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Connector Meets to Look at Customer Service, Plan Choices, & Provider Look-Up

Connector Meets to Look at Customer Service, Plan Choices, & Provider Look-Up

July 10, 2015

On Thursday, the Connector Board met to discuss:

  • customer service improvements;
  • Conditional Award of 2016 Seal of Approval;
  • implementing a provider search tool; and
  • the agency’s Fiscal Year 2015 and 2016 administrative budgets.

Materials from the meeting are posted here. Our full report takes a click below.

HHS regional Director Rachel Kaprielian also joined the meeting, introduced herself and shared a few words with the board.

Executive Director’s Report

Health Connector Executive Director Louis Gutierrez started off the meeting with enrollment numbers. Overall, Health Connector enrollment has increased. As of June 1st, the Health Connector covered 165,000 people, with 119,719 enrolled in ConnectorCare. Over 43,000 individuals enrolled in dental coverage. In addition, the HIX eligibility system surpassed making 1 million eligibility determinations. Gutierrez reports the HIX system and website is on track to deliver 2016 open enrollment renewal functionality on August 14th. The plan is to further discuss the Connector’s open enrollment outreach plan at the next board meeting, including an announcement of Navigator grantees. Last, in the wake of first risk adjustment payments last week, Gutierrez noted that the Connector has hired a third party to review all the risk adjustment calculations.

Customer Experience Update

Multiple calls to call center still prevalent

Connector Chief Operating Officer Vicki Coates presented data suggesting that urgent services, account changes, member requested refunds, and verifications have been significantly reduced or even resolved. 

The volume of calls to the Call Center peaked in February at 184,471 but have since stabilized in the mid- 70,000 range per month.  Coates stated that the key driver for the drop in call volume from April to June has been the reduction in repeat calls, which she states is directly correlated to the reduction or resolution of the above-stated issues. 

Next, Coates highlighted short-term and long-term improvements to the online premium payment portal, including confirming the user is a member before accepting payment, displaying the amount due, and live, immediate email confirmation that a payment has been received. 

Coates emphasized that the Connector is striving to achieve the highest customer satisfaction and customer levels by implementing key solutions to meet customer expectations.  For the next two months, the Connector is prioritizing:

  • establishing rigorous controls for premium billing,
  • credit balance handling and collection processes, continuing to meet average speed of answer levels through proactive and improved forecasting plans,
  • improving the Call Center’s ability to resolve issues on the first call by improving training, accountability and point of service capabilities of Customer Service Representatives, and
  • improving and simplifying the enrollment and financial file exchange processes with health plans.

Lastly, the results of the Call Center Satisfaction survey were discussed.  The surveys captured the opinions of about 1,800 members a month and were conducted from January through June.  The results show that issue resolution rates were as low as 40% through March but increased to 61% by the end of June.  In January, 73% of members called the Call Center three times or more but by the end of May, 48% of members called fewer than three times. One of the ways the Connector is hoping to streamline the call resolution process is to establish a separate phone line for enrollment assisters, which will be piloted beginning in August. Coates noted that there was much still much to be done and that customer satisfaction is her team’s number one priority.  

Conditional Award of 2016 Seal of Approval

Seal of Approval results

With the 2016 Seal of Approval, the Connector hopes to simplify the consumer shopping experience by offering relatively fewer plan choices, thereby empowering consumers to find a plan that best suits their needs.  As such, the Connector made several key changes to the Qualified Health Plan (QHP) and Qualified Dental Plan (QDP) plan offerings.  The Connector eliminated two standardized plan designs and limited the total number of non-standardized or alternative network plans available (also see the Boston Globe story, here).

Per the RFR, Issuers were required to offer at least one plan on their broadest commercial network on each of the four standardized plan designs (1 Platinum, 2 Gold, 1 Silver). Issuers could propose one additional version of each plan offered on a different network (e.g., narrower or tiered) for a maximum of eight possible standardized plans offered per carrier. In addition, there is no longer a standardized Bronze plan design. Instead carriers were required to propose one  Bronze plan of their own design on their broadest commercial network and could propose one additional version of their proposed Bronze plan offered on a different network (e.g., narrower or tiered) for a total of two Bronze plans.

There was a subsequent reduction in standardized plan designs and overall plan submission limits; the QHPs available for the Board’s consideration had already been reduced from 126 plans in 2015 to 81 plans (a reduction of 30%).  All issuers proposed at least one plan for each of the four standardized plan designs on the Issuer’s broadest commercial network.  Both Fallon Community Health Plan and Harvard Pilgrim Health Care proposed standardized plans on alternative networks.  Issuers submitted 27 non-standardized plans, including 20 new non-standardized plans for 2016.  The majority of these new offerings are Bronze tier, per the RFR requirements.  All issuers submitted Catastrophic plans, with five issuers electing to waive their Catastrophic plan offering.     

There was emphasis that consumers in plans that were eliminated will be mapped to benefit designs most similar to the one they had.  In addition, Harvard Pilgrim decided to stop offering two non-standardized plans, which will be “frozen” - members will be allowed to keep their coverage but no new members will being accepted for those plans. 

