Plan Management Advisory Group Meeting - September 6, 2018
P
L
A
N
M
A
N
A
G
E
M
E
N
T
A
D
V
I
S
O
R
Y
G
R
O
U
P
M
E
E
T
I
N
G
September 6, 2018
W
E
L
C
O
M
E
A
N
D
A
G
E
N
D
A
R
E
V
I
E
W
ROB SPECTOR, CHAIR
PLAN MANAGEMENT ADVISORY GROUP
1
A
G
E
N
D
A
2
A
G
E
N
D
A
P
l
a
n
M
a
n
a
g
e
m
e
n
t
a
n
d
D
e
l
i
v
e
r
y
S
y
s
t
e
m
R
e
f
o
r
m
A
d
v
i
s
o
r
y
G
r
o
u
p
M
e
e
t
i
n
g
a
n
d
W
e
b
i
n
a
r
T
h
u
r
s
d
a
y
,
S
e
p
t
e
m
b
e
r
6
,
2
0
1
8
,
1
0
:
0
0
a
.
m
.
t
o
1
2
:
0
0
p
.
m
.
September Agenda Items
Suggested Time
I.
Welcome and Agenda Review
10:00 - 10:05 (5 min.)
II.
Plan Selection Decision Support Tools: Future Capabilities Discussion
10:05 - 10:40 (35 min.)
III.
Benefit Design 2020
10:40 – 11:05 (25 min.)
IV.
Subcommittee Update
11:05 – 11:45 (40 min.)
I.
AB 1810 Affordability Reporting Requirements
II.
Survey Results
V.
Open Forum
11:45 – 12:00 (15 min.)
N
o
t
e
s
:
•
Q
u
a
l
i
t
y
R
a
t
i
n
g
S
y
s
t
e
m
f
o
r
2
0
1
9
O
p
e
n
E
n
r
o
l
l
m
e
n
t
w
i
l
l
n
o
w
b
e
d
i
s
c
u
s
s
s
e
d
i
n
O
c
t
o
b
e
r
.
•
O
c
t
o
b
e
r
m
e
e
t
i
n
g
h
a
s
b
e
e
n
m
o
v
e
d
f
r
o
m
t
h
e
4
t
h
t
o
t
o
t
h
e
1
1
t
h
,
d
u
e
t
o
B
o
a
r
d
m
e
e
t
i
n
g
s
h
i
f
t
.
P
L
A
N
S
E
L
E
C
T
I
O
N
D
E
C
I
S
I
O
N
S
U
P
P
O
R
T
T
O
O
L
S
:
F
U
T
U
R
E
C
A
P
A
B
I
L
I
T
I
E
S
D
I
S
C
U
S
S
I
O
N
MARGARETA BRANDT, SENIOR QUALITY SPECIALIST
PLAN MANAGEMENT DIVISION
3
P
L
A
N
S
E
L
E
C
T
I
O
N
D
E
C
I
S
I
O
N
S
U
P
P
O
R
T
T
O
O
L
S
:
F
U
T
U
R
E
C
A
P
A
B
I
L
I
T
I
E
S
•
Prescription Drug Search: a tool that would enable a consumer to search by
prescription drug and see whether the drug is covered by a health plan.
•
Primary Care Provider (PCP) Selection: a tool that would enable a consumer to
select a PCP after they have selected a health plan and their selection would be
transmitted to the health plan along with their enrollment information.
•
The goal of implementing either of these tools is to enable consumers to make an
informed decision when selecting a health plan through Covered California and
improve the enrollment experience.
4
C
U
R
R
E
N
T
C
O
N
S
U
M
E
R
P
R
E
F
E
R
E
N
C
E
S
P
A
G
E
S
:
M
E
D
I
C
A
L
S
E
R
V
I
C
E
U
S
A
G
E
5
C
U
R
R
E
N
T
C
O
N
S
U
M
E
R
P
R
E
F
E
R
E
N
C
E
S
P
A
G
E
S
:
P
R
E
S
C
R
I
P
T
I
O
N
D
R
U
G
U
S
A
G
E
6
C
U
R
R
E
N
T
C
O
N
S
U
M
E
R
P
R
E
F
E
R
E
N
C
E
S
P
A
G
E
S
:
P
R
O
V
I
D
E
R
S
E
A
R
C
H
T
O
O
L
7
P
R
E
S
C
R
I
P
T
I
O
N
D
R
U
G
S
E
A
R
C
H
:
M
N
s
u
r
e
E
x
a
m
p
l
e
8
Formulary search screenshots from MNsure shopping tool: https://www.mnsure.org/
Language in questions
and disclaimers can be
edited by Covered
California.
