UW MEDICINE HEALTH INSURANCE EXCHANGE AND MEDICAID EXPANSION

Transcription

1 UW MEDICINE HEALTH INSURANCE EXCHANGE AND MEDICAID EXPANSION TASK FORCE COMMUNICATION UPDATE SEPT 2013

2 The Affrdable Care Act (ACA) is the federal health care law passed in The bjective is t increase access t health care acrss the cuntry, imprve quality and affrdability in the health care system. The Affrdable Care Act will ffer mre ptins thrugh Medicaid Expansin and the Exchange fr WA residents. By assessing ne prtal thrugh Washingtn Healthplanfinder their eligibility path fr either Washingtn Apple Health (Medicaid Expansin) r the Exchange can be determined. Washingtn Healthplanfinder will be a new nline marketplace fr individuals, families and small businesses t cmpare and enrll in health insurance. Fr the Exchange, yu can determine if yu are eligible fr financial assistance thrugh cst sharing and/r premium reductins. Enrllment begins n Octber 1, 2013 with cverage effective n January 1,

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5 Starting Oct 1 st hw can a WA resident access Washingtn Healthplanfinder t enrll: Enrll at hme n-line Cntact the Washingtn Healthplanfinder Custmer Supprt Call Center (beginning 9/3 will pen fr plan/enrllment questins) WAFINDER ( ) Hurs f Operatin 8 am t 8 pm seven days a week Spanish speaking representatives, alng with access t a language line translatr ffering 175 languages Cntact an Agent/Brker G thrugh the In-Persn Assister Netwrk: Lead Organizatins Partners G t a UW Medicine designated enrllment site that ffers staff trained certified as in-persn assisters (IPA): Use a self-serve kisk & ask questins as needed Sit dwn w/an IPA & walk thrugh the prcess tgether Nte: Self-serve kisk statins may be dependent n entity/enrllment site at UW Medicine. 5

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7 WA Healthplanfinder Enrllment Screen 7

8 When accessing WA Healthplanfinder the individual r family s incme will direct the enrllment path: 0% - 138% FPL~ Medicaid Expansin 139% - 400% FPL~ Exchange Washingtn Apple Health (Medicaid Expansin): 325K WA residents expected t enrll Creates a new Medicaid grup - newly eligible individuals age 19 up t 65 wh: <=138% FPL (annual incme ~ <=$15,856 fr a single adult/<=$32,499 fr a family f fur) Meet citizenship requirements Are nt incarcerated Are nt entitled t Medicare Infrmatin patients will need when they are ready t apply: husehld mnthly incme Scial Security numbers and dates f birth fr each member f their husehld immigratin infrmatin if applicable Washingtn Healthplanfinder will make data-matches with the Internal Revenue Service, Scial Security Administratin and Hmeland Security, in rder t verify incme level and citizenship, and check fr any natinal security issues Estimated 45 minutes t apply nline and with a cnfirmatin accept/deny at the end f yur sessin If yu re accepted, yur Apple Health cverage will start n January 1, Beginning Octber 1, fr new applicants fr children, pregnant wmen and family medical Medicaid/Apple Health prgrams, cverage will begin n the first day f the mnth in which the applicatin was submitted. Enrllment is cntinuus with n end date Applicants can als apply via mail, phne r in persn. Nte: Infrmatin is subject t change as new infrmatin becmes available. The Task Frce will cntinue t prvide updates. 8

9 Nte: Infrmatin is subject t change as new infrmatin becmes available. The Task Frce will cntinue t prvide updates. Health Insurance Exchange: 175K WA residents expected t enrll % FPL (annual incme ~ <=$45,960 fr a single adult/<=$94,200 fr a family f fur) Estimated 20 minutes t apply nline; may take lnger t decide based n plan chices especially in the first year f being launched Items patients will need when they are ready t enrll: adjusted grss incme frm the prir year (cpy f tax return r if they dn t have it then Washingtnhealthplanfinder.rg will pull IRS data) Scial Security numbers and dates f birth fr each member f their husehld address & credit card /frm f electrnic payment t pay their first mnths premium Washingtn Healthplanfinder will make data-matches with the Internal Revenue Service, Scial Security Administratin and Hmeland Security, in rder t verify incme level and citizenship, and check fr any natinal security issues Between % FPL will be eligible fr federal subsidies (sliding fee scale) t help with the mnthly premium cst Cst sharing reductins available <250% FPL Sign up by the Dec 23rd t be eligible by Jan 1 st r if enrlled after Jan 1 st then eligible the 1 st day f the mnth fllwing if enrlled by the 23 rd (fr example enrll by Feb 23 rd 2014 t be enrlled by March 1 st 2014.); n eligibility retr rll back Initial enrllment perid is Oct 1 st 2013 t Mar 31 st 2014; certain qualifying cnditins allw enrllment after the enrllment perid ends; enrllment perid ging frward will be Oct 1 st - Dec 31 st beginning in

