Health Insurance Exchanges – States Sharing Resources, Solving Problems Peter VanLoon Executive Director, Access Health Exchange Solutions Subramanian Muniasamy Chief Information Officer, Maryland Health Benefit Exchange For the Council of State Governments/Eastern Region Health Policy Committee May 20, 2015

Exchange Basics ●Health Insurance Components Specific to a Successful Exchange –Carrier management Choice and certification –Carrier operations Data exchange –Customer service integration Carriers and exchange –Outreach and education Basic number skills Insurance basics Health care system –Decision support –Stakeholder engagement Regulatory oversight Providers ●Components of a Successful Exchange Implementation –Plan Definition of Success Scope Metrics Timeline –Program Management Technology Operations –Partner Strategy Broker Engagement –Outreach and Education –Stakeholder Leadership –Vendor and Contractor Management –Customer Service integration One stop service –Medicaid Integration

ACA Exchange – A Short History ●Results –CT Halved uninsured rate to 4% –110K Purchasing Insurance –>500K Medicaid »50-60K New Medicaid 92% Approval Rating ●Reality –No More Development Money –States must Pay their Own Way ●Options –Traditional Revenue Options for States: Assessments Fees Appropriations Ancillary Products All of Above –What Else? Share Services and Technology Collaborate Abandon SBM for FFM ●Two Open Enrollment Cycles –First Year – 2014 Policy Year Problematic with SBMs and FFM –Second Year – 2015 Policy Year Much less problematic ● What Changed? –Technology Evolved/Improved Money was thrown at the problems –Customers became more sophisticated Experience Outreach ● Experience –Effective from 10/1/13 CT, KY, CA, NY –Improved for 11/15/14 MD, CO, FFM –Failures OR, HI –Still Improving RI, MA, VT, WA, MN

SBMs – What are their Costs? ●Administration –People –Legal –Accounting –Human Resources ●Initial State Efforts to Decrease Cost –Curtail Advertising and Outreach –Automate Training and Education –Mature Technology to Obviate Need for Customers to Call –Separation of Duties Insurance – Exchange Medicaid – State Agency ●Initial Interstate Efforts to Decrease Cost –MD use CT technology –MD and CT Collaborate on Training and Education –KY share operational processes with OR –HI go to FFM –VT may go to FFM ●Technology –Fix What They Have Avoid Manual Workarounds –Continued Development Add New Functionality –Dictated by CMS –Discretionary –Maintenance and Operations “Keep the Lights On” ● Operations –Call Centers Cost Directly Related to Customer Challenges and Technology Maturity –Outreach/Education –Customer Service Printing/Mailing Issue Resolution –Marketing/Advertising

SBMs – What Does Future Hold? ●Friction Points for Interstate Collaboration –Individual State Procurement Rules –History of Independent Operations –Many Stakeholders –Historical Financing from CMS State Based ●Challenges –Governance –Time –Knowledgeable Resources –Little Stomach for Additional Appropriations –Uncertainty on King v. Burwell ●Interstate Collaboration Opportunities –Joint Technology Development –Joint Technology Infrastructure –Joint Customer Contact/Call Centers –Sharing Administration and Operations People and Infrastructure –Common Contracting –Regional Exchanges Common Base Technology and Operations Individual State Exchange Look and Feel Use of “Cloud” Infrastructure as better/cheaper/faster ● Harsh Reality –Every State Has Challenges to Fund Their Exchange Operations –No State Can Declare Victory at This Point

Exchange Opportunity – the Path Forward –Market Customers are being put in charge of their own decisions –Move from defined benefit to defined contribution, with customer in control –Public and private exchanges Move from wholesale, i.e. company sponsored, to retail Opportunity to become the individual’s trusted advisor –Connecticut’s Health Insurance Exchange Experience Initial Goal – provide the exchange for individuals to purchase health insurance Ultimate Product – –Ability to engage and enable individuals to make complex, confusing, anxiety-ridden, and large financial decisions –People, processes, and technology üPeople committed to customer service üProcesses for effective collaboration of company, partners, and the customer üTechnology to make administration transparent to the customer –Critical Success Factors Educate customers: Outreach, education, decision support Engage customers: Simple administration, multiple lines of communication, 24/7/365 support Enable customers: Effective operations, transactional excellence, issue resolution