NMHIX Board Meeting, Jan 9, 2015

8/9/2019 NMHIX Board Meeting, Jan 9, 2015

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January 9, 2015

New Mexico HealthInsurance ExchangeBoard Meeting


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1 !elco"e, roll call, con#r"ation o$ %uoru" and a&&ro'al o$ agenda ()hair"an J* +a"ron, M+

2 )hair"ans *e"ar-s . /i" o$ odays Meeting ( )hair"an J* +a"ron, M+

&date on Enroll"ent and 3rant 4unding 2015 ( /"y +owd, )E

6 *e'iew odays /genda ( Jon 7ingsdale, 8h+, !a-ely )onsulting

5 *e'iew o$ 8rogress against 3oals $or 201615 ( Jon 7ingsdale, 8h+, /"y

+owd

: 8ro&osed 3oals $or 20151: ( Jon 7ingsdale, 8h+

; &tions $or &ath $orward ( Jon 7ingsdale, 8h+


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)hair"an J* +a"ron, M+

)hair"ans *e"ar-s


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/"y +owd, )E

&date on Enroll"ent and3rant 4unding $or 2015


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Enroll"ent &date

1;,55:New Mexicans selected a health plan through NewMexicos health insurance exchange between November 15 andDecember 15, 2014

59 &ercent, or approximatel! 10,000 individuals, are customersnew to "e#ellNM

61 &ercent, or approximatel! $,200 individuals, who selected aplan are renewal customers that made change in their householdor plan selection prior to December 15, 2014 %&hose renewalcustomers that didnt ma'e a change in their plan selectionbe(ore December 15 will still be automaticall! reenrolled (or)anuar! 1*

; &ercent have received +nancial assistance to reduce thecost o( their coverage

NoteA M- does not collect previous uninsured.uninsured status, so we do not 'nowwhether these individuals were uninsured or not M- has not provided carrierselections, metal levels, gender or age


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)un 1 /Nov 1

Nov 1

Dec1$

Dec

1 )an

&oda!

*eca& o$ E'ents eading to odays+iscussion

M- indicatedverbal approval o(no=wrong doorsyste" during )une

design review "oard decision to

dela! go/live mplementation

timeline (or existingdesign updatedwith 2015 go/live

Design anddevelopmentprogresses

Design submitted(or (ormal approval

M- indicated need(or (urther

discussion ondesign

M- noti+edNM3 o( need(or s!stemcourse/

correction to asingle=doorapplications!stem andgreaterintegration

pdates made todesign andcorrespondinggrant application

6rant submitted &eam progresses

on +ne/tuning

design

NM3 needs toalign on

pre(erred paththat supportsmission andgoals

6rantapplicationdenied

-wi(tl!developedoptions (or boardconsideration ontechnolog!solutions

2015 budget

reviewed andpotential costsavingsidenti+ed


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*e'iew o$ 3rant /&&lication

&he 6rant 7pplication 8eview 9rocess

:&hree reviewers that independentl! score several sectiono( the application

: 7ll grant applications stand alone reviewers ma! not'now o( previous grant applications

: 7 minimum o( $0 points (rom reviewers re;uired toreceive an! mone!

: "udget negotiations are not intended to change thescore o( the application

: Notice o( decision is issued (ollowing budgetnegotiations


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/&&lication strengthsA: 3o'ernance structure 'ery good: i"e=$ra"es outlined were reasona?le: Bac-ground ele"ents were 'ery strong

)M> $eed?ac- on a&&licationA: In general, so"e sections were "ore detailed than othersD needed "ore

detailed narrati'e on I wor-&lan and cost allocation ie, s&eci#cs on hourlyrates on contractors was not &ro'idedF

: !anted to see "ore G'er?ose and glowing descri&tion o$ &rogress ( didnt&ro'ide enough detail on acco"&lish"ents

: etters attached to the a&&lication indicated state was %uestioning the ?ene#to$ the changes that were re%uired and stated that )M> has already a&&ro'edwith which )M> disagrees