10 HIX & ME Citizenship and Immigratin Eligibility Chart 10

11 Health Insurance Exchange Plans 11

12 Characteristics f newly insured patients ~ fur things t knw. New patients may yield higher reimbursement levels fr prviders, but they may als require a different, mre intensive mix f services. While thse purchasing within the exchanges vary demgraphically, they are likely t have: Limited familiarity with the health care system. Many patients wh jin the exchanges will be relatively yung, may have nly a high schl educatin, and may prefer a language ther than English. They'll need help navigating the prvider landscape as they seek care fr themselves and their families. Unmanaged chrnic cnditins. Because many f these patients previusly culdn't affrd care, they are likely t have unmanaged, pssibly undiagnsed chrnic cnditins. It is crucial t direct these patients t lw-cst care settings and invest in helping them manage their cnditins regularly. These patients are uniquely prne t inpatient medical treatment. Minimal educatin abut preventive and elective care. New health cverage will enable these patients t access previusly unaffrdable services. Sme patients will nt knw t pursue recmmended preventative care r understand their ptins fr elective services. Prviders must wrk t recruit these patients fr rutine primary care services and educate them abut the types, benefits, and prices f available services. Cncerns abut the value f care delivered. Because they will be enrlled in plans with high deductibles, these patients will be pricesensitive, discerning custmers. They are likely t shp arund fr prviders wh ffer a clear value prpsitin: high-quality service fferings, an easily navigable care envirnment, and affrdably priced ptins. 12

13 UW Medicine has launched an enterprise-wide Task Frce t practively assist ur patients find, cmpare and enrll in a health plan that meets their needs and budget. The Task Frce bjective is t prvide mnthly enterprisewide cmmunicatins that highlights: Our prgress in preparing fr a majr change in healthcare Impact t ur patients & rganizatin Cllabrative effrts that span acrss the enterprise This initiative is aligned with Patients Are First in that we will help ur patients successfully navigate thrugh the changes while they gain access t affrdable healthcare. The Task Frce and six subgrups represent a cmprehensive team that is inspired t be a part f this patient fcused initiative. HMC NWH UWMC UWNC UWP VMC 13

14 Patient Access Subgrup Update Team Leads: Julie Nelsn, Jane Blackwell and Elise Chayet Training Designated staff will becme certified in-persn assistrs (IPA) thrugh the prgram ffered by King Cunty Public Health Training t ccur in Sept fr Patient Access & Scial Wrk; PFS & Epic Training are als participating fr infrmatinal purpses Once certified Patient Access & Scial Wrk can assist with patient enrllment, checking nging eligibility, and reenrlling Medicaid Expansin qualified patients if they want t change their assigned Scripting n hw t interact with the enrllee t be defined Prcess Establish enrllment sites with assigned wrkstatins and resurce list Develp wrkflw, training and prcedures Partner with Public Health n apprpriate patient scripting t ensure a smth interactin Cmpile a list f alternative enrllment sites as a patient resurce Reaching ut t Cmmunity Partners Outreach t leverage resurces Partnering with HCA t ptentially have their staff statined t answer Medicaid Expansin questins & manage wrk queues; based n the prpsed timeline it may nt happen until Jan 2014 Cmmunicatins Partnering with Marketing subgrup t streamline the utreach effrts: Patients: Intranet, business cards, brchures, fact sheet Aut messaging when placed n hld Aut messaging thrugh TeleVx (t be evaluated fr Nv) Staff wh are certified t assist patients will wear buttns Staff: System-wide Intranet updates All-staff mem alert Rad shws Nte: Patient Access strategy may vary by entity 14

15 Cntracting Subgrup Update Our purpse is t keep the HIX Task Frce infrmed f UW Medicine s cntracting activities as they relate t the WA HealthCare Exchange Market and it s participating plans. Team Leads: Michele Fisher & Arla Mathiasn Here s the WA HIX landscape as f Aug 26 th 2013: Fur Health Insurance Exchange (HIX) plans were apprved by the WA Office f the Insurance Cmmissiner (OIC), hwever still require Exchange apprval which leads t certificatin. 1)Bridgespan (a Regence plan) King cunty 2)Grup Health King cunty 3)Lifewise (a Premera plan) All 39 cunties 4)Premera All except Clark cunty OIC may recnsider adding mre plans fr 2014 even thugh the deadline has passed (ie, Mlina, CHPW and/r Crdinated Care). Qualified Health Plan (QHP) is a health plan that is certified by the Exchange, prvides the essential benefits package, and cmplies with ther requirements established by Health Human Services and the Exchange. A QHP can add prviders thrughut the year. This can create changes t the UW Medicine prviders that are available t patients thrugh the Exchange. 15

