Enrollment Standards and User Experience Sam Karp, VP of Programs October 6, 2011 Implications for Human Services Integration Work Support Strategies Webinar

C ALIFORNIA H EALTH C ARE F OUNDATION  Context and Current Practice  Enrollment Standards  User Experience (UX) Design Project  Vertical and Horizontal Integration  Q & A Webinar Outline

C ALIFORNIA H EALTH C ARE F OUNDATION  States vary…  ACA offers states opportunities  Challenges abound Context

C ALIFORNIA H EALTH C ARE F OUNDATION We Live in a Digital Society

C ALIFORNIA H EALTH C ARE F OUNDATION Current Practice

C ALIFORNIA H EALTH C ARE F OUNDATION Where Are We Today?  However, not widespread…  Impact of the recession  Best intentions  Significant simplification efforts

C ALIFORNIA H EALTH C ARE F OUNDATION Persistent Barriers  Local control  The welfare institution  Inadequacy of systems  Complexity of rules / silos

C ALIFORNIA H EALTH C ARE F OUNDATION

Disclaimer

C ALIFORNIA H EALTH C ARE F OUNDATION

Single Application Process  Medicaid  CHIP  SNAP  TANF  WIC  EITC  LIHEAP  County Indigent Care Programs  California Kids  Healthy Kids  Kaiser Permanente Child Health Plan  Child Health and Disability Prevention Program  Child Tax Credit  Low-Cost Auto Insurance Program

C ALIFORNIA H EALTH C ARE F OUNDATION Enrollment Standards and Protocols

C ALIFORNIA H EALTH C ARE F OUNDATION § HIT Enrollment, Standards and Protocols Not later than 180 days after the enactment, the Secretary, in consultation with the HIT Policy and Standards Committees, shall develop interoperable and secure standards and protocols that facilitate enrollment in Federal and State health and human services programs. Affordable Care Act

C ALIFORNIA H EALTH C ARE F OUNDATION Enrollment Workgroup  20 members representing various stakeholders  Integrated into CMS regulations and ACA guidelines  Held eight pubic hearings and “listening session” with State representatives  Developed 10 recommendations  Recommendations adopted by Secretary Sebelius on September 17,

C ALIFORNIA H EALTH C ARE F OUNDATION Enrollment Standards & Protocols 1.Consumer-Centric Approach 2.Core Data Elements 3.Electronic Verification 4.Business Rules 5.Transmission of Enrollment Information 6.Privacy and Security

C ALIFORNIA H EALTH C ARE F OUNDATION Core Data Elements  Reviewed 34 programs in 10 states  Variation in data name, format and definition  Standardize to increase interoperability  National Information Exchange Model selected as standard  Implementation approach  Range of complexity in data harmonization

C ALIFORNIA H EALTH C ARE F OUNDATION Electronic Verifications  ACA §1411 requirement o Citizenship SSA o Income IRS o Legal status DHS  Additional interfaces to Federal, State or other widely-available data sources  Federal reference software model  Standardized Web services exchange CMS building Federal Data Services Hub

C ALIFORNIA H EALTH C ARE F OUNDATION Business Rules  Express in consistent, clear and unambiguous language  Transparent to consumer by providing understandable eligibility determinations  Federal government establish repository of business rules needed to administer ACA health insurance coverage options

C ALIFORNIA H EALTH C ARE F OUNDATION Transmission of Enrollment Information Utilize existing HIPAA transaction standards — from health insurance coverage options to public and private health plans and to other health and human services programs

C ALIFORNIA H EALTH C ARE F OUNDATION

Enroll UX 2014 Project Objectives  Provide federal and state governments with a human-centered design to support enrollment  Help achieve a first-class user experience that promotes informed enrollment decision-making  Help ensure that large numbers of eligible consumers successfully enroll in and retain coverage

C ALIFORNIA H EALTH C ARE F OUNDATION Public/Private Partnership

C ALIFORNIA H EALTH C ARE F OUNDATION 11 Participating States Alabama, Arkansas, California, Colorado, Illinois, Massachusetts, Minnesota, Missouri, New York, Oregon, Tennessee

C ALIFORNIA H EALTH C ARE F OUNDATION UX 2014 Design Partner World-class design, engineering and innovation firm

C ALIFORNIA H EALTH C ARE F OUNDATION Project Overview  Individual market and SHOP  All insurance affordability programs (Medicaid, CHIP, tax credits, cost sharing reductions, BHP)  Full eligibility, enrollment, plan selection and retention experience  Multiple pathways  Designing for diversity and ADA compliance  Vendor / system neutral

C ALIFORNIA H EALTH C ARE F OUNDATION Design Phases / Timeline

C ALIFORNIA H EALTH C ARE F OUNDATION Research Phase

C ALIFORNIA H EALTH C ARE F OUNDATION Behavioral Segmentation Helps to design a system that is responsive to people’s different needs, desires and expectations.

C ALIFORNIA H EALTH C ARE F OUNDATION Initial System Flows and Wireframes

C ALIFORNIA H EALTH C ARE F OUNDATION Design Workshop San Francisco, September 12-13

C ALIFORNIA H EALTH C ARE F OUNDATION Multiple Enrollment Channels

C ALIFORNIA H EALTH C ARE F OUNDATION Immediate Mobile Opportunities ACTIONABLE ALERTS  Renewal reminders  Prompt to submit missing info  Status changes/updates  Secure messaging MOBILE HELP/SUPPORT TOOL  Voice/Text  Location-based support services ENROLLMENT TRACKER FOR APPLICATION STATUS  Text /  Automated phone messages MOBILE UPLOAD  Data upload with photo support

C ALIFORNIA H EALTH C ARE F OUNDATION Preliminary Visual Design

C ALIFORNIA H EALTH C ARE F OUNDATION Design Refinement Phase  Further review and user evaluation  Publish comprehensive design specifications  Develop working functional prototype  Develop communications materials for sharing design

C ALIFORNIA H EALTH C ARE F OUNDATION Public Website

C ALIFORNIA H EALTH C ARE F OUNDATION Vertical & Horizontal Integration

C ALIFORNIA H EALTH C ARE F OUNDATION Considerations for States  Does it makes sense to leverage interest, focus and resources on ACA enrollment modernization efforts?  What level of integration? What programs? Phased approach?  How or whether to conform eligibility rules?  Cost-allocation implications / August 2010 OMB Circular A-87 Exception Letter  Planning today for tomorrow…

C ALIFORNIA H EALTH C ARE F OUNDATION Questions & Answers