'erall )ontext o$ /&&lication )ycleA

: )M> leadershi& has less a&&etite to continue to in'est in I ( ?ut stronga&&etite $or >BEs: ess "oney a'aila?le o'erall ( only $unded one new technology &ro@ect

/r-ansasF, "ost states recei'ed less than re%uested, un-nown i$ any otherstate recei'ed ero

: )M> ?elie'es that NM has had 15 years to wor- on this detail ( and co"&aredto other states NM wasnt as $ar along

:)M> loo-ed at where a state should ?e in their ?uild a$ter this ti"e and a"ounts&ent to=date and ?elie'ed that NM should ha'e ?een $urther along

*e'iew o$ 3rant /&&lication


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&tion 1

7 -ee' M- approval (or a >ingle=+oors!stem design usingexisting (ederal (unds and develop plan to close delta betweenavailable (unds and cost

" -ee' M- approval (or a new, updated No=!rong +oordesign %modeling a(ter daho* using existing (ederal (unds anddevelop plan to close delta between available (unds and cost

&tion 2

-ee' M- approval (or a 4ederal 8lat$or" ease arrangement

re/allocating some existing (ederal (unds (or other activities%outreach, bro'er support, etc* and update +nancialsustainabilit! plan to pa! (or lease

8ath 4orward &tions $or +iscussionoday


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*e'iew o$ odays /genda

Jon 7ingsdale, 8h+, !a-ely )onsulting


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1 !elco"e, roll call, con#r"ation o$ %uoru" and a&&ro'al o$ agenda ()hair"an J* +a"ron, M+

2 )hair"ans *e"ar-s . /i" o$ odays Meeting ( )hair"an J* +a"ron, M+

&date on Enroll"ent and 3rant 4unding 2015 ( /"y +owd, )E

6 *e'iew odays /genda ( Jon 7ingsdale, 8h+, !a-ely )onsulting

5 *e'iew o$ 8rogress against 3oals $or 201615 ( Jon 7ingsdale, 8h+,

/"y +owd

: 8ro&osed 3oals $or 20151: ( Jon 7ingsdale, 8h+

; &tions $or &ath $orward ( Jon 7ingsdale, 8h+


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*e'iew o$ 8rogress /gainst3oals $or 201615

Jon 7ingsdale, 8h+ and /"y +owd


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Mission . 3oals $or 201615

Mission= to enroll all ;uali+ed New Mexicans in the NewMexico 3ealth nsurance >xchange thereb! improving thecollective health and well/being o( New Mexicans b!(acilitating better access to competitive, a?ordable, high/;ualit!, timel! medical care through greater healthcare

coverage

6oal @1= -tand up and develop the NM3 %individual nongroup and -3A9* with continued re+nement to ensureoptimum (unctionalit! and mar'etplace e?ectiveness

6oal @2= >nroll eligible New Mexicans in the NM3

6oal @xchange

6oal @4= >nsure a +nanciall! viable and sustainable


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3oals $or 201615

6oal @1= -tand up and develop the NM3%individual non group and -3A9* with continuedre+nement to ensure optimum (unctionalit! andmar'etplace e?ectiveness AbBectives

1 -tand up the non/group >xchange and operate bothexchanges soundl!C2 -upport the No #rong DoorE conceptCnroll peoplec* >nsure coverage is in e?ectd* ollectionse* 9a!ments to insurers(* ontinual improvement to each


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6oal @1= AbBectives %cont*

4 9romote ade;uatel! trained, certi+ed and supported3ealthcare 6uides and commissioned bro'ers and agentsto educate and enroll all ;uali+ed individuals andemplo!ersC

5 -upport a rapid real/timeE accurate eligibilit! and

veri+cation & s!stemCG 9romote an e?ective, seamless, and eHcient & s!stemC

$ >ndorse a continuous Fow (rom initial application toenrollment, billing and collections in a selected I39C

9rovide a (ast laneE (or unsubsidiJed shoppers to moveto the issuers website and enroll directl!C

K Develop and deplo! a sel(/evaluation and processimprovement toolsC

108ecruit, train and retain a pro(essional, eHcient andcaring sta?