16 CONTRACTING SUBGROUP UPDATE Fr the HIX enrllment prcess, what des this mean t UW Medicine? HMC/UWMC/NWH/VMC/UWP are cntracted with Bridgespan (a Regence Plan) as PCP s (i.e. the patient can sign up with a UW Medicine PCP at any entity with this plan). The fllwing are cntracted, hwever mre than likely nt clearly identifiable in the enrllment prcess: HMC/UWMC/NWH/UWP are cntracted with Grup Health Cperative fr specialty care nly when a referral and authrizatin are in place. NWH & VMC are cntracted with Lifewise fr certain prviders, hwever the netwrk is nt disclsed. All services f NWH r VMC may nt be available t the patient wh signs up fr this plan. NWH & VMC are cntracted with Premera fr certain prviders, hwever the netwrk is nt disclsed. All services f NWH r VMC may nt be available t the patient wh signs up fr this plan. Nte: Stay tuned as infrmatin is subject t change. Patient scripting will be defined in the Sept Public Health-Seattle & King Cunty training. Scripting will be an essential cmpnent based n ur rle as an In-Persn Assister (IPA). 16

17 Marketing Subgrup Update Our purpse is t will develp the messaging t cmmunicate with cnsumers, staff, emplyers and the cmmunities we serve abut the enrllment fr HIX plans and Medicaid Expansin. The bjective will channel resurces fr all eligible patients t reduce charity/bad debt while prviding ur patients with access t affrdable healthcare. Team Leads: Tina Mankwski, Liz Nlan and Karen Peck Prgress: Develped Q&A fr enterprise-wide distributin Designed cmmunicatin tls that includes: PwerPint, custmized letters, n-hld messaging, tent cards r lapel buttns, banners, messaging fr big screen TVs and ther ptins t help in cmmunicating t patients ; t be presented t Task Frce fr apprval & rllut timeline Creating a series f internal cmmunicatins Partnering with Patient Access subgrup t streamline marketing effrts 17

18 PFS Subgrup Update Our purpse is t evaluate enterprise-wide financial plicies impacted by the Health Insurance Exchange plans & Medicaid Expansin specifically Charity. The bjective is t prmte cnsistency when assisting ur patients while reducing rganizatinal risk. Team Leads: Jerry Brks & Janet Walthew Prgress: Team meeting regularly t ensure rganizatinal readiness Develping scenaris t address charity qualificatin prcess based n HIX plans and prpsed determinatins Evaluating standardizing UW Medicine Charity apprval timelines 18

19 Accunting & Reprting Update Our purpse is t evaluate the Accunting and Reprting implicatins related t the Health Infrmatin Exchange (HIX) & Medicaid Expansin (ME). The bjectives are t: review existing plicies and prcedures fr changes needed based n patients cmpliance with enrllment and changes in state regulatins prmte cnsistency within the accunting and reprting prcess (if feasible) acrss the UW Medicine entities prvide financial reprting t the task frce and subgrups as needed t supprt this initiative t better understand the payr shift impact Team Leads: Tammy Ayyub Prgress: Evaluating tracking/reprting needs internally and externally Targeting end f Sept t dcument an enterprise-wide strategy t successful meet the rganizatin requirements frm an Accunting, Reprting and PI/Budgeting, Reimbursement perspectives 19

20 PI & Reimbursement Update Our purpse is t identify and mnitr financial perfrmance fr PI/Budget and Reimbursement. The bjectives ffer an pprtunity t where we can strategize t prmte cnsistent imprvement in areas that we can directly impact: HIX & ME PI/Budget Bad Debt Charity Care Reimbursement (Exchange, Medicaid, Medicare, Cmmercial, Self-Pay) Team Leads: Charlie Brwn, Andrea Gannn and Mike Smith Prgress: Fr PI/Budget purpses, cllectively we have targeted $17M in pprtunity Partnering with ur subgrups: Accunting and Reprting t define accurate and cnsistent reprting fr the PI s while assessing reimbursement PFS as they play a key rle in managing the risk with ur Charity sectr Cntracting t understand the implicatins fr the HIX sectr 20

21 RESOURCES SharePint Enterprise-wide Cmmunicatin Site fr Health Insurance Exchange (HIX) & Medicaid Expansin Specific Questins Cntact: UW Medicine HIX & Medicaid Expansin Task Frce 21