Lead Orgs. IPA Panel. consensus. consensus

Navigator Program Input

Lead Orgs

IPA Panel

WACMHC Wakely Board Questio

ns

Others NTAC

1. Expand Navigator support at Call Center (more knowledgeable CSR, limit waiting)

No

consensus X X X X

2. Extend enhanced user access to partner organizations

No

consensus X X X

3. Establish broker-navigator hand-off procedures X X X X

4. Stability in contract cycles X X X X

5. Health literacy X X X X X

6. Create an approach to supporting organizations that deliver services in multiple Lead Org service areas

X X

7. More funding to establish QHP network X X X

Redesign the partnership functionality – does not support the way we do business (included with enhanced user access response)

X X X X

Co-location with HCA out-stationed workers when possible

X X X

Enable consumers to partner with organization rather than a specific Navigator (included with enhanced user access)

X X X

Leverage CHC IPAs and standardize support X X X

Training on immigration statuses X X X

Identify and seek new partnerships that reach QHP eligible individuals

X X X

Unpaid partners need support for outreach, resolving issues

X X X

Need data/information to identify low-income QHP populations

X X X X

Standardize the approach between Lead Orgs and CHCs

X X

Solicit more input from partners, document and share best practices X X Lead Orgs IPA Panel

WACMHC Wakely Board Other Partners

2 CHCs to become “comprehensive service” site for

consumers-–outreach, enrollment, education, utilization

X X

Need partners who can accommodate those who drop in X X Maximize use of partners with “no wrong door” approach. X X How to help people through the decision-making process

who are uncertain/hesitant

X X

Reassess how hospitals/providers are supported – impact to lead orgs

Mixed X

More IPA training around QHP plan selection X DSHS relationship is still a barrier in some areas Mixed

Enrollment targets for QHP X X

Revise performance standards X

Identify potential QHP sites (libraries) X

All Hands on Deck events X

Centralize system and user support at HBE Mixed X

Translation of website into more languages X

More functionality for lead organizations to directly resolve issues

X

Leverage work done by private vendors, like Cardon X

Lead Organizations: (1) Better Health Together, (2) Benton-Franklin Community Action Connections, (3) Yakima Neighborhood Health Services,

(4) Clark County Public Health, (5) Cowlitz Family Health Services, (6) CHOICE Regional Health Network, (7) Kitsap Public Health Department, (8) Pierce County Health Department, (9) Seattle-King County Public Health Department, (10) Whatcom Alliance for Healthcare Advancement - WAHA

IPA Panel: Board-selected IPA panel consisting of Better Health Together Lead Organization, Within Reach Navigator Organization for two Lead

Organizations (King and WAHA) and Kristin Robak, Interfaith CHC.

WACMHC – Washington Association of Community and Migrant Health Centers

Wakely – Wakely Consulting Group performed an evaluation of the Navigator-Broker Program after first open enrollment. Board – HBE Board questions submitted to HBE.

Other Partners: Feeback at various partner meetings, such as WACOMO, First Friday, WAHA partner meetings and others. NTAC – Navigator Technical Advisory Committee

Current status

 There is a dedicated Navigator/Broker line staffed by 25 designated CSRs who are knowledgeable about the Navigator program.

 During peak call times when all 25 CSR’s are tied up, callers will have a wait.

 Navigators can also ask the Lead Organization for assistance.

 Navigators can make appointments with a CSR to address multiple issues at once.

 Navigators can use the consumer support center e-mail to send a question or issue.

 We have heard that some Navigators try to circumvent waiting by selecting a different option. In this case, they will get a random CSR who may or may not be familiar with the Navigator Program.

Advantages Disadvantages

 Additional resources could make it possible to resolve an issue while the client is still present with the navigator and less chance of losing the

enrollment.

 Devoting more resources to Navigators/Brokers will result in longer waiting times for other consumers.

 Consumers who are navigating the system on their own have no other avenue for support, while Navigators can seek assistance from Lead Org enhanced users or schedule an appointment.

Potential Solutions

 The original plan was for the Call Center to support all users (including Navigators and Brokers); however, to date they have not had the capacity to do so.

 In Open Enrollment 2, Brokers in the independent market (not businesses) were transitioned to Call Center support so the Broker team could focus on small business enrollment.

 Navigator issues are no different than any other consumer and a single point of entry for system support would be preferable.

 Navigator Program would prefer a plan that moves system and user support back to the Call Center so that Navigator resources could be devoted to outreach, application, enrollment and renewal assistance, and to integrate health literacy activities.

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2. Request: Extend enhanced user access to partner organizations

Current status

 Lead Organizations have enhanced users who provide user and system support to Navigators within their service area.

 This was never an expectation for Lead Orgs and having Lead Organizations fulfill this work was intended to be a temporary solution until HBE could stabilize and provide system-wide user and system support.

 Costs for the Lead Organization enhanced users are paid through the Navigator grant funding and are in addition to administrative costs that most organizations charge.

