Cover Oregon Update Presentation

8/13/2019 Cover Oregon Update Presentation

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COVER OREGON UPDATE

ROCKY KING, EXECUTIVE DIRECTOR

AARON KARJALA, COVER OREGON CIO

CAROLYN LAWSON, OHA CIO

NOVEMBER 20, 2013


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Provide access to affordable, quality health carefor Oregonians, including 560,000 uninsured

Create a single portalfor OHP, Healthy Kids, taxcredits, commercial plans (individual and small

employer markets)

Feature apples-to-apples comparisons of plans,including searching for your doctor

Help small employers provide full range of optionsto employees (all plans, all carriers)

OREGONS STRATEGY


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Encourage competition and transparency 11 medical carriers in the individual market program

8 medical carriers in small employer program

Portland has the lowest premium rates of 18 major cities

Reach Oregonians where they live, work and play

Through community partners and agents around the

state Strategic education, outreach and marketing campaigns

OREGONS STRATEGY


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Comprehensive program goals leads tocomplexity

Scope

Other states Washington

California

OREGONS CHALLENGE


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Oct. 1, 2013: Open enrollment begins

Dec. 4, 2013: Deadline to submit paperapplication

Dec. 15, 2013: Deadline to enroll for coveragestarting Jan. 1, 2014

Jan. 1, 2014: Coverage for commercial plansbegins

March 31, 2014: Open enrollment ends forindividual market commercialplans

OVERALL TIMELINE


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COVEROREGON.COM
http://www.coveroregon.com/http://www.coveroregon.com/


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HOME PAGE


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FINDING AGENTS/COMMUNITY PARTNERS


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BROWSE PLANS


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IT UPDATE


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May 2013: Cover Oregon took over managementof IT project from OHA

Aug. 2013: Decision made to launch with agentsand community partners

Sept. 2013: Delayed launch of public and CPAportal for further development and testing

Oct. 2013: Contingency plans for paperapplications implemented

Stepped up hiring of temporary staff

Enlisted assistance from OHA

STATUS UPDATE


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IT system is complex, but it is not broken

Systems and processes are securemet federalrequirements

Needed more time to adequately test systems System Integration

User Acceptance

Regression

Performance

Security

STATUS UPDATE


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Individual

About Cover Oregon

Plan SelectionQuick browse

Get started

PDF Application

Eligibility Determination

Working In Progress

Enroll

Portal Application

Portal Data Verification


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Tribal

About Cover Oregon Set Tribal Sponsorship

Member ManagementRegister Tribe

Complete In Progress

Dashboard


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Employer

About Cover Oregon

Create Plan Universe

Anonymous Quote

Group Setup

My Account

Apply



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Employee

About Cover Oregon

ConfirmApply

My account

Plan Selection



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CPA

About Cover Oregon

Manage clients

Become CPA

My account

Account Set Up



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Customer Service

External Account Create Backend Application


Integrated Voice System

Service Request Create

Ticketing System

Backend Application

Application Review

Backend Enrollment

Manual Medicaid Cont.


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Enrollment

Carriers

Carrier Assessment


Small Group Quote

Rate/Benefit Validation

Billing & Reconciliation

Provider Directory


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Interfaces

CMS Interfaces Medicaid Enrollment


Employment DepartmentSERFF

Medicaid Verification

Bank Transactions


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Global Functions

Internal Billing Environments


System IntegrationAccount Provisioning

Medicaid Verification

Message Center

Document Center


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Vendor selection

Cover Oregon has taken successive andescalating actions

Performing code reviews

Escalating to senior VPs over summer

Requiring VP level onsite management

Reorganized development approach, breaking down silos

Withholding payment for development services pendingdiscussions with vendor

5% hold back (per contract terms)

MANAGING THE IT PROJECT


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ORIGINAL IT DEVELOPMENT TIMELINE

Jan-Feb

2013

May-Jun Jul-Aug Sep-Oct Nov-DecMar-Apr Jan-Feb

2014Nov-Dec

2012

Internal System Use

Open

Enrollment

System

Training

Coverage

Begins

System

Development

& Testing

i15* i16 i17

UAT

IV&V


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FUNCTIONAL DELIVERY TIMELINE (OCT-DEC)

Oct. 1, 2013

Fullexchange,includingSHOP andIndividualDEADLINE

MISSED

Ability to startbut not finishapplicationDEADLINE

MISSED

Oct. 15 & 30,

2013

Fullexchange,includingSHOP andIndividualDEADLINE

MISSED

Nov. 18, 2013

Eligibilitydeterminationprovided byCPAsCOMPLETED

Target

Nov. 25, 2013

Ability tomanually enrollthrough thesystembackendPROJECTED

COMPLETION

Target

Dec. 9, 2013

Full end-to-endfunctionalitythroughCPAsPROJECTED

COMPLETION

Target

Dec. 16, 2013

Full system(minus SHOPand Tribalregistration)PROJECTEDCOMPLETION


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GETTING ENROLLED IS WHAT

MATTERS


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HOW TO APPLY (PAPER APPLICATION)

Applicant is enrolled in private plan! (pay premium to carrier)

Applicant chooses plan and sends packet back to Cover Oregon

If eligible for a private plan, applicant receives packet to select plan; Ifeligible for OHP, automatically enrolled!

