Julie Keeffe is the Director of Exchange Strategy and Implementation for Community Health Plan of Washington.
Q: Julie, thanks for making time to chat with us.
Q. First, I thought I’d ask a more general question about how CHPW has thought about engaging the individual exchange market versus the SHOP.
A: We want to focus on the individuals already receiving care at our CHCs and maintaining continuity of care with their CHC providers. Approximately half of the individuals who will be eligible for subsidies and cost-share reductions through the Exchange are already being seen by our CHCs. Due to the unknown risks associated with SHOP at this time, we chose to postpone our participation.
Q. CHPW was one of the few plans to submit a letter of intent to participate in the SHOP earlier this year. I understand that you have decided against participating on that exchange – and that practically every plan has. Walk us through that decision and why CHPW chose not to participate there.
A: Our decision to withdraw from participation in SHOP was based on the risk of adverse selection and uncertainty about the amount of loss protection we would receive through the Federal Risk Adjustment and Risk Corridor Programs. After careful consideration of the risks associated with small group business, we have decided to re-evaluate our small group participation in 2015.
Q. Were there things that could have been done by the Exchange board to have made it more appealing to participate in 2014? Or maybe more appropriately, are there things for 2015 that the Exchange board should be doing in order to make participation in the SHOP more of interest?
A: It is our desire to work with the Exchange board, share our issues and concerns, and identify how we can best participate in SHOP in the future.
Q. How anxious is this time right now? I mean, it’s driving everyone a little nutty, right? How is CHPW working through it all?
A: This is a very exciting time for Community Health Plan of Washington. We embrace the opportunity to participate in the Exchange and are eager to reach more people who need affordable quality health care.
Q. As CHPW looks to the individual market, how does CHPW plan to approach individual consumers on the commercial market? Given the tie to specific CHCs across the state, will you be focused on lower income folks in the areas where you have existing CHC relationships?
A: We plan to approach the individual consumers in the commercial market with the same diligence and understanding we use to meet all the complex needs of our current membership. Our focus is always on the low-income uninsured and underserved population that currently receive care in our network and those who work and live in communities that surround our clinics. However, the Exchange is providing opportunities to reach more people who are searching for affordable care. We will be working attentively with our clinics to communicate and provide information as needed.
Q: What do you think of the Apple Health Plus model the HCA is promoting? Will that help address the issues of ‘churn’ on and off Medicaid?
A: We believe that mitigating churn is important because it will improve health outcomes. We’re concerned that HCA’s Apple Health Plus proposal doesn’t do much to address churn for Medicaid enrollees – instead focusing on individuals churning down from subsidized Exchange coverage and remaining with their Exchange plan. Identifying solutions that would impact the broader market is key to helping address churn and is noticeably missing from this proposal. We would recommend that the state evaluate 12-months of continuous eligibility for Medicaid adults and implement a Federal Basic Health Program. Finally, if the Exchange clearly displays which Exchange plans are also serving the Medicaid market – it would allow for mixed status families to better select a plan that meets their family’s needs.
Q: As we move through this period of transition, what are the data points or points of reference you’ll be paying the closest attention to? What will you be watching as this moves forward to help navigate CHPW?
A: We will certainly be focused on comparing the Exchange products, plans, and rates when they are posted by the OIC. Our primary focus is on assisting our CHCs in their efforts to educate their patients on the coverage opportunities available to them through the Exchange and how to enroll in a health care plan. Our goal is to provide health care insurance to the eligible and currently uninsured population.
Q: Thanks so much for taking the time to chat with us.
A: We’re happy to help in any way we can.