As a result of changes to the federal Actuarial Value (AV) calculator, 2015 Bronze plan designs have a 2016 AV of 67% and can no longer be sold as either a Bronze or Silver plan.  All 11 issuers have submitted Bronze QHPs for 2016, with significant variations in plan design meeting the new standard (60% Bronze, 70% Silver).  The Connector reviewed the 2016 Bronze plan offerings and, while they meet the AV requirements, they offer a lower level of benefits compared to any non-Catastrophic plans previously offered.    The Connector will come back to the Board with the recommendation for the final 2016 Seal of Approval in September, after the Division of Insurance (DOI )  reviews and approves carriers’ proposed rates.  

Connector Board member Nancy Turnbull recommended that members in the 2015 Bronze plans be offered a default renewal into plans of comparable actuarial value to their 2015 plan, be informed of the choices they have, and be allowed to change the default renewal should they choose, instead of being placed in plans that have materially less coverage. Board member Mark Gaunya, the broker representative, asked what the impact of the state’s Minimum Creditable Coverage  (MCC) standards are on the new Bronze plans. Connector staff responded that while the new Bronze plan AV requirements do not meet MCC requirements, carriers offering these plans can seek a MCC waiver.

Board member Dolores Mitchell asked whether the Connector’s actuarial consultant could model the reduction in plans offered through the Health Connector and the impact on risk and premiums. Connector staff said they will consider this. Board member Michael Chernew, the health economist representative, said that there are trade-offs between a lot of choice, which may make shopping more complicated, and ensuring the Connector is offering enough choice and not eliminating valuable options.

In the 2016 Qualified Dental Plan overview, Connector staff reported that all five existing QDP issuers responded and submitted a total of 13 non-group plans and 25 small group plans, an increase of one plan compared to 2015.  All issuers proposed at least one plan for recertification for each of the three standardized plan designs.  All 2015 non-standardized plans have also been submitted for recertification, along with one new non-standardized plan from Delta Dental. 

As stated earlier, there are approximately 43,000 individuals enrolled in dental plans through the Health Connector, most of whom are also enrolled in a health plan through the Connector. Turnbull expressed concern and the need to find a solution to the undermining of the pediatric dental coverage requirement under the ACA, whether that is through requiring this benefit be embedded in health plans, or requiring carriers that offer embedded dental benefits outside the Connector also offer these pland inside the Connector. Fallon Health is currently the only health plan offered through the Health Connector that embeds pediatric dental benefits.

The board voted to approve  the Connector recommendation of the 2016 Conditional Seal of Approval to Altus Dental, Blue Cross Blue Shield of Massachusetts, BMC HealthNet Plan, CeltiCare Health Plan, Delta Dental of MA, Fallon Health, Guardian, Harvard Pilgrim Health Care, Health New England, MetLife, Minuteman Health, Neighborhood Health Plan, Tufts Health Plan – Network Health, Tufts Health Plan, and UnitedHealthcare. The Board will vote on the final 2016 Seal of Approval at the September meeting.

Provider Search Tool Procurement

 Consumers’ Checkbook to stand up a short  term, standalone provider search tool that consumers will be able to use for 2016  Open Enrollment

The Board approved to enter into contract with Consumer’s Checkbook, a vendor selected to implement and support a provider search tool for an initial term of three years at an estimated budget, a portion of which is eligible for federal grant funds, of $630,000.  The organization has implemented multi-carrier provider search tools for several other exchanges, including the state exchanges for Illinois, Washington D.C., Nevada, and CaliforniaChoice (private exchange).  The current Health Connector website does not offer a provider search function, requiring users to visit each issuer’s website to determine if a particular provider is offered within one of their plan’s networks.  Consumer’s Checkbook seeks to alleviate that disjointed experience by allowing consumers to search and compare up to three providers in an integrated way with the Connector website.  One important limitation raised at the meeting is that only doctors (MDs and Dos) and acute care hospitals will be searchable to start with, effectively leaving out many behavioral health providers with other licensures (e.g. PhDs or LICSWs).  The Connector is aiming to have the vendor build in these capabilities later on.

Health Connector Administrative Budget

The Fiscal Year 2015 Year-End Budget Projection started off on a positive note, with Director of Finance Kari Miller stating that the projection was an $8.4M budget surplus instead of the $10.1M loss predicted in July 2014.  Miller alleged that the major drivers of the surplus were:

  • An allocation of $9.4M in costs for hCentive/dual track implementation to the HIX budget, as opposed to utilizing reserves,
  • $5M decrease in operating costs,
  • $4.1M increase in revenue to offset existing administrative costs.

Additionally, a membership increase was driven by a higher-than-anticipated enrollment of 35,000 Qualified Dental Plan members, which offset fewer ConnectorCare members due to the extension of Commonwealth Care.  Miller said that the FY15 net position will allow the Health Connector to build up their reserves to offset the expected costs of FY16. 

Unlike Fiscal Year 2015, Fiscal Year 2016 is projected to incur a loss of approximately 15.8M due to the phasing out of federal revenue to support operations and continued investments to improve member experience, primarily through IT improvements.  The Health Connector assumes that investments will continue to be needed to stabilize operations and resolve member issues, continue integration of hCentive with existing systems, and ongoing costs associated with the operation and maintenance of the Exchange.   

The FY16 Administrative budget reflects 237,421 members by June 2016 and anticipates a net increase of 25,000 ConnectorCare members during the year.   The Connector will use reserves to absorb the anticipated loss in FY16.  The Board voted to approve the proposed FY16 administrative budget.

       -- Michelle Savuto