CONNECT FOR HEALTH COLORADO STRATEGIC PLANNING PROCESS. Board of Directors Meeting March 9, 2015

Transcription

1 CONNECT FOR HEALTH COLORADO STRATEGIC PLANNING PROCESS Bard f Directrs Meeting March 9, 2015

2 Table f Cntents Planning Prcess Timeline Value Prpsitin Reprt-ut Business Cases in Prcess Plicy Directin & Decisins (discussin tday) 2

3 Planning Prcess Annual Plan Garner External Input Legislatrs State Partners Advisry Grups Brkers, HCG s, Carriers Industry experts Garner Internal Inputs Bard f Directrs Envirnment Scan Internal staff, cntractrs Identify Value prpsitins, critical assumptins Data Analyses Cmpile existing analyses (e.g. staffing gaps/plans) Financial reviews Key metrics analyses (e.g. service center) Strategic Directin Define & answer plicy-level questins Synthesize int required business cases Define utcmes, strategies and metrics Translate lng-term strategic directin & financial plan Staff drafts 2015/16 strategic plan & budget Recmmend fr Bard apprval and Legislative Cmmittee review 3

4 Timeline March April May June Input, Analyses & Business Case Dev., Final Plan (3/1 3/15) Budget (3/1-5/1) Ops & FC (5/15-5/31) Final Bard Apprval LIRC (6/15 6/30) Three mnths t apprve strategic plan, 2016 C4HCO fee rates and budget. Legislative Implementatin Review Cmmittee (LIRC) reviews strategic plan and apprves budget by June 30. 4

5 5 Strategy Develpment

6 Strategy Develpment Custmer Value Prpsitin Strategy Business Case T Be Cnstructed Individual: Financial Assist Individual: Nn-Financial Assist 6 Leverage APTC Systems Usability Cmpetitive Pricing Plan transparency Custmer Aggregatin Health Literacy Access t Private AND Public Public Insurance Thru C4HCO?? Pint t Right/Best Dr?? Cnduct Strategic Directin Planning Becme an MA Site (CBMS) Right-size Custmer Service<> Resurces Enhance Health Insurance Literacy Increase NFA sales vlume Imprve Shpping<>Mdeling Institute Quality Ratings Requirement Finance Value Prpsitin Strategy Sustainability Cnsumer Cst/Value Mdel Sustainability Optins Capital Re-Investment Business Efficiency Assess Optimal Fee Structures Ancillary Value Delivery Efficient Capital Investment Cnduct Vendr & Partner re-bids Cmpliance Fund depreciatin/capital reinvestment Tighten Cmpliance Prcesses Business Systems/Prcess Value Prpsitin Strategy Marketplace Shared Eligibility System EDI Carriers Financial Systems Channel Supprt Privacy Cmpliance & Oversight Functinality & Usability t serve Custmers Custmer Service Levels Efficient Marketing & Sales Learning & Grwth Value Prpsitin Strategy Organizatin Design Staff Capacity Aligned Gals, Strategy & Perf. Operatinal & Efficiency Cntinuus Imprvement Staff Capacity Maximized Infrmed Legislatin Develp User-friendly Eligibility Assessment Imprve SLA Management Plug & Play Carrier Cnnectins Tighten Cmpliance Prcesses Increase data-driven decisin-making Cnduct Org Design Prcess Up-level directr authrity & skillsets Medicaid Plicy Interperability Plicy Cnfirmatin Enrllment Targets & Sales (incl. SHOP) Decisin Supprt / hcentive Radmap APTC Impacts Cmpliance / Internal Audit Planning Hsting Plan Release 3.0 Renewal Prcess Carrier Onbarding Strategy Prduct Strategy Architecture Staffing Plan Organizatinal Develpment

7 Strategy Directin: Decisin Tree Example Decisin Tree: Plicy Ppulatins Served? (Private QHP AND Medicaid??) Strategy If Yes, Interperability Maximized: If N, Interperability Minimized: Tactical MA Site Vendr Cmpsitin Call Ctr Strategy Minimal CBMS Access Clarify Call Ctr Handffs Resurces Strefrnt, Branded Medicaid, etc. Highly Integrated 50-75% Match Revenue; Hi Expenses Lwer cst N Revenue, Minimize Csts 7

8 Plicy Directin: Custmer Segments End f pen enrllment findings that suggest C4HCO is nw utilizing 40%+ f its resurces serving nn-private insurance custmers (i.e. Medicaid, CHP+). Questin: Given the statutry missin f Cnnect fr Health Clrad under its enabling legislatin (CRS et seq.) and under the prvisins f the Affrdable Care Act anticipating the frmatin and peratin f state-based marketplaces, wh are the cnsumers Cnnect fr Health Clrad shuld serve? 8

9 Plicy Directin: Custmer Segments Medicaid Supprt & Enrllment: Why is this a questin nw? Missin: Supprting Medicaid t the degree C4HCO is, is beynd Statute Budget: 40-45% f csts spent n Medicaid custmer supprt (est. $10m +/-) Custmer Service: Much cnsumer cnfusin, significant case management, Cunties and HCPF call centers are cnversely fielding APTC questins Capacity: Service Center is increasingly spending its fixed time n Medicaid at the expense f enrlling fr FA, NFA and SHOP System Access (CBMS): The Marketplace des nt have access t CBMS n its wn; must becme a Medical Assistant site (including a literal frnt dr) Channels: Up t 80% f Cverage Guide time is Medicaid supprt (paid fr by C4HCO, CO Health Fdn). Brkers spending 20% f time and nt cmpensated. Brand: The Marketplace is increasingly knwn as a Medicaid supprt ffice and cnfusing the established brand. We are cnflating private and public insurance, as well as respnsible entities, in cnsumers eyes. Gvernance: Unclear relatinships, decisin-authrity, resurce negtiatin 9

10 Plicy Directin: Custmer Segments Cnsideratins: Statutry authrity and intent: Given the statutry missin f Cnnect fr Health Clrad under its enabling legislatin (CRS et seq.) and under the prvisins f the Affrdable Care Act anticipating the frmatin and peratin f state-based marketplaces, wh are the cnsumers Cnnect fr Health Clrad shuld serve? Cre Cmpetencies Custmer Experience System Access Stakehlder Rles: What rles d ther stakehlders (Cunties, etc.) need t play? Resurces, Funding Clarify handling, training, resurce requirements, gvernance, et al Implicatins? 10

11 Plicy Directin: Interperability Questin: Given recent technical and prcess eligibility system challenges, what is the apprpriate level f interperability between Cnnect fr Health Clrad perating as state-based marketplace and Health Care Plicy and Financing? 11

12 Plicy Directin: Interperability Systems Interperability: the Issue Systems effectiveness: eligibility system & interfaces facing technical and prcess challenges; cnsumer trust cmprmised; additinal investment required Budget: Channel csts increased substantially ver expectatins Capacity: Service Center is increasingly spending its fixed time n system issue reslutin System Access (CBMS): The Marketplace des nt have access t CBMS n its wn; must becme a Medical Assistant site (including a literal frnt dr) Channels: Up t 80% f Cverage Guide time is Medicaid supprt (paid fr by C4HCO, CO Health Fdn). Brkers nt cmpensated. Brand: The Marketplace is increasingly knwn as a Medicaid supprt ffice and cnfusing the established brand Gvernance: Unclear relatinships, decisin-authrity, resurce negtiatin 12

13 Plicy Directin: Interperability Cnsideratins: Bard Existing Plicy: On March 12, 2012, the Bard adpted minimum interperability with the state Medicaid/CHP system, including the shared use f an eligibility determinatin system and sharing f custmer data. Custmers: N wrng dr fr medical eligibility (web-based drs) Custmer Experience & Visibility/Management System Design: Single/shared MAGI eligibility prcess fr Private Insurance and Medicaid/CHP+ Assessment vs Determinatin Mdel Gvernance, Change Management SLA s Vendrs in place Investment Made t Date Ttal Cst ging Frward 13

14 Plicy Directin: Interperability 14 Optins: 1) Cntinue with the cncept f minimum interperability define intersectins mre clearly Retain separate eligibility team, call center, appeals, C4HCO wns APTC plicy and requirements D nt enrll Medicaid, d nt becme an MA site, steer Medicaid custmers t MA sites Cnstruct better tls and metrics t track custmer segments 2) Mve t Intermediate level f Interperability Retain separate eligibility team, call center, appeals, C4HCO wns APTC plicy and requirements Becme an MA site, enrll Medicaid, receive up t 75% reimbursement Cnstruct better tls and metrics t track custmer segments s HCPF reimbursement is pssible Increase C4HCO fees t cver the 25-50% we will nt get back frm HCPF 3) Increase Interperability t Maximum with HCPF Systems, Plicies, Gvernance Merge key functins f C4HCO peratins with HCPF and cede respnsibility fr eligibility, plicy, requirements and ther key ACA functins t HCPF. HCPF becmes eligibility arm and fllw their lead with respect t FA custmers, churn, etc. Becme an MA site, enrll Medicaid, receive up t 75% reimbursement Shared service center we take all calls fr all prgrams.

15 Next Steps Given Plicy Directin, Initiate End t End Review Teams identify Decisin Tree cmpnents & ptins Facilitated Team wrk sessins: OIT, HCPF, C4HCO, Vendrs Utilize Cmmittee structures t vet ptins Bard decisin 15