Profiles in Exchanges—Part One: Nevada

With just about one year until either state-based, partnership or federally facilitated health insurance exchanges will be operational across the country, many states have embarked on a full sprint toward the finish line. These states are cementing key policy decisions related to their exchanges, including how to build exchanges that are ultimately consumer-oriented. In a new series of blog posts, we will highlight the perspectives of state exchange leaders, and the approach each state has taken toward incorporating consumers’ needs into its exchange. Today’s installment features Jon Hager, Executive Director of Nevada’s Silver State Health Insurance Exchange.
From application through enrollment, how does your state’s exchange envision the process by which consumers will acquire coverage?
Jon: Any way a consumer can get an application in, we will accept it. All information from an application will ultimately be transcribed into our web portal—the design of which is highly modeled after the guidelines released by Enroll UX 2014. The web portal will contain several support tools to then assist consumers with sorting through and enrolling in public or private coverage. These tools will include provider directories, formularies and tools so that consumers can easily filter out or rank plans as they browse options. We strive to help consumers whittle down choices to a top two or three, but it has been daunting to capture these experiences in an online portal.
We are one of few states planning to aggregate premiums for both our individual and SHOP exchanges and bill individuals or employers directly. We believe it makes sense to have one system that can aggregate bills for families whose members may be enrolled in different plans (public or private; medical, dental or vision). Despite higher upfront costs of building our system in this way, by 2016 our vendor has estimated the cost of aggregation services to be approximately $.40 per person, less than a postage stamp. Finally, our system will allow for consumers to pay bills through several mechanisms, including through the web portal, making it very convenient for them.
We felt it was important to have all services—from application to billing and payment—conducted by the exchange. This will improve brand recognition among our consumers and boost enrollment in the long-term, we believe. We hope consumers will return each year during open enrollment and see this as a tool through which they can acquire the best coverage for their unique circumstances. This will force carriers to continually update their plans to meet market demand.
What are your plans for consumer assistance through the exchange?
Jon: For our navigators, we are planning a competitive grant program that will be open to entities such as outreach organizations and state agencies. Each entity that receives a grant will be required to have at least one individual certified by the Division of Insurance to be an “Exchange Enrollment Facilitator.” While other individuals in the organization may assist with applications, only certified individuals may assist consumers with enrollment into health plans.
We have conducted a survey of several outreach organizations and state agencies to assess interest. We expect that many of these groups will be willing to provide services for very low cost, similar to our State Health Insurance Assistance Program (SHIP).
Our broker community has also been highly engaged in our exchange planning and will be enabled to sell products through the exchange. Each will have the ability to log into the exchange with his or her unique producer number. After completing enrollment in a plan, the broker’s number will be relayed to carriers, who will then pay brokers directly for their services in the same or a similar manner as they are paid today. We plan to update our continuing education requirements for brokers, so that they will be certified to appropriately serve individuals or employers through the exchange.
What important lessons have you learned about building an exchange that is consumer-friendly? What advice might you offer your fellow exchange leaders?
Jon: While we have conducted some market research, it is difficult to take that information and turn it into actionable policies. It is important to have data, but make sure to clearly outline the decisions you are trying to make based upon that data. It is much easier to use your data once you know your questions.
Additionally, all exchanges are new agencies in the process of implementing a program. On the other hand, other state agencies, like Medicaid, are busy operating existing programs. Because of this distinction, priorities do not always align between agencies and interaction can be challenging. It is important to work closely with sister agencies, keeping in mind that they are often doing exchange-related work on top of their normal workload.
This blog post series is made possible through generous support from the Nathan Cummings Foundation.