 A larger and larger proportion of Navigator funding is now going to support these functions. When first introduced, Lead Orgs designated 1-2 enhanced users. Now most Lead Organizations have 2-4.

 Not all lead organizations support extending this access to partner organizations due to high risks outlined below.

 HBE has a contractual relationship with Lead Orgs that establishes responsibility and liability for their actions.

 Enhanced users are placed in an HBE employee role in Healthplanfinder – there is no non-employee role that has the functions they need and want.

 Enhanced users receive higher level training to understand how to use expanded functions.

 The CSR role provides access to several functions that the enhanced users are not authorized/permitted to use. This can only be trained as an expectation – the system will not stop them from performing actions they should not perform.

 The role enables the user to access and change any Healthplanfinder account, not just accounts for their own Navigators. This means they have access to PII for all enrollees.

 The user must be an advanced Healthplanfinder user. Incorrect actions cause significant adverse impacts to a consumer account that can take a long time to undo.

 Risks were mitigated by keeping the group of enhanced users limited.

 One full time position on the Navigator team supports the current enhanced users.

 Removal of invoicing and payment will resolve many current account issues.

 Discontinuation of documentation verification for SEP will also eliminate waiting for individuals with qualifying life events.

Advantages Disadvantages/Risks

 Would provide more functionality at the lowest level to resolve common account issues without assistance from the Call Center or Lead Organization.

 Provides needed functionality to more efficiently serve clients at the time of enrollment.

 Eases workload for Lead Organizations.

 We do not have contracts with these partner organizations, and doing so would have a significant administrative impact.

 It will be very difficult to limit to a few organizations – we have dozens of organizations who want this access.

 High risk related to giving the user unrestricted access to all accounts. There is no way to restrict access to only their own Navigators’ accounts.

 High risk related to giving access to functions they are not permitted to perform but the system will not prevent them from performing.

 High risk related to placing non-employees in a role designed only for HBE employees if a problem occurs (public/media perception).

 High risk of enhanced user errors causing significant account issues.

 No HBE procedures or monitoring in place – problem would likely only be detected after it occurs.

 If a breach (intentional or unintentional) occurs, it would likely result in taking the permission away from all enhanced users, including Lead Orgs.

 Larger proportion of Navigator budget going to pay for user/system support.

 User-system support was never intended to be a function of the Navigator Program, and impacts funding for outreach, enrollment, training and support of Navigators.

 Expanding the function would solidify as functions of the program rather than

working toward centralizing the support using the call center and IT help functions.

 Adversely impacts program enhancements, such as health literacy activities and retention of QHP enrollments year after year.

 It takes one full time person on the HBE Navigator staff to support the current enhanced users. Without additional resources, it would become another place they wait for assistance.

Potential solutions:

 Navigator/Broker program has a number of change requests submitted (but not prioritized for a future release) that would address the biggest issues. Discontinuing premium aggregation and document verification related to SEPs will reduce issues.

o Create or revise a role in Healthplanfinder that is tailored to provide the specific permissions and access appropriate for this user type.

o Redesigning partnership and search functions would resolve the most common problems

 Transition Navigator user-system support to Call Center and HBE IT Help program as originally intended. Continue funding lead organization enhanced users until HBE has capacity to centralize these services.

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3. Request: Establish broker-navigator hand-off procedures

Current status

 HBE published “guidelines” for Navigator-Broker relationships

 Referral procedures have been established and referrals are working well in some areas.

 Lead Organizations have lists of Brokers in the area, including those with language capabilities.

 Navigator Program has facilitated “Healthy Hour” events in Spokane, Vancouver, Everett, Marysville, and Bellingham and plans to resume these events after SEP is closed. (Healthy Hour brings Navigators and Brokers together to meet, talk about how they can work together and establish protocols.)

 All HBE-sponsored events now include both Navigators and Brokers.

 Many Lead Orgs extend invitations to Brokers.

 There are system limitations that make partnering more difficult.

Advantages Disadvantages

 Lead Organizations are on board and working with Brokers in most areas

 Navigators want to make sure that when they make a referral the Broker is actively enrolling in Healthplanfinder and will follow up

 System limitations discourage partnership between Navigator and Broker.

Potential solution:

 Healthplanfinder enhancement to allow consumer to authorize more than one person to access information and assist with enrollment. Healthplanfinder would need ability to have both Broker and Navigator partnership.

 Continue and expand Healthy Hour events.

 Reach out to larger Navigator organizations to see if they need help establishing a Broker partnership and to assist them in understanding the protocols for the relationship.

4. Request: Stability in contract cycles

 Contracts have followed grant award cycle.

 We are notified very late about grant awards.

 We often contract in advance of contract awards making contracts “dependent on the availability of funds”

 It has been very challenging for organizations in terms of staffing and turnover

 Grant awards have been lower than request level

 Uncertain how future funding supports a more consistent grant cycle.

