CMS says the federally facilitated exchange will likely leverage some design aspects of the health insurance exchange prototype portal that the private-public partnership Enroll UX unveiled at a congressional briefing on Monday (June 18). The prototype, crafted over the past 14 months by a partnership of 11 states, CMS officials and eight health care foundations, aims to offer states and the federal government a tested, user-friendly exchange design approach that officials can build on and customize to meet their own policy and functionality goals, Enroll UX's project director Terri Shaw said.
CCIIO Deputy Director Tim Hill indicated that CMS believes it would not be in the agency's best interest to spend two years working on a project and then “go off on our own.”
Richard Fiori, executive director of Alabama's health insurance exchange, called the effort unprecedented and said that it will result in “tremendous savings” in both time and resources.
As part of the research process, the design team examined existing sites such as travel websites, shopping sites, and sites that allow users to file taxes, Shaw said. The prototype allows users to check eligibility for premium tax credits, and it is intended that the state be populated with as much existing data from other sources as possible, which would ease the process. For example, a user could simply input their name and social security number, and the site would quickly show that person's expected monthly income. It would allow the user to note if the information is correct or should be changed.
The site would also allow a user to decide if they'd rather use all or only a portion of the advanceable, refundable premium tax credits, which could shield some users from having to repay at the end of the year due to expected income changes.
In the “shopping” section, the site includes a filter that allows consumers to identify their priorities in a health plan -- such as whether their current physician would be covered.
The design allows users to browse some of the site's functions without creating an account, but a representative from New York said that their state will likely expand upon that option. New York is also planning to customize the iconography on the site to make it more New York-centric, says Ruchika Bajaj, of the state's Department of Health.
In addition to New York and Alabama, other states involved in the project's development include: Arkansas, California, Colorado, Illinois, Massachusetts (in collaboration with Rhode Island and Vermont), Minnesota, Missouri, Oregon and Tennessee. Several other states provided assistance, and 18 states attended a January forum on the project. The health care foundations include: Robert Wood Johnson Foundation, the Atlantic Philanthropies, Blue Shield of California, The California Endowment, California Healthcare Foundation, the Colorado Health Foundation, New York State Health Foundation, and Kaiser Permanente Community Benefit.
While the prototype is the property of the foundations, it is intended to be available for use by all states at no cost, Shaw said. The product is not functional and it relied upon placeholder language, which each state could replace with wording at a literacy level that officials see fit. Other key state decisions that were discussed during Monday's briefing included what other languages will be available, whether to use the site for billing, and the degree of integration with other state-based health insurance programs.
Many of the outstanding issues may require large amounts of data to proceed. For example, one audience member praised the concept of allowing users to see which physicians may be covered under a plan, but wondered about cases in which a doctor may be technically in a network, but is not taking new patients.
This would be a “huge data challenge,” Fiori of Alabama said. Further filtering to determine coverage of particular drugs -- which was also broached by an audience member -- would also require extensive data capability, Shaw said. -- Amy Lotven ( alotven@iwpnews.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it )
source: Inside Health Policy
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