P
R
E
S
C
R
I
P
T
I
O
N
D
R
U
G
S
E
A
R
C
H
:
M
N
s
u
r
e
E
x
a
m
p
l
e
9
Formulary search screenshots from MNsure shopping tool: https://www.mnsure.org/
Once a consumer searches by
the prescription drug name, they
are prompted to select the
dosage for the drug.
In the MNsure tool, a consumer
must select a dosage.
10
10
Formulary search screenshots from MNsure shopping tool: https://www.mnsure.org/
P
R
E
S
C
R
I
P
T
I
O
N
D
R
U
G
S
E
A
R
C
H
:
M
N
s
u
r
e
E
x
a
m
p
l
e
P
R
E
S
C
R
I
P
T
I
O
N
D
R
U
G
S
E
A
R
C
H
:
M
N
s
u
r
e
E
x
a
m
p
l
e
11
11
After a consumer
selects the drugs they
would like to search by
and then moves
forward to view plans,
the plan tile indicates
whether the drug is
“Covered” or “Not
Covered”.
Hover text also notes
whether Prior
Authorization is
required and whether
Step Therapy is
required for a drug.
The hover text is drug
specific.
Formulary search screenshots from MNsure shopping tool: https://www.mnsure.org/
P
R
E
S
C
R
I
P
T
I
O
N
D
R
U
G
S
E
A
R
C
H
:
D
A
T
A
E
L
E
M
E
N
T
S
•
Information currently provided to Covered California by issuers:
•
RXCUI – a unique identifier for prescription drugs
•
This unique identifier can be mapped to a name, dosage and description of the drug using a
crosswalk.
•
Tier Level
•
Tier 1 – Most Generic Drugs
•
Tier 2 – Preferred Brand Drugs
•
Tier 3 – Non-Preferred Brand Drugs
•
Tier 4 – Specialty Drugs
•
Whether prior authorization is required
•
Whether step therapy is required
•
Other data elements needed?
•
Dosage information
1
2
P
R
E
S
C
R
I
P
T
I
O
N
D
R
U
G
S
E
A
R
C
H
:
C
O
N
S
I
D
E
R
A
T
I
O
N
S
•
Determine an agreed upon data source
•
Issuer formularies
•
RXCUI unique identifier for prescription drugs and crosswalk
•
Frequency of updating data to support the search
•
Currently, Covered California only receives prescription drug information once per year during
the QHP Certification Application process
•
Ease of search
•
Do consumers know the prescription drug generic or brand names?
•
Display of information
•
Are the “Covered” and “Not Covered” symbols clear?
•
Is different hover text needed?
•
Potential unintended consequences or perverse outcomes
13
13
P
R
I
M
A
R
Y
C
A
R
E
P
R
O
V
I
D
E
R
(
P
C
P
)
S
E
L
E
C
T
I
O
N
•
This functionality would enable a consumer to select a PCP after the consumer has
selected a health plan
•
Each member would be able to select a unique PCP (one PCP per family member)
•
The consumer’s PCP selection information would then be passed to the issuer via an 834 transaction
•
This functionality would address the issue of auto-assignment to a PCP by an issuer
•
However, using the PCP Selection tool would be optional for consumers
•
PCP Selection would be available to a consumer making an initial plan selection or
actively changing plans during renewal
•
Based on
the current design mock ups, a consumer would only be able to select a PCP during
enrollment and would not be able to return to their portal and make a PCP Selection later
•
Would require standardization and validation of additional data elements in the
provider data submissions received from issuers
•
Would require system changes for issuers
14
14
P
C
P
S
E
L
E
C
T
I
O
N
:
D
R
A
F
T
M
O
C
K
U
P
15
15
Covered
California can
adjust the filters,
or choose not to
display filters.
Language can be
edited by Covered
California.
P
C
P
S
E
L
E
C
T
I
O
N
:
D
R
A
F
T
M
O
C
K
U
P
16
16
Each member would
be able to select a
unique PCP.
One PCP could be
selected for each
family member.
