Profiles in Exchanges—Part Two: New York

While states’ declarations about who will run the health insurance exchanges are makingheadlines, the 22 states and DC that are likely to establish a state-based or partnership exchangeare busy making policy decisions that will greatly affect the experience of consumers using the exchanges. Last week, we interviewed Nevada’s exchange director about consumer-related exchange decisions. In this post, we talk with Donna Frescatore, Executive Director of the New York Health Benefit Exchange. New York declared in July its intent to run a state-based exchange. As Donna explains, the state’s approach centers on the goal of integration, achieved by building off of past successes.
From application through enrollment, what decisions has New York made to facilitate the coverage process for consumers?
Donna: A key part of New York’s vision is to have an integrated front door where a consumer can come to apply for any insurance program. To make this vision a reality, we are building a common infrastructure for Medicaid, the exchange, and other state health programs. A major piece of this work is transitioning Medicaid eligibility from local offices to a central point of entry. We’re also automating as much of the process as possible, including using federal and state databases for verification, to minimize the amount of documentation consumers need to provide.
Automation also includes developing a consumer-friendly web portal. We are one of the states that worked on the UX 2014 project and we’re looking at that as one possible prototype, among others. We’re also working with a literacy group so the text on the web portal will be easy for everyone to understand, and in multiple languages.
What types of decisions around insurance plan management on the exchange has New York made with consumers in mind?
Donna: Early on we heard concerns from consumers that the plan selection process needed to be easy to understand and that too much choice is just overwhelming to a consumer. One way we’re making it easier is providing filters on the website for a person to gauge what’s most important to them: provider participation, quality ratings, and costs before and after the application of subsidies. We’re also talking to health plans about offering a product in each “metal” tier that has standard cost sharing provisions (deductibles, copays) so that people can easily compare plans.  Plans would also have the option to offer non-standard plans that are innovative.
Easing consumer transitions across Medicaid and the exchange is important. We’re in an ongoing dialogue with the traditional Medicaid health plans about participating in the exchange. We’re also considering whether the Basic Health Program might help with transitions.
What are some innovative consumer assistance strategies you’re planning for New York?
Donna: Along with the integrated web portal, we are planning an integrated customer service center. If someone needs assistance, they can call the same place regardless of what coverage program they’re eligible for. Wherever possible, we’re leveraging currently successful state processes and programs. For example, we already have a call center for our public insurance programs that even includes telephone renewals. Our plan is to leverage that capability and build it out for the exchange as well. We’ll add features, such as a co-browsing, so someone at the call center can help a consumer on the web portal, with their permission. Now we are thinking through the training for assisters to help both Medicaid and the exchange consumers. We’ll add to the current Medicaid curriculum and also add exchange information.
We also already have a network of community-based organizations throughout the state that is successful at facilitating enrollment in Medicaid and CHIP. That’s a good solid foundation for our in-person assistors and navigators. We will also work with the Department of Insurance, which regulates brokers, to develop training for brokers to enter into an agreement with the exchange and sell exchange products. One of our studies showed 88 percent of small businesses in our state use a broker. Some brokers may be interested in the navigator program, and others may want to continue in their more traditional role.
What lessons have you learned about building an exchange that is consumer-friendly? What issues are you still working through?
Donna: We’re viewing this as an opportunity to create a consumer-friendly application process. New York’s public programs currently don’t have an online application. We think there’s great potential for consumer friendliness in going online, and integrating Medicaid and exchange applications.
We think of small businesses as consumers. New York already has a very robust small-group market, so it’s important that the SHOP exchange can add value. We’re talking to small businesses that haven’t been purchasing insurance to see what barriers we might address. We’re also talking to small businesses that do currently offer insurance, to learn what features are important to them.
One area we continue to work on is appeals. We’re discussing how to create an appeals process for all programs that is consumer friendly and efficient for consumers.  We want to make sure it is accessible, and happens quickly for consumers regardless of the program for which they’re eligible.
This blog post series is made possible through generous support from the Nathan Cummings Foundation.