1. Accountable Care Organizations and Status of Exchange Implementation
Presentation to
MN Health Action Group
September 27, 2012
Manny Munson-Regala

2. Key provisions of the Patient Protection and Affordable Care Act (PPACA)
Expanded Coverage
Medicaid
Tax credits and subsidies
Employer and individual mandates
Insurance Reforms
Exchanges
MLR/Premium requirements
High-risk pools
Payment Reforms
Cuts
Reduced Medicare Advantage subsidies
Bundling, global payments
Accountable Care Organizations (ACOs)
Workforce Enhancements
Primary care physicians (PCPs)
Advanced practice nurses and physician extenders
Quality Improvements
Reduced payment for Hospital Acquired Conditions (HACs) and preventable readmissions
Core measures
Patient satisfaction

3. What is an Exchange?
An Exchange is an online marketplace where Minnesotans can find, compare, choose, and obtain health care coverage that best fits their personal and family needs

4. Affordable Care Act (ACA)
Why an Exchange?
Subject of ongoing dialogue in Minnesota since 2006
Provision within the federal
Affordable Care Act (ACA)
enacted in March 2010
Affordable Care Act
The federal health care reform law enacted in March The law was passed in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, The name “Affordable Care Act" is used to refer to the final, amended version of the law.

5. How will an Exchange work?
Insurers
Consumers
HIX IT &
Operations
State Government
Certify which insurers and benefit plans are qualified for participation
Operate a toll-free hotline and website for providing information
Provide standardized comparative information on insurers and benefit plans
Set up open enrollment and special enrollment periods
Determine eligibility for individual and employer subsidies
Determine eligibility for Medicaid and facilitate enrollment
Facilitate eligibility and enrollment using a uniform format in “real-time”
Make an electronic calculator available to display the cost of coverage
Communicate with employers regarding employee subsidy eligibility, cancelation of coverage
Use an electronic interchange to share information with state and federal agencies to determine eligibility, amount of subsidies, determine exemptions from coverage requirements, etc.
Establish a “Navigator” program
Federal Government

6. Current Exchanges
State run- Massachusetts Connector and Utah Health Exchange
Private Exchanges- CBIA, Bloom Health, HealthPass of NY, AON, Extend Health, California Choice, Bloom, Highmark and Towers Watson

7. States submit blueprint application
Timeline
November 16, 2012
States submit blueprint application
October 1, 2013
Open Enrollment
January 1, 2014
Coverage Begins

8. ISSUES State vs. Federal Governance Role in Marketplace
Role of Existing Market Regulator
Integration of Medicaid
Distribution Channel
Costs and Sustainability
Products Sold

9. Policy Issues Governance Role vis a vis Regulators
Facilitator vs. Purchaser
Sustainability
Assisters/Navigators/Agents and Brokers
Adverse Selection
Stakeholder Engagement
Governor has said no final policy decisions until after election
Many unknowns – still early in the planning process
Governance – state agency, quasi or non-profit
Small Group Market – 50 or 100 employees
Allow large employer participation in 2017?
Health plan offerings – essential benefits and enough choices to need consumer needs
Navigators – requirements and compensation
Funding – establishment via federal grants through 2015; state funding after
Market Competition and Value (Certification, Market Rules, Risk Sharing, and Avoiding Adverse Selection):
Avoiding adverse selection (certification, participation, and market rules inside and outside Exchange - regulatory simplification)
Incenting competition and improved health outcomes for high risk individuals – risk adjustment and wellness discounts
Risk adjustment – consideration of MN alternative methods
Merger of the individual and small group markets
Other:
Basic Health Plan or private subsidies through Exchange for % FPL – what happens to MinnesotaCare?
Measurement and reporting of cost, quality, and satisfaction for insurers, health benefit plans, and providers
Small group: Defined contribution and “true” portability for individuals

10. Financing Federal Grant of $1 M Federal Grant of $4.2 M
February 2011
Federal Grant of $4.2 M
August 2011
Federal Grant of
$23 M
February 2012
Applied for
Federal Grant of $42.5 M
August 2012
Purpose
Analyze the impact of Exchange requirements and options
Estimate the level of upfront and ongoing funding for implementation and operation
Develop a work plan and budget for federal implementation
Components
- Background Research Stakeholder Engagement
- Program Integration Resources and Capabilities
- Governance Financing
- Technical Infrastructure Business Operations
- Legal and Regulatory

11. Organizational Structure
Executive Order Directing
Commerce to Design and Develop Exchange
Governor’s August 2012 Letter
Transfer to Minnesota Management and Budