Vermont Health Benefit Exchange

1. Vermont Health Benefit Exchange Advisory Group Meeting 4 Monday, June 27, 2011

2. Today’s Meeting • Updates on H.202 Implementation – Robin Lunge • Review of Basic Health Program Analysis • Amy Lischko, Tufts University • Proposed Approach to Marketing/Outreach and Navigators • Beth Waldman, Bailit Health Purchasing

3. Today’s Meeting • Updates on H.202 Implementation – Robin Lunge • Review of Basic Health Program Analysis • Amy Lischko, Tufts University • Proposed Approach to Marketing/Outreach and Navigators • Beth Waldman, Bailit Health Purchasing

4. ACA Basic Health Program Option for states to implement a program for people 134-200% FPL (outside the Exchange) Must include essential health benefits and consumers may not be charged more than what they would have been charged in the Exchange State receives 95% of the premium tax credits and cost sharing subsidies for each person covered under the Basic Health program Must establish a managed care system with care coordination, incentives for preventive services, etc. What is the Basic Health Program? 4

5. Options Analyzed for Vermont regarding Basic Health Program Do not establish a Basic Health Program and move all adults above 133% FPL from VHAP and Catamount to Health Benefit Exchange Transition VHAP, Catamount, and Dr. Dynasaur adults between 134-200%FPL to new Basic Health Program 5

6. Steps to Estimate Costs of Implementing Basic Health Program Determine eligible population Consider take-up rates Estimate revenue state will receive: From 95% subsidy towards silver private market premium, and Cost sharing subsidy amount Estimate cost of Basic Health Program 6

7. Assumptions Used Take-up rates are 50% for uninsured and 90% for transitions from public programs Catamount premiums are used for private market rates and adjusted to mirror actuarial value of plans in Exchange Administrative costs are assumed to be 20% in private plans and 15% in Basic Health Program All mandated benefits are in premiums and 2011 premium data are used 7

8. Estimates of Adults Eligible for Basic Health Program in Vermont

9. PPACA Provisions for Tax Subsidies

10. Premium and Cost Sharing Revenue that Vermont would Receive for BHP

11. Financial Impact of Moving People out of Exchange into Basic Health Program

12. Policy Considerations • Continuity of care • Financial protection for consumers • Access to providers • Preferences of consumers • Safety net viability • Effect on Exchange enrollment • Risk selection • Transition to single payer

13. Today’s Meeting • Updates on H.202 Implementation – Robin Lunge • Review of Basic Health Program Analysis • Amy Lischko, Tufts University • Proposed Approach to Marketing, Outreach and Navigators • Beth Waldman, Bailit Health Purchasing

14. Proposed Approach to Marketing, Outreach and Navigators: Developing Recommendations • Recommendations based on information gathered from variety of sources: • Market Decision reports (uninsured, underinsured, small business, brokers, and non-profit organizations) • Meetings held with brokers, insurers and non-profits in May/June • Details from meetings included in 6/24 memo

15. Proposed Approach to Marketing & Outreach • Develop comprehensive marketing and outreach plan, based on phases: • Pre-Implementation • Implementation • On-going as needed Should leverage experience in Catamount Health but consider different populations.

16. Proposed Approach to Marketing & Outreach 2. Develop overarching message and branding for Exchange • Consider when, to what extent, and how to weave in single payer goal • Must identify goals, audiences and messages • Convey messages through multiple means (media brochures, fact sheets, public forums, community events)

17. Proposed Approach to Marketing & Outreach 3. Hire a marketing firm • Policy experts are not marketing experts • Conduct market research to shape strategies and messages

18. Potential Approach to Marketing & Outreach • 4. Develop strategy for providing more detailed and targeted marketing as implementation nears. • Focus on who Exchange can cover immediately • Reduce fears about who is not impacted by Exchange

19. Potential Approach to Marketing & Outreach • 5. Utilize a multi-pronged outreach and educational strategy; including: • State employees • Social service agencies • Schools • Community-based organizations • Private Employers • Business Groups • Health care providers (hospitals, CHCs, physicians) • Health Insurers

20. Potential Approach to Marketing & Outreach • 6. Marketing must include a targeted focus on small businesses • This is essential to success of Exchange

21. Potential Approach to Marketing & Outreach • 7. Targeted outreach and comprehensive training are essential • Training must be widespread to ensure consistent messaging and understanding • Train the trainers have worked well • Must clearly define and delineate roles of state staff, call center staff, Navigators and community advocacy staff

22. Potential Approach to Marketing & Outreach • 8. Where possible, tie education to enrollment • Will enhance access to the Exchange • Allows individuals to apply for program at time being educated about it

23. Proposed Approach to Navigators 1. Navigator Program should be central to education and outreach effort • Provide both general and specific information • One-on-one assistance available, as needed: • By phone • By email • By internet • In person

24. Proposed Approach to Navigators 2. State funds are needed for the Navigator program; enhanced funding should be made available up front • More robust navigation assistance will be required up front. • Need for Navigators will continue beyond initial enrollment

25. Proposed Approach to Navigators • 3. Navigators should have capacity to serve clients over the phone, by mail and in person. • While in person service can be helpful, not all consumers will require face to face interactions

26. Proposed Approach to Navigators • 4. Navigator function must be well-coordinated with state and call-center staff • Clear role definition and training is essential • Consumers and employers need consistent messages

27. Proposed Approach to Navigators • 5. Navigators will need to utilize different approaches for different populations • Cannot have one size fits all approach for individuals and businesses • May need different entities to serve as Navigators for different populations

28. Proposed Approach to Navigators • 6. State has flexibility on how to contract for Navigator services • Navigators must be paid through grants • State can take a number approaches to contracting: • Hire staff directly • Contract with individuals and/or organizations; with state staff managing vendors • Contract with individuals and/or organizations; with single entity managing Navigator program

29. Proposed Approach to Navigators • 7. Navigators must receive significant training • Either licensure or certificate of training should be required to begin • Continual training should also be required • Navigators should also provide feedback to the State

30. Proposed Approach to Navigators • 8. State should not automatically include or exclude any particular type of entity as Navigators • Focus should be on clearly defining role in terms of specific skills and outcomes • State should develop an RFP to hire qualified individuals and agencies • Serve individuals and/or small businesses • Serve statewide or regions

31. Proposed Approach to Navigators • 9. Navigators should be measured based on performance and outcomes • Payment must be through grants, but some portion of payment should be tied to outcomes

32. Questions/Input/Next Steps • Questions • Public Input • Next Steps in Process: • Awaiting federal proposed regulations on Exchanges • Draft full Exchange Design • Draft Implementation Plan • Draft Implementation Grant (Level 1) • Next Meeting: September 12, 2011