Applicant receives letter notifying them what they are eligible for

Cover Oregon determines eligibility for tax credits, OHP andHealthy Kids

Fill out application and send to Cover Oregon


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31 Outreach and Enrollment Grants

18 Provider Outreach and Enrollment Grants

14 Public Education and Outreach Grants

10 Small Business Grants

6 Tribal Grants

OUTREACH GRANTS


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FAST TRACK ENROLLMENT

For families pre-screened as newly eligible for OHP based on

SNAP applications or kids enrolled in Healthy Kids

More than 260,000 Oregonians received letter fromOHP/Healthy Kids letting them know theyre eligible

If people receive a notice, they just need to fill out and signthe form and send back

Once they send back the form, theyll get coverage starting

Jan. 1, 2014!

More than 70,000 Oregonians have already signed up!

More info at: http://ohp.oregon.gov/
http://www.oregon.gov/oha/healthplan/pages/fast-track.aspxhttp://www.oregon.gov/oha/healthplan/pages/fast-track.aspxhttp://www.oregon.gov/oha/healthplan/pages/fast-track.aspx


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Nov. 20: Medford

Nov. 21: Eugene Nov. 22: Bend

Nov. 23-Nov. 24: Portland

Nov. 25: Salem

APPLICATION FAIRS

Cover Oregon is helping Oregonians aroundthe state to complete the application:


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UPDATING OUR PROJECTIONS


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CURRENT STATISTICS

COVER OREGON METRICS

Reporting Period: 10/1/13

11/18/13

Paper and Electronic Applications1 24,486

Eligibility Determinations2 1,371

Electronic Accounts3 4,223

Calls to Customer Service Center4 39,465

Total Visits to CoverOregon.com 796,887

Unique Visits to CoverOregon.com6 470,752

1-Includes applications received by mail, fax, and fillable PDF. To be counted, an application must have the

applicants name and sufficient contact information to reach theapplicant.2-Number of people Cover Oregon has determined eligible for OHP and QHPs. Includes both manual and

electronic system determinations.

3-Consumer accounts created on the web portal by agents and community partners.

4-Calls that entered the Service Centers interactive voice response system.

6-Estimate based on unique cookie values in the visitors browser.


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Evaluated how current realities and Cover Oregondelays may impact enrollment

Still modeling the impacts of grandfathering existing plans

Revisions result in:

Lower projections of enrollment across the Individual andSmall Employer programs

Individual enrollment occurs later in the 2014 open

enrollment period

Small Employer Program enrollment begins later in 2014due to delayed program launch

ENROLLMENT PROJECTION REVISIONS


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Reduction 9% 24% 15% 12% 23% 14% 21% 25% 8%

98,800161,200

233,700144,900

207,400279,900

191,100253,600

326,100

29,300

56,600

87,800

48,800

78,000

97,500

58,500

87,800

107,300

128,100

217,800

321,500

193,700

285,400

377,400

249,600

341,400

433,400

0

100,000

200,000

300,000

400,000

500,000

Low Mid High Low Mid High Low Mid High

Prior QHP Projections

88,500137,200

189,200124,700

173,000236,700

144,500204,100 306,40025,700 28,500

85,300

40,900

45,400

89,200

46,700

51,900

93,000

114,200

165,700

274,500

165,600

218,400

325,900

191,200

256,000

399,400

0

100,000

200,000

300,000

400,000

500,000

Low Mid High Low Mid High Low Mid High

CY 2014 CY 2015 CY 2016

(New) Revised QHP Projections

Individual SHOP*As of December 31st of each year

ENROLLMENT COMPARISON

CY 2014 CY 2015 CY 2016


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FINANCIAL UPDATE

Federal grant funds through 2014

No state funding

Starting in 2015 must be self-sufficient, raising revenuethrough an administrative charge on carriers and state

programs Using contract negotiations and remedies to keep

expenditures within overall projected amounts

Temporary staffing through open enrollment wasaccounted for in budgetpaper application process justmoved up timing of hires


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GRANT SNAPSHOTTO DATE

Grant Total Budget Budget

Remaining

Grant

ExpirationDate

Level 1, Tier 1 $11,164,600 $0 August 13,2013

Level 1, Tier 2 $6,682,701 $0 May 15, 2014

Level 2 $226,442,074 $147,107,441 December 31,2014

Total $244,289,375 $147,107,441


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OPERATING STATEMENTJAN-SEPT 2013

Total Actuals Budget Variance

Operating Revenues (federal grant) $85,142,163 $88,995,312 ($3,853,149)

Operating Expenses $85,628,691 $88,995,312 ($3,366,621)

Total Net Income/Loss ($486,527) $0 ($486,527)


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DISCUSSION AND QUESTIONS


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