3oals $or 201615


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:6oal @2= >nroll eligible New Mexicans in theNM3 AbBectives

1 >nrollment=

a* -upport consumers in selecting wisel! among thehealth plans available to them through educationand simpli(!ing the process and options, so the!can con+dentl! and readil! shop (or coverage andenroll

b* 9romote the NM3 to be accessible to wal'/ins,telephone and internet

c* >nsure there are well/trained supported3ealthcare 6uides, customer servicerepresentatives, bro'ers and agents

d* >nsure a No #rong DoorE enrollment strateg! isemplo!ed

3oals $or 201615


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6oal @2= AbBectives %cont*2 Autreach=

b* 9er(orm aggressive and e?ective outreach toma'e eligible residents o( New Mexico awareo( the >xchange, the need (or coverage and

the availabilit! o( subsidiesCc* Motivate eligible New Mexicans to explore and

sign up (or health insurance coverage ma'ing the uninsured the primar! target (oroutreach

3oals $or 201615


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: 6oal @xchange

: 6oal @4= >nsure a +nanciall! viable and

sustainable NM3

3oals $or 201615


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8ro&osed 3oals $or 20151:

Jon 7ingsdale, 8h+


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-;uare the budget (or 2015 while maintaining+nancial sustainabilit!

Maintain well/(unctioning NM3

>nroll man! New Mexicans&argeted outreach to the uninsured and 3ispanic

population

n(orm consumers to shop e?ectivel! (or health

plans

8ro&osed 3oals $or 20151:


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Morning Brea-


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Jon 7ingsdale, 8h+

&tions $or 8ath 4orward


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&tion 1

7 -ee' M- approval (or a >ingle=+oors!stem design usingexisting (ederal (unds and develop plan to close delta betweenavailable (unds and cost

" -ee' M- approval (or a new, updated No=!rong +oordesign %modeling a(ter daho* using existing (ederal (unds anddevelop plan to close delta between available (unds and cost

&tion 2

-ee' M- approval (or a 4ederal 8lat$or" ease arrangement

re/allocating some existing (ederal (unds (or other activities%outreach, bro'er support, etc* and update +nancialsustainabilit! plan to pa! (or lease

&tions $or +iscussion


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&tion 1/A >ingle=+oor&tion 1/

-ee' M- approval (or a >ingle=+oor s!stem design using existing (ederal (unds anddevelop plan to close delta between available (unds and cost

: 9ros= M- approval li'el!

ndependent >xchange

ustomiJed consumer experience 7ccess to data

: ons=&imeline needed to implement

-ome un'nowns remain around cost

8educed (unding (or other areas o( >xchange %Mar'eting, Autreach, >nrollment,all enter*

No auto/renewal due to budget constraints

: 7dditional &echnolog! mplementation ost= L2K5M %down (rom L


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&tion 1B

-ee' M- approval (or a new, updated No=!rong +oor design %modeling a(ter daho*using existing (ederal (unds and develop plan to close delta between available (undsand cost

: 9ros ndependent >xchange

ustomiJed consumer experience, but experience ma! not be as good as other

options&ime to implement less compared to 17

: ons M- approval needed and unli'el!

-ome un'nowns remain around cost

Mixed (amilies and Medicaid.NM3 trans(ers can be con(using (or consumer 8educed (unding (or other areas o( >xchange %Mar'eting, Autreach, >nrollment,

all enter*

No auto/renewal

No room (or error no contingenc!

: 7dditional &echnolog! mplementation ost= L10$5M

: mpact to 2015 budget= &a'ing into account signi+cant cuts in other budget areas, the

&tion 1BA Modi#ed No=!rong +oor


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!hat )hanges will Be!ellNM Need toMa-e &tions 1/ or 1B !or-

&echnolog! 8aB

ow/cost, basic call center (unctionalit! Michael

8educed Autreach, >nrollment and Mar'eting inda

MA with A- 7m!