Not all family
members would be
required to select a
PCP.
P
C
P
S
E
L
E
C
T
I
O
N
:
D
A
T
A
E
L
E
M
E
N
T
S
Covered California currently receives monthly provider network data files from
issuers, but not all data fields are standardized across issuers.
Required elements from issuers:
•
Identification of PCPs per issuer product (PPO, EPO, HMO)
Possible data elements to display for each PCP:
•
Medical group affiliation
•
Independent Physician Association (IPA) affiliation
•
PCP Specialty
•
Gender
•
Language
•
Accepting New Patients or Panel Status
17
17
P
C
P
S
E
L
E
C
T
I
O
N
:
C
O
N
S
I
D
E
R
A
T
I
O
N
S
•
Search may need to differ based on product (PPO, EPO, HMO)
•
Issuers have noted the need to be able to search by medical group/IPA first and then select a
PCP for HMO products
•
The 1 to many relationship of PCPs to medical groups/IPAs
•
How many PCPs does this impact?
•
Does a consumer need to select a medical group/IPA first and then search to select a PCP?
•
Need to standardize medical group/IPA names across all issuers
•
Will need to standardize other data fields
•
Language
•
Gender
•
Accepting new patients
•
Determine the necessary information to transmit to issuers on an 834
•
CalHEERS and GetInsured would need to build a PCP Selection tool for Covered
California
•
Opportunity to implement along with Covered California’s transition to using the
statewide provider directory (IHA Provider Directory Utility)
18
18
B
E
N
E
F
I
T
D
E
S
I
G
N
2
0
2
0
ALLIE MANGIARACINO, SENIOR QUALITY ANALYST
PLAN MANAGEMENT DIVISION
19
19
B
E
N
E
F
I
T
D
E
S
I
G
N
2
0
2
0
:
W
O
R
K
G
R
O
U
P
P
L
A
N
N
I
N
G
D
i
s
c
u
s
s
i
o
n
T
o
p
i
c
s
(
t
e
n
t
a
t
i
v
e
)
•
2020 Standard Benefit Plan Designs
o
Copay-only plan design
o
MHPAEA impacts to standard benefits
o
Funded Savings Account Plans
•
Beyond 2020
o
Understanding cost-sharing experience by enrollee disease state
o
VBID-X: National workgroup proposal on designing a Value-Based Insurance Design (VBID) for
the individual market
P
r
o
p
o
s
e
d
S
c
h
e
d
u
l
i
n
g
•
4 – 6 meetings
•
Every other Wednesday, 10 a.m. – 12 noon or 1 – 3 p.m.
•
Discussion topics for 2021 may transition to the Plan Management Advisory Group
meetings starting in January
20
20
S
U
B
C
O
M
M
I
T
T
E
E
U
P
D
A
T
E
ROB SPECTOR
CHAIR, PLAN MANAGEMENT ADVISORY GROUP
21
21
A
B
1
8
1
0
A
F
F
O
R
D
A
B
I
L
I
T
Y
R
E
P
O
R
T
I
N
G
R
E
Q
U
I
R
E
M
E
N
T
S
KATIE RAVEL, DIRECTOR
POLICY, EVALUATION & RESEARCH
22
22
A
B
1
8
1
0
A
F
F
O
R
D
A
B
I
L
I
T
Y
O
P
T
I
O
N
S
R
E
P
O
R
T
•
AB 1810 Trailer Bill requires Covered California to develop an Affordability Options Report
to the Legislature, Governor, and the new Council on Health Care Delivery Systems
•
Covered California must:
Consult with stakeholders, Department of Health Care Services, and Legislature and develop
options for providing financial assistance to help low- and middle-income Californians access
health care coverage.
Include options to assist low-income individuals paying a significant percentage of income on
premiums, even with federal financial assistance, and individuals with annual income of up to
600 percent of federal poverty level.
Consider maximizing all available federal funding and determine whether federal financial
participation for Medi-Cal would otherwise be jeopardized.
