The California Health Benefit Insurance Exchange

California is a leading state in formation of Health Benefit Exchanges. The Health Reform Law as specified in the Patient Care and Affordability Act two years ago mandates the formation of Insurance Exchanges for each state to create a structure to make available plans for the uninsured or uninsurable.

California frequently goes where no man has gone before, or where others dare not trend. Unlike many states who have chosen to push back on federal mandates with legal means, or refusal to initiate a health benefit exchange, California is travelling down the tracks at great speed.

I took some time to sit in on a Webex presentation (archive available) of the recent California Health Benefit Insurance Exchange today. For those who missed it (probably 99.999% of my readers) The link(s) here will take you to an archive of the meeting. The Agenda is also here..

This is the second anniversary of the passage of the Affordable Patient Care Act. (2010)

Important points of the California Health Benefit Insurance Exchange meeting follow:

Health provider and Public misperceptionis that the Health Insurance Benefit Exchange program is a government run entity. This is not true. The current involvement is a grant mechanism as a startup for HBIEs. This grant funding will end in December 2014, after which the HBIE must be self sustaining from it’s own business model.

Should the state(s) decide not to build their own exchange, then the federal government has the option or mandate to do it for each state.

I thought it important for a physician to attend this meeting. I was unable however to attend the “executive session” which was not broadcast.

The development of the California Health Benefit Insurance Exchange is well underway.

Mission:: For all Californians to have Health Care. The CBHIE goal is to develop a marketplace

California’s unique challenges

California is larger than most countries, and most states, with great diversity in income, rural/urban, ethnicity,languages, education,

California Timeline for plan and implementation relatively short.

Consumer centric: rural urban education

Exec Director Peter Lee

Business development..tracks

CBHIE Human Resource Needs for staffing

Qualified Health Plans by Price Waterhouse

CBHIE Enrollment System: Critical Backend IT platform

Assessing Federal Regulations

Setting standards for QHPs

Multi-state plans may be exempt from some requirements

CBHIE Will include dental plans, mental health,

Standard rates

At The Table was Donald Berwick MD former CMS head

Assessments:

Several shifts in Individual markets ,Group, Medi-Cal, Uninsured, Undocumented ? 1 million

Exchange prediction is working from vague statistics and estimates.

Enrollment penetration: 2014 20% 2019 100% Rates will be critical

Market surveys.

Beware of program being construed as a ‘government program”

Balanced approach, linked to health services

Spectrum of support services

Much of Health Benefit Insurance Exchange planning involves outreach and research into transitions, loss of employment, moves, divorce, connecting graduation, education, student loan program

Pre-enrollment from other plans from public programs, and for life transitions.