 Creates an opening to reassess current program and make changes on a regular cycle.

 The environment the program is operating in is still changing and it may require adjustments in program operations to maximize enrollment (uncertain funding level, DSHS resuming Medicaid enrollment)

Advantages Disadvantages

 Stability makes it easier for contractors to commit.

 Decreases turnover in staff if they can plan longer-term.

 Helps us engage at a more strategic level if we know we have time to implement improvements over time.

 HBE, Lead Orgs and partners get attached to practices quickly and it is harder to implement changes.

 Organizations make investments that may be difficult to change.

 As the environment continues to change, we need to adapt, and having long-term contracts makes it more difficult. Potential Solutions

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5. Request: Integrate health literacy activities in Navigator Program.

 We have hired an Access and Consumer Education specialist in the Navigator Program (4/1/15)..

 We have limited funds to invest in new activities and our long term budget is unknown.

 Many organizations are engaged in various health literacy activities. We will be reaching out to learn what is already being done.

Advantages Disadvantages

 Could result in increased QHP enrollment

 Benefit to enrollees (learning how to choose the best plan, use benefits to best advantage, save money, improve health)

 Could improve QHP renewal rate

 There is significant interest from stakeholders and partners for integrating health literacy.

 We have the opportunity to try new approaches and identify promising practices.

 How to implement effectively with limited resources and uncertain sustainability.

Potential Solutions

 Continue to gather information, connect with stakeholders interested in this topic.

6. Request: Expand the IPA network to include statewide and regional organizations.

 We conducted an RFP for statewide organizations and funded 8 with a total of $700,000. (Within Reach did not submit a proposal.)

 Those contracts ended 12/31/14 or once the organization met the outcomes in their contracts.

 These organizations were outside the Lead Org umbrella.

 Overall, impact was harder to measure. Some struggled to achieve enrollment targets.

 One organization that was very successful has continued under two lead organizations.

 Overall, organizations under a Lead Organization performed better.

 The Lead Organization could provide training, system support and communication, and access to broader resources, events, and print material.

 Organizations outside the Lead Organization framework relied on the Call Center for support as the navigator program did not have staff resources to address their system and user issues.

 Lead Orgs are able to make adjustments among network partners based on demand and performance more easily than HBE.

 Impact of DSHS resuming Medicaid work could significantly reduce the need for HBE-funded Navigators performing Medicaid enrollment.

 We learned from this experience and could integrate improvements that contribute to better outcomes.

Advantages Disadvantages

 Organizations spanning several regions would not need to comply with varying requirements of multiple lead organizations.

 Creates competition and innovation.

 Provides a direct contractual relationship between HBE and the organization.

 Creates stand-alone programs that are not connected to the larger network.

 We will likely have less money in future budget years and it could result in spreading resources too thin.

 More organizations requires more support from HBE Navigator team.

 Organizations may have to rely on the Call Center for support.

 RFP process is time consuming. Possible solutions

 Depends on resource/budget allocation.

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7. Request: Financial support to develop QHP network that mirrors the IPA network.

 The current network is significantly skewed toward Medicaid enrollment because that is where the greatest need was.

 In addition to new enrollments, all existing Medicaid recipients had to be converted to Healthplanfinder and their accounts had to be “touched” to make the conversion. This was an enormous, unanticipated workload.

 Partners were recruited and trained to meet the needs of this population.

 Medicaid enrollments have now levelled off at a lower level.

 Renewals are occurring at a rate between 65 and 70 percent – dramatically reducing the renewal workload.

 Organizations have 7 months outside open enrollment period to assess networks and align to changing demand.

 If DSHS resumes Medicaid enrollment for public assistance recipients, this will fill a large gap that IPAs have been filling by being present in CSO’s around the state.

 CHCs will also continue to be funded for Medicaid enrollments through HRSA.

 We believe we are in a good position to redirect existing resources to more effectively reach into the QHP population.

 Cost allocation for the Navigator program is 50% Medicaid reimbursement and 50% state-based funding.

 We are talking with our partners about how we can balance enrollments and focus efforts and resources to QHP enrollment and renewal during the annual open enrollment period.

 It is unlikely that the Navigator Program will have more funding than it had during the implementation period and we need to make adjustments within existing resources.

Advantages Disadvantages

 Identify partners that are a point of entry for individuals likely to be QHP-eligible.

 More consistent with the future funding formula.

 Opportunity to reassess Navigator network and composition and make adjustments based on evolving needs of the program.

 Resource limitations.

Potential solutions:

 Redefine enrollment expectations and priorities to reflect the expected resource allocation (50-50 Medicaid-QHP).

 Conduct an RFP that causes organizations to reconsider their structure and make needed changes.

 Within available resources, solicit partner organizations that reach all priority populations, including QHP and Apple Health.

 Consider adding new partners that are more closely aligned with the QHP-eligible population.

 Establish clear expectations through compensation approaches that incent QHP enrollment and renewal during the annual open enrollment period.