•
Report due by February 1, 2019
23
23
A
F
F
O
R
D
A
B
I
L
I
T
Y
W
O
R
K
G
R
O
U
P
•
Request volunteers to participate as members of the Affordability workgroup
•
W
o
r
k
g
r
o
u
p
m
e
m
b
e
r
s
w
i
l
l
b
e
e
x
p
e
c
t
e
d
t
o
p
a
r
t
i
c
i
p
a
t
e
i
n
t
w
o
t
o
t
h
r
e
e
w
o
r
k
g
r
o
u
p
m
e
e
t
i
n
g
s
b
e
t
w
e
e
n
O
c
t
o
b
e
r
a
n
d
J
a
n
u
a
r
y
t
o
p
r
o
v
i
d
e
i
n
p
u
t
o
n
a
f
f
o
r
d
a
b
i
l
i
t
y
o
p
t
i
o
n
s
•
I
f
y
o
u
a
r
e
i
n
t
e
r
e
s
t
e
d
i
n
p
a
r
t
i
c
i
p
a
t
i
n
g
o
n
t
h
e
w
o
r
k
g
r
o
u
p
,
p
l
e
a
s
e
e
m
a
i
l
M
a
n
d
y
H
o
r
r
e
l
l
(
m
a
n
d
y
.
h
o
r
r
e
l
l
@
c
o
v
e
r
e
d
.
c
a
.
g
o
v
)
24
24
P
L
A
N
M
A
N
A
G
E
M
E
N
T
A
D
V
I
S
O
R
Y
S
U
R
V
E
Y
O
N
T
O
P
I
C
P
R
I
O
R
I
T
I
E
S
A
N
D
F
O
R
U
M
S
LINDSAY PETERSEN, SENIOR QUALITY SPECIALIST
PLAN MANAGEMENT DIVISION
25
25
S
U
R
V
E
Y
R
E
S
U
L
T
S
:
R
E
S
P
O
N
D
E
R
B
R
E
A
K
D
O
W
N
26
26
S
U
R
V
E
Y
R
E
S
U
L
T
S
S
u
r
v
e
y
r
e
s
u
l
t
s
i
n
d
i
c
a
t
e
d
o
v
e
r
a
l
l
g
r
o
u
p
d
e
s
i
r
e
t
o
:
•
Continue subcommittees on
•
Benefit Design
•
Dental Technical
•
Address the following either as an ad hoc or folded into a different subcommittee:
o
Access and Cost of Care
o
Prescription Drugs
o
CCSB
T
h
e
f
o
l
l
o
w
i
n
g
t
o
p
i
c
s
h
a
d
s
p
l
i
t
o
p
i
n
i
o
n
s
:
•
Consumer Experience
•
Health Equity
•
Quality of Care
N
e
w
t
o
p
i
c
s
s
u
g
g
e
s
t
e
d
:
•
Renewal notice template (completion ~May)
•
Medi-Cal/Covered California transition continuity
27
27
S
U
R
V
E
Y
R
E
S
U
L
T
S
:
N
E
X
T
S
T
E
P
S
•
Separate benefit design and dental technical work groups will continue.
•
Updates to Plan Management Advisory on any standing, or ad hoc subcommittee activities will
continue.
•
Respondents indicated desire to be present if any of these topics were addressed, and expressed
importance of prioritizing based on specific issue need, and staggering throughout the year due to
limited bandwidth.
•
Based on feedback, Covered California will determine forums for the other topics and will
update the group.
•
Staff will use more channels to communicate about past and future Plan Management Advisory and
subcommittee meetings.
•
All Plan Management Advisory meeting agendas are posted publicly on the
Plan
Management stakeholder page
, in addition to a master calendar with all meetings dates.
•
Subcommittee announcements take place at public meetings, but additional subcommittee
announcements and contact information can be added to stakeholder page.
28
28
Thank you for completing the survey!
ROB SPECTOR, CHAIR
PLAN MANAGEMENT ADVISORY GROUP
29
29
O
P
E
N
F
O
R
U
M
A
N
D
N
E
X
T
S
T
E
P
S
O
P
E
N
F
O
R
U
M
I
T
E
M
S
•
M
e
m
b
e
r
s
h
i
p
s
o
l
i
c
i
t
a
t
i
o
n
f
o
r
t
h
e
M
a
r
k
e
t
i
n
g
,
O
u
t
r
e
a
c
h
,
a
n
d
E
n
r
o
l
l
m
e
n
t
A
s
s
i
s
t
a
n
c
e
(
M
O
E
A
)
A
d
v
i
s
o
r
y
G
r
o
u
p
o
Covered California seeks members who bring knowledge and expertise in the areas of
marketing, outreach, and enrollment assistance, and who also have experience serving or
working with California’s richly diverse populations to join the Marketing, Outreach, and
Enrollment Assistance (MOEA) Advisory Group
o
A
n
y
o
n
e
i
n
t
e
r
e
s
t
e
d
i
n
s
e
r
v
i
n
g
i
s
i
n
v
i
t
e
d
t
o
s
u
b
m
i
t
a
n
a
p
p
l
i
c
a
t
i
o
n
a
n
d
l
e
t
t
e
r
o
f
i
n
t
e
r
e
s
t
t
o
M
O
E
A
G
r
o
u
p
@
c
o
v
e
r
e
d
.