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echnology )hanges to Ma-e &tions1/ or 1B !or-

-imple exchange design, no possibilit! o( enhancements %ie,provider director!, prescription search, etc*

hange in vendor pa!ment arrangement %de(erredpa!ments.9M9M with increased MA, etc*

No auto/renewal.data migration

3-D identi+ed cost/savings


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)ost )ategory $or )all )enter I"&le"entation and Integration

Integration/Confguration

TrainingCall Center Vendor

PMOFacility Build Out

Costs

Business $unctionincluded in the

initial sco&e o$ wor-

ntegrate vendor andNM3 s!stems

includingcon+guration, testingand documentationost does include

collaboration with3-D

&raining on integrateds!stem as well asdevelopment o(

"ro'er, 7ssistor and-8 training

Averall all enterimplementation o(

approved vendor wor'plan and proBect plan

ost (or vendor to co/locate in the 7"I

metro area &his costincludes building out(acilit! with (urniture

and hardware

)ost Esti"ates (initial sco&e o$ wor-

L


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*eco""endations to )all )enter i"&le"entation andcon#guration

Initial i"&le"entation esti"atesA L56 M

/d@usted i"&le"entation esti"atesA L200 ( L250 M

Esti"ated )all )enter sa'ingsA L29 = L6 M

*eco""endation to )all )enter &ricing strategy

Est 2016 )all )enter &ricing with 8M8MA L625 M

Esti"ated with 8er &ricingA L150 ( L250 M Esti"ated M. sa'ingsA L1;5 ( L2;5 M

)all )enter )hanges to Ma-e &tions1/ or 1B !or-


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Mar-eting, )o""unications,utreach, Enroll"ent )hanges toMa-e &tions 1/ or 1B wor-&his sections reviews and reduced budgets (or three programs at"e#ellNM=

: Mar'eting, ommunication, Autreach >nrollment %&rac's 1/4 *

: Autreach 9artners

: >nrollment >ntit! 9rogram


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rac- neA Mar-eting )hanges to Ma-e&tion 1/ or 1B !or-

)ost >a'ingsA

8IN 1 ( *educe 50 s&ots

8IN 2 ( *educe ;50 s&ots

Branded )ollateral ( we can

continue to use well in 4 201:

8rint /ds ( sa"e as collateral

*adio ( $ocus on rural areas,

less ex&ensi'e "edia ?uy

>xisting 7genc! -cope=

-trateg!

&P

8adio

9rint Digital

"illboards

>nrollment Autreachollateral

9roduction costs


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rac- woA )o""unication )hanges toMa-e &tion 1/ or 1B !or-

>xisting 7genc! -cope=

-trateg! Management

Media 8elations 7nnual 8eport

Media &raining

&estimonial Pideos

-ocial Media

N7 Media >ngagement 6overnance

)ost >a'ingsA

*educe >trategy .Manage"ent )ost

+elete Media raining +elete esti"onial ideos

+elete Nati'e /"erican MediaEngage"ent

)olla?orate with carriers to&ic- u& N/ "edia cost


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rac- woA utreach . Enroll"ent8rogra" Manage"ent )hanges to Ma-e

&tion 1/ or 1B !or->xisting 7genc! -cope=

-trateg!

9artner >vent -upport

-ta'eholder, 7gent "ro'er >ngagement

>nrollment entit!management

&raining development

)ost >a'ingsA

*educe 8artner . E'ent>u&&ort

*educe >ta-eholder, /gent .Bro-er Engage"ent su&&ort

*educe Enroll"ent entity"anage"ent su&&ort

)ontinue trainingde'elo&"ent


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rac- hreeA !e?site )hanges to Ma-e&tion 1/ or 1B !or-

>xisting -cope=

#eb development

Qeep basic upgrade

activities as needed #eb maintenance

hange to a lower costvendor

)ost >a'ingsA

*e"o'e new we?de'elo&"ent disco'ery andstrategy

*e"o'e digital "ar-etingdesign strategy . executiona?sor?ed ?y agencyF


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rac- 4ourA *esearch )hanges to Ma-e&tion 1/ or 1B !or-

>xisting -cope=

Qeep statewide messaging

surve! %done*

Qeep statewidebenchmar' surve! %done*

Qeep statewide mid/

enrollment surve! %inprocess*

Qeep statewide post

enrollment surve! trac'ing Qeep web/based surve!

