Following a presentation by Executive Director Peter Lee on Covered California’s “story” of success and need to transition from start up mode to a mature operation with sustainable financing, Thursday’s Board meeting had exactly one action item: approval of the Covered California budget for fiscal year 2015-2016.
Comings and Goings
Director Lee announced the retirement from 35 years of state service of David Panush, after three years as Covered California’s Director of External Affairs and previously many years in the California State Senate. We at Health Access wish David Panush well in his future efforts, which likely will include playing music in a band.
Executive Director Report: Building on Covered California’s Story of Success
As an active purchaser exchange, Covered California has made the promise of reform real for millions of Californians, not just cutting the uninsured rate almost by half, but also delivering on the triple aim: better care, healthier people, and lower costs. Those with coverage have better coverage—and as the largest purchaser in the state with 1.3 million covered lives (“Sorry, CALPERS”), Covered CA has real clout to extend its impact even further and in all insurance markets.
Going forward, Covered California will be leveraging its role as an “active purchaser” to ensure enrollees are getting the right care at the right time through delivery system reform. As a condition for offering products on Covered CA, all plans will…
- participate in payment reform and quality collaborative;
- develop programs to chart progress in reducing disparities;
- determine the health status of adults and use that information to improve health;
- encourage consumers to use their benefits and seek preventive care;
- help consumers select a PCP or team-based care or clinic;
- help those with chronic conditions manage their health;
- Provide and update information showing total costs and out of pocket costs for the most used services.
In their comments advocates heartily applauded Lee’s plans to “raise the bar” on these efforts and others addressing health equity. Speaking for Health Access, Beth Capell urged Covered California to meet the quadruple aim (the triple aim + equity), especially given the populations covered in Covered CA. Betsy Imholz of Consumers Union and Cary Sanders of CPEHN (California Pan-Ethnic Health Network), too, welcome the opportunity to address disparities through delivery system reforms. To ensure that equity goals are “baked into the mission,” Covered California has a new Disparities Officer assigned to these issues, Jonathan Tran, though Lee made a point of clarifying that it is the job of all on the staff to address disparities.
Covered CA is in the top seven states in enrolling the subsidy-eligible population. Special enrollment numbers showed that since the last open enrollment 129,800 have enrolled, with lost insurance as the number one reason (53,303). The second highest category of SEP enrollees (42,413) enrolled thanks to the special SEP circumstance created earlier this year: informed of tax penalty. Enrollment by ethnic groups has been closer to projections, though a significant number (30%) still don’t disclose their ethnicity when they enroll.
Covered California’s $335 million budget reflects the transition away from federal exchange establishment funds toward exclusive reliance on health plan assessments. As presented by Finance Director Jim Lombard, the 2015-16 budget also reflects:
- a continued focus on enrollment and retention
- an investment in analytics and a data warehouse to understand enrollees’ experience with health care and to help them get the right care and the right time, through delivery system reforms.
The new budget also puts the focus on helping people understand their benefits and making sure they have information they need, in the right formats, to make informed choices.
To those ends, consumer advocates had hoped to see a stronger commitment to navigators and consumer assistance in the 2015-16 budget.
Elizabeth Landsberg of Western Center on Law and Poverty described the calls she gets from a number of groups, including the California Hospital Association—very often, if their caseworkers encounter complex problems, they call HCA (Health Consumer Alliance)—but the new budget reduces their funding to $1.3 million.
Earlier in the week some of the consumer and legal assistance and navigator groups that work with the most vulnerable populations met with Lee to challenge recommendations to reduce funding for navigators (see Asians Advancing Justice Coalition letter). In response Lee pointed out Covered CA’s history of responsiveness to feedback from advocates recommendations along these lines. After meeting with navigators and advocates, Lee agreed to set aside $3 million for navigator tied to meeting precise performance criteria.
Overall, despite arguments by Obamacare opponents, Covered California has shown itself to be sustainable, said Anthony Wright of Health Access, who urged that Covered California invest more in marketing, outreach, and enrollment, given that would contribute to the exchange’s long-term sustainability. He suggested an evidence-based trigger to use Covered California’s substantial reserves to make the investments necessary to meet or exceed the enrollment targets.
The budget as proposed was adopted unanimously by the Board. With no meeting in July, the Board is set to reconvene in August.VIEW THE FILE Hospitals