c
a
.
g
o
v
b
y
S
e
p
t
e
m
b
e
r
1
4
,
2
0
1
8
.
T
h
e
m
e
m
b
e
r
s
h
i
p
a
p
p
l
i
c
a
t
i
o
n
a
s
w
e
l
l
a
s
a
d
r
a
f
t
c
h
a
r
t
e
r
d
e
s
c
r
i
b
i
n
g
t
h
e
g
r
o
u
p
i
n
m
o
r
e
d
e
t
a
i
l
c
a
n
b
e
f
o
u
n
d
a
t
h
t
t
p
:
/
/
h
b
e
x
.
c
o
v
e
r
e
d
c
a
.
c
o
m
/
s
t
a
k
e
h
o
l
d
e
r
s
/
M
a
r
k
e
t
i
n
g
-
O
u
t
r
e
a
c
h
-
E
n
r
o
l
l
m
e
n
t
/
o
Questions can be addressed to Ashley Nichols at
MOEAGroup@covered.ca.gov
30
30
Welcome to the Plan Management Advisory Group meeting on September 6, 2018. The agenda includes discussions on Plan Selection Decision Support Tools, Benefit Design 2020, Subcommittee Updates, and more. Explore the future capabilities of prescription drug search tools, consumer preferences in medical and prescription drug usage, and provider search tools. Stay updated on the latest enhancements to improve consumer experience in selecting health plans.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
PLAN MANAGEMENT ADVISORY GROUP MEETING September 6, 2018
WELCOME AND AGENDA REVIEW ROB SPECTOR, CHAIR PLAN MANAGEMENT ADVISORY GROUP 1
AGENDA AGENDA Plan Management and Delivery System Reform Advisory Group Meeting and Webinar Thursday, September 6, 2018, 10:00 a.m. to 12:00 p.m. September Agenda Items Suggested Time I. Welcome and Agenda Review Plan Selection Decision Support Tools: Future Capabilities Discussion 10:00 - 10:05 (5 min.) II. 10:05 - 10:40 (35 min.) III. Benefit Design 2020 10:40 11:05 (25 min.) IV. Subcommittee Update I. AB 1810 Affordability Reporting Requirements II. Survey Results Open Forum 11:05 11:45 (40 min.) V. 11:45 12:00 (15 min.) Notes: Quality Rating System for 2019 Open Enrollment will now be discusssed in October. October meeting has been moved from the 4th to to the 11th, due to Board meeting shift. 2
PLAN SELECTION DECISION SUPPORT TOOLS: FUTURE CAPABILITIES DISCUSSION MARGARETA BRANDT, SENIOR QUALITY SPECIALIST PLAN MANAGEMENT DIVISION 3
PLAN SELECTION DECISION SUPPORT TOOLS: FUTURE CAPABILITIES Prescription Drug Search: a tool that would enable a consumer to search by prescription drug and see whether the drug is covered by a health plan. Primary Care Provider (PCP) Selection: a tool that would enable a consumer to select a PCP after they have selected a health plan and their selection would be transmitted to the health plan along with their enrollment information. The goal of implementing either of these tools is to enable consumers to make an informed decision when selecting a health plan through Covered California and improve the enrollment experience. 4
CURRENT CONSUMER PREFERENCES PAGES: MEDICAL SERVICE USAGE 5
CURRENT CONSUMER PREFERENCES PAGES: PRESCRIPTION DRUG USAGE 6
CURRENT CONSUMER PREFERENCES PAGES: PROVIDER SEARCH TOOL 7
PRESCRIPTION DRUG SEARCH: MNsure Example Language in questions and disclaimers can be edited by Covered California. Formulary search screenshots from MNsure shopping tool: https://www.mnsure.org/ 8
PRESCRIPTION DRUG SEARCH: MNsure Example Once a consumer searches by the prescription drug name, they are prompted to select the dosage for the drug. In the MNsure tool, a consumer must select a dosage. Formulary search screenshots from MNsure shopping tool: https://www.mnsure.org/ 9
PRESCRIPTION DRUG SEARCH: MNsure Example Formulary search screenshots from MNsure shopping tool: https://www.mnsure.org/ 10
PRESCRIPTION DRUG SEARCH: MNsure Example After a consumer selects the drugs they would like to search by and then moves forward to view plans, the plan tile indicates whether the drug is Covered or Not Covered . Hover text also notes whether Prior Authorization is required and whether Step Therapy is required for a drug. The hover text is drug specific. Formulary search screenshots from MNsure shopping tool: https://www.mnsure.org/ 11
PRESCRIPTION DRUG SEARCH: DATA ELEMENTS Information currently provided to Covered California by issuers: RXCUI a unique identifier for prescription drugs This unique identifier can be mapped to a name, dosage and description of the drug using a crosswalk. Tier Level Tier 1 Most Generic Drugs Tier 2 Preferred Brand Drugs Tier 3 Non-Preferred Brand Drugs Tier 4 Specialty Drugs Whether prior authorization is required Whether step therapy is required Other data elements needed? Dosage information 12
