The Board of the California Health Benefits Exchange met for the ninth time today. New to the dais today was the newly hired Executive Director, Peter Lee.
The first substantive discussion held in open session was the adoption of the Vision, Mission, and Values of the Exchange. Lee prefaced the review of the proposed language by saying that words are important, process were important–and that the results that the Exchange eventually achieves are the true measure by which their success would be evaluated.
Peter Lee suggested several changes up front, and then suggested others after the Board heard and discussed comments made by stakeholders.(Health Access was pleased that many of the suggested changes were taken.) The language modified and adopted (to my best ability to follow) is:
Improve the health and health care and its affordability for all Californians
The California Health Benefit Exchange will increase the number of insured Californians, improve quality, and lower health care costs by facilitating and innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.
Consumer Focused: The exchange puts the people it serves – including patients and their families, small business and their workers – at the center of its efforts, recognizing the diverse cultural, language, economic, educational and health status needs of Californians, and provides an easily accessible, consumer friendly experience for all.
Affordability: The Exchange will promote affordability while assuring the accessibility and quality in providing health insurance across the entire state.
Catalyst: The Exchange will foster innovation in the provision of high-value health care, the promotion of prevention and wellness, and the reduction of health disparities, through insurance coverage and stimulating change in the health care system.
Integrity: The Exchange will earn a reputation for trust, speed, agility, responsiveness, reliability, cooperation, accountability and transparency.
Partnership: The Exchange welcomes and will actively work with consumers, providers, health plans, employers and other purchasers, government partners, and others to help shape and guide its efforts.
Results: The exchange will measure its results based on how it contributes to expanding coverage and access, promoting better health, wellness and health equity, and reducing costs for all Californians.
(Please check the Exchange website for the official version once it is posted)
The Board also discussed a number of the proposed federal regulations related to health reform, and in particular the comments that the Board of the Exchange has or will be submitting in conjunction with the DHCS and MRMIB. The various entities felt it appropriate to coordinate their response as they will be taking some of these actions together.
The Board’s consultants flagged a number of issues for the Board that the state should weigh in on. Among those were the process by which individuals will be screened for eligibility for new coverage programs. Additionally, the Board looked at rules that govern how the affordability subsidies will be calculated, handled, disbursed, and reconciled. Key issues include the calculation of affordability, particularly in cases where dependent coverage is unaffordable but not taken into account, as well as COBRA. Other issues raised by stakeholders included the role of brokers and the importance of measures to mitigate adverse selection. The Board delegated authority to the Executive Director to finalize and submit comments at the end of the month.
The last item that the Board discussed today was the design of the IT systems to partner the Exchange, DHCS, and MRMIB, which is temporarily being called the California Affordable Coverage Enrollment System. Staff emphasized that this discussion, meant to frame the solicitation of IT vendors, is simply a discussion of systems, business processes and functionality. Mr. Lee also shared the staff’s timeline – he expects that in the next month or 6 weeks, staff will have draft specifications out for public comment in hopes of having an RFP out by the end of the year. The confusing discussion served to underscore the complexity of implementing the back end of a “no wrong door” eligibility and enrollment system. Perplexity revolved around whether a single application would be used for enrollment statewide, or whether different applications would feed into a single portal, and whether this decision needs to be made prior to IT systems being built. Consumer advocates contend that the IT systems can not be thought of without the context of the consumer experience, no matter what their diverse needs and with an eye on the needs of the system in the future, not just the immediate implementation deadlines.