with tax forms by re-affirming Covered CA’s commitment to addressing such issues. Lee has formed a workgroup to address these problems.
  • Positive Coverage of Covered CA: Lee called our attention to a NY Times editorial saying California is proving health reform is not only working but offering a model for the nation. According to the pharmaceutical industry-sponsored National Health Council, Covered CA has thus far done a good job on patient-centeredness, but could do better with transparency on out of pocket costs (see report). Further progress on this front, notes Lee, will have to wait until the 2017 calendar year.

Policy Items (Recommendations for Formal Board Action in Early October)

  • Adult Vision Benefit through Covered CA: Covered California is considering offering a link to be able to purchase vision coverage–essentially a portal to individual vision services providers–despite concerns raised by Western Center on Law and Poverty, Health Access, and other partners that such an offering could erode the Covered CA brand by or possibly mislead consumers by connecting them to a non-negotiated, non-standardized benefit of unknown value. For LEP (Limited English Proficiency) consumers the vision services offering could bring additional confusion, says Doreena Wong of Asians Advancing Justice.  Another concern, raised by Jen Flory of Western Center on Law and Poverty, is that consumers shopping for vision services may be directed away from the regular enrollment process and not come back to the site to complete their primary enrollment in a Qualified Health Plan.  The Health Plan Advisory Committee will continue work on this proposal for final action by the Board in October.  After that the roll out of the vision services portal could potentially move very fast. Over time this program can evolve toward the preferred active purchasing approach to procurement.
  • Insurance agents’ payment and responsibilities, including the interface with Medi-Cal. Starting in January 2016 the definition of small groups will change from the current 1-50 to 1 to 100, but the commission structure for the 1-50 groups will remain the same. Agents enrolling any businesses in the 51-10- range till be 5%. Agents’ involvement in Medi-Cal enrollment will be the main topic for the August 28 meeting of the Plan Management Advisory Committee. That so many Medi-Cal enrollees and potential enrollees are from mixed status families makes this an extra critical area of concern.

Covered CA meetings will resume October 8—the September meeting is cancelled, though most of the advisory committees (Plan Management, Marketing/Outreach, and Small Business/SHOP) will meet in September and generally on a monthly basis (see full meeting schedule).

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