PRESCRIPTION DRUG SEARCH: CONSIDERATIONS Determine an agreed upon data source Issuer formularies RXCUI unique identifier for prescription drugs and crosswalk Frequency of updating data to support the search Currently, Covered California only receives prescription drug information once per year during the QHP Certification Application process Ease of search Do consumers know the prescription drug generic or brand names? Display of information Are the Covered and Not Covered symbols clear? Is different hover text needed? Potential unintended consequences or perverse outcomes 13
PRIMARY CARE PROVIDER (PCP) SELECTION This functionality would enable a consumer to select a PCP after the consumer has selected a health plan Each member would be able to select a unique PCP (one PCP per family member) The consumer s PCP selection information would then be passed to the issuer via an 834 transaction This functionality would address the issue of auto-assignment to a PCP by an issuer However, using the PCP Selection tool would be optional for consumers PCP Selection would be available to a consumer making an initial plan selection or actively changing plans during renewal Based on the current design mock ups, a consumer would only be able to select a PCP during enrollment and would not be able to return to their portal and make a PCP Selection later Would require standardization and validation of additional data elements in the provider data submissions received from issuers Would require system changes for issuers 14
PCP SELECTION: DRAFT MOCK UP Covered California can adjust the filters, or choose not to display filters. Language can be edited by Covered California. 15
PCP SELECTION: DRAFT MOCK UP Each member would be able to select a unique PCP. One PCP could be selected for each family member. Not all family members would be required to select a PCP. 16
PCP SELECTION: DATA ELEMENTS Covered California currently receives monthly provider network data files from issuers, but not all data fields are standardized across issuers. Required elements from issuers: Identification of PCPs per issuer product (PPO, EPO, HMO) Possible data elements to display for each PCP: Medical group affiliation Independent Physician Association (IPA) affiliation PCP Specialty Gender Language Accepting New Patients or Panel Status 17
PCP SELECTION: CONSIDERATIONS Search may need to differ based on product (PPO, EPO, HMO) Issuers have noted the need to be able to search by medical group/IPA first and then select a PCP for HMO products The 1 to many relationship of PCPs to medical groups/IPAs How many PCPs does this impact? Does a consumer need to select a medical group/IPA first and then search to select a PCP? Need to standardize medical group/IPA names across all issuers Will need to standardize other data fields Language Gender Accepting new patients Determine the necessary information to transmit to issuers on an 834 CalHEERS and GetInsured would need to build a PCP Selection tool for Covered California Opportunity to implement along with Covered California s transition to using the statewide provider directory (IHA Provider Directory Utility) 18
BENEFIT DESIGN 2020 ALLIE MANGIARACINO, SENIOR QUALITY ANALYST PLAN MANAGEMENT DIVISION 19
BENEFIT DESIGN 2020: WORKGROUP PLANNING Discussion Topics (tentative) 2020 Standard Benefit Plan Designs Copay-only plan design MHPAEA impacts to standard benefits Funded Savings Account Plans Beyond 2020 Understanding cost-sharing experience by enrollee disease state VBID-X: National workgroup proposal on designing a Value-Based Insurance Design (VBID) for the individual market o o o o o Proposed Scheduling 4 6 meetings Every other Wednesday, 10 a.m. 12 noon or 1 3 p.m. Discussion topics for 2021 may transition to the Plan Management Advisory Group meetings starting in January 20
SUBCOMMITTEE UPDATE ROB SPECTOR CHAIR, PLAN MANAGEMENT ADVISORY GROUP 21
AB 1810 AFFORDABILITY REPORTING REQUIREMENTS KATIE RAVEL, DIRECTOR POLICY, EVALUATION & RESEARCH 22
AB 1810 AFFORDABILITY OPTIONS REPORT AB 1810 Trailer Bill requires Covered California to develop an Affordability Options Report to the Legislature, Governor, and the new Council on Health Care Delivery Systems Covered California must: Consult with stakeholders, Department of Health Care Services, and Legislature and develop options for providing financial assistance to help low- and middle-income Californians access health care coverage. Include options to assist low-income individuals paying a significant percentage of income on premiums, even with federal financial assistance, and individuals with annual income of up to 600 percent of federal poverty level. Consider maximizing all available federal funding and determine whether federal financial participation for Medi-Cal would otherwise be jeopardized. Report due by February 1, 2019 23
AFFORDABILITY WORK GROUP Request volunteers to participate as members of the Affordability workgroup Workgroup members will be expected to participate in two to three workgroup meetings between October and January to provide input on affordability options If you are interested in participating on the workgroup, please email Mandy Horrell (mandy.horrell@covered.ca.gov) 24
PLAN MANAGEMENT ADVISORY SURVEY ON TOPIC PRIORITIES AND FORUMS LINDSAY PETERSEN, SENIOR QUALITY SPECIALIST PLAN MANAGEMENT DIVISION 25
SURVEY RESULTS: RESPONDER BREAKDOWN Participant Type Number of Responders Plan Management Advisory or Board Member 11 Non-member regular attendee 10 Total 21 Stakeholder Category Number of Responders Advocate 7 Health Plan 9 Provider Organization 4 Other 1 Total 21 26
SURVEY RESULTS Survey results indicated overall group desire to: Continue subcommittees on Benefit Design Dental Technical Address the following either as an ad hoc or folded into a different subcommittee: Access and Cost of Care Prescription Drugs CCSB The following topics had split opinions: Consumer Experience Health Equity Quality of Care New topics suggested: Renewal notice template (completion ~May) Medi-Cal/Covered California transition continuity o o o 27
SURVEY RESULTS: NEXT STEPS Separate benefit design and dental technical work groups will continue. Updates to Plan Management Advisory on any standing, or ad hoc subcommittee activities will continue. Respondents indicated desire to be present if any of these topics were addressed, and expressed importance of prioritizing based on specific issue need, and staggering throughout the year due to limited bandwidth. Based on feedback, Covered California will determine forums for the other topics and will update the group. Staff will use more channels to communicate about past and future Plan Management Advisory and subcommittee meetings. All Plan Management Advisory meeting agendas are posted publicly on the Plan Management stakeholder page, in addition to a master calendar with all meetings dates. Subcommittee announcements take place at public meetings, but additional subcommittee announcements and contact information can be added to stakeholder page. 28 Thank you for completing the survey!
OPEN FORUM AND NEXT STEPS ROB SPECTOR, CHAIR PLAN MANAGEMENT ADVISORY GROUP 29
OPEN FORUM ITEMS Membership solicitation for the Marketing, Outreach, and Enrollment Assistance (MOEA) Advisory Group o Covered California seeks members who bring knowledge and expertise in the areas of marketing, outreach, and enrollment assistance, and who also have experience serving or working with California s richly diverse populations to join the Marketing, Outreach, and Enrollment Assistance (MOEA) Advisory Group o Anyone interested in serving is invited to submit an application and letter of interest to MOEAGroup@covered.ca.gov by September 14, 2018. The membership application as well as a draft charter describing the group in more detail can be found at http://hbex.coveredca.com/stakeholders/Marketing-Outreach-Enrollment/ o Questions can be addressed to Ashley Nichols at MOEAGroup@covered.ca.gov 30
