A Conversation with Exchange Leaders: Part Two—Policy Directors

While the exchange websites make the big news, the policy behind exchange operations may have the larger impact on transforming the health care system. Exchanges’ policy decisions drive important operational elements including plan structure and benefits, the assistance consumers receive, the source of exchange funding, and risk pool management. In this second installment of our blog series catching up with state-based exchange officials, we had a conversation with the policy directors of two state exchanges. Molly Voris is the Policy Director of Washington Healthplanfinder. Debra Curtis is the Deputy Director for Policy and Exchange Programs at DC Healthlink. (See Part One for a conversation with exchange executive leaders from Connecticut and Kentucky.)
Reflecting back on the 2014 open enrollment period, what were the top successes from your perspective as a policy director?
Debra (DC): Our top success was that we stayed operational throughout the entire open enrollment period. The other substantive success is that our enrollment is very young, which indicates we hit our target audience of previously uninsured people, who we knew were a young demographic.
Molly (WA): I want to echo a bit of what Debbie said. From a policy director perspective, we had similar goals as our colleagues. Even prior to open enrollment, one success was that we held to a scope of work that allowed us to go live and be operational for October 1. From the earliest days, we knew we had a lot to do in a short period of time. There were a lot of policy issues that we held off on, like adult dental and choice architecture. But sticking to what we needed to get through for open enrollment, allowed us to build a system that operates with integrity.
Debra (DC): I agree, our goal for year one was for it to work and to be correct. In year two we want to do more, like having a searchable provider directory, and allowing choice in plan shopping along more criteria.
Can you describe something you learned mid-course that turned out to be very important?
Molly (WA): I would say we learned that we didn’t know what we didn’t know. We thought we knew what to expect, but we didn’t. We needed to make sure we were reacting as quickly as possible. When something came up, being transparent allowed us to get information out to partners like in-person assisters, brokers, and call centers about a problem with our system. We could tell them about potential workarounds or let them know when it would be fixed. Transparency was key.
Debra (DC): I think Molly said that well. The way I have always said it is that change is hard. It sounds cliché, but it is true. Things may make sense to people who design them, but they don’t always make sense when people see them for the first time.
What are some best practices that you will carry forward into 2015 and future years?
Debra (DC): Our one touch enrollment centers were very successful. We brought together Medicaid, in-person assisters, brokers and other partners in one place so no matter what the problem, people had their issue fixed. The added value was getting those people together in one room. It allowed them to understand their roles better and how they could work together. We will definitely continue these centers next year.
Molly (WA): We will continue to trust the experts—the in-person assisters and people on the ground. Getting the stakeholder input from those working with specific populations is really helpful. From a policy perspective, as we’re talking about new work, we plan to talk about things as early as possible to familiarize people early on. For example, we’re starting to familiarize assisters with the auto-renewal process, and coordinating the notices consumers will receive around that.
Debra (DC): I agree. We used a stakeholder process as well.  We developed advisory working groups made up of stakeholders representing consumers, providers, insurers, small businesses, etc. to develop policy.  This helped ensure we are creating policy with strong community support. That process has been hugely beneficial and we will continue to use it.
From your perspective as a policy director, can you discuss your priorities and upcoming opportunities you see as you plan for 2015 and beyond?
Debra (DC): Our upcoming priorities are to keep things running smoothly, and to go back to things we weren’t able to do early on, like a provider directory, shopping improvements, standardized plan names to help consumers, and thinking further out about in person consumer support.  While we were one of the few states with a broker portal from day one, we are also enhancing its functionality based on our experience to date and ongoing input from brokers.
Molly (WA): Our priorities include getting information out to the public and coordinating with partners. Auto-renewal is another big priority. Our board will be looking at pretty substantivepolicy issues like adding a consumer rating system and adding adult dental. Our board has also been looking at the strategic position of the exchange in broader health reform going forward.
This blog series is produced by the State Health Exchange Leadership Network, a project that supports exchange leaders and staff, housed at NASHP. The State Health Exchange Leadership Network is supported by state contributions and the Robert Wood Johnson Foundation.