%ongoing*

)ost >a'ingsA

+elete $ocus grou&s

+elete sho& &ost enroll"ent

+elete enroll"ent counselors"ar-eting . "edia sur'ey

+elete uninsured &ostenroll"ent sur'ey

+elete sur'ey o$ recent

enrollers


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rac- 4ourA Enroll"ent Entities8rogra" )hanges to Ma-e &tion 1/ or

1B !or-)ost >a'ingsA *educe nu"?er o$ enroll"ent entities . counselors

>elect two 'endors to wor- with entire state

Nati'e /"erican

His&anic/nglo Engage ?ro-ers through ?ro-er "anage"ent .

training su&&ort to re&lace enroll"ent counselors


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2015=201: E Budget

Ariginal hanged

Mar'eting omms

L,200,000 LG,GKK,5nrollment L5,


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&he MA, scheduled to end 12.8SS activities

: 9rovide initial and ongoing >nrollment ounselor certi+cationincluding review o( criminal bac'ground chec's, maintenance o(

records, in(ormation gathering, preparation distribution o(identi+cation cards, and noti+cation o( application outcome

: 9rovide in(ormation and noti+cation to licensed producers

: 8eceive and provide (ollow/up on consumer complaints

Me"orandu" o$ nderstanding = >I


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Develop and utiliJe capabilit! to evaluate and cost e?ectiveness o(

I39s and ID9s, and report to the public on I39s and ID9 ;ualit!,using technologies not limited to 7ll 9a!er laims Database %79D*and 6eographic n(ormation -ervices %6-*

7de;uatel! sta? these (unctions within NMA- so as to provide theservices contemplated on a timel! basis %10 positions*

&o date, one pa!ment o( L2$5Q has been made to A- %4.201


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&tion 2

8ro&ose a 4ederal 8lat$or" ease arrange"ent re=allocating so"e existing$ederal $unds $or other acti'ities outreach, ?ro-er su&&ort, etcF and usea&&ro'ed #nancial sustaina?ility &lan to &ay $or lease

: 8rosA It already wor-s, consu"er ex&erience is good

ow to no technology i"&le"entation cost

8otentially lower costs $or M. /uto=renewal

8otential increased $unding $or other areas o$ Exchange Mar-eting,utreach, Enroll"entF

)onsA

/&&ro'al needed ( ?ut li-ely

ess Qexi?ility on consu"er ex&erience custo"iation

n-nowns on cost, access to data

>tate=Based Exchange designation $or >)> at ris-

>o"e cost to de'elo& &ro&osal and negotiate ter"s

8erce&tion o$ "oney already s&ent

: ther 8ros and )ons

&tion 2A 4ederal 8lat$or" ease


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!hat will Be!ellNM Need to Ma-e&tion 2 wor-

7greement with M- o( conceptual (ramewor' to support"e#ellNM as a -tate/"ased >xchange


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unch Brea-


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Jon 7ingsdale, 8h+ and )hair"an J* +a"ron, M+

!ra&=& n 3uidance


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7lignment on pre(erred path (orward thatsupports mission goals

Next -teps

9ar'ing otE ssues (or Sollow/p

!ra&=& on 3uidance


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Matters 4ro" the 4inance)o""ittee

+irector 8atsy *o"ero, )hair and reasurer


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+irector 3a?e 8arra, )hair

Matters 4ro" the &erations)o""ittee


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: >co&eA&he 8S9 was designed to be a competitive bid (or 9roBect

Management -ervices (rom ;uali+ed vendors to manage and overseethe design, development and implementation o( an ntegrated >ligibilit!and >nrollment -!stem %Medicaid and Iuali+ed 3ealth 9lans*

: 8rocessA&he >valuation ommittee met on 12.


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/d@ourn"ent

Documents

NMHIX Board Meeting, Jan 9, 2015