State-run HIX streamline operations, improve efficiency

With year three open enrollment on the horizon, state-run health care exchanges are busy building out systems and processes while renegotiating contracts, all to improve the customer experience, data flow and costs.

The Washington D.C. exchange is still building functions, as it rushed in the beginning and initially kept things “pretty basic,” the exchange’s director of marketplace innovation, Rob Shriver, said Wednesday.

Speaking at a HIX policy summit in the nation’s capital, Shriver said the DC Health Benefit Exchange wants to add programs that include a doctor directory (currently in beta testing), out-of-pocket cost calculator and have the exchange’s carriers standardize benefit plans, so consumers have a real apple-to-apple comparison.

Connecticut, which is often lauded as an exchange success story and a state that sold its exchange platform technology to other states, is focusing on process improvement.

Over the last nine months, the exchange has been looking into “operational efficiencies,” said James Wadleigh, chief executive of AccessHealthCT. As all state-run exchanges must be self-sustaining by the end of 2015, AccessHealthCT has already gone through a “tough process” of reviewing contracts, reducing spending and reducing resources.

Also see: Local outreach called key for state-run HIXs in ’16

The DC Health Benefit Exchange also renegotiated contracts with two separate vendors in order to lower costs, the exchange’s executive director, Mila Kofman, said in a separate conference session. Both exchanges did not name the companies the contracts were renegotiated with.

“I may love my vendors … but when it comes to the bottom line, that is more critical to me,” Kofman said. “I need a better deal out of my vendors.”

AccessHealthCT is now set on reducing expenses while improving customer service, with a particular focus on its call center. Wadleigh said the rush to get the call center to market impacted customer service. 

Also see: Healthcare.gov CEO: Market runs ‘risk of offering too much choice’

The exchange is also working on implementing a plan comparison tool and a system to ensure that an exchange customer picks the best plan that is right for them. A majority of users are selecting bronze plans due to price, but after factoring in co-pays and deductibles, a gold or platinum plan would have been overall cheaper for many of them, Wadleigh explained.

In Kentucky, in addition to provider directories, the exchange is working to simplify data management. In the past, information was sent from the exchange to carriers, which would then note discrepancies. “It was not an efficient process and became very painful during the [Form] 1095A process,” said Nicole Comeaux, deputy executive director of the Kentucky Health Benefit Exchange.

The exchange is also exploring better customer division support tools. “We see a big opportunity … to help consumers in finding plans right for them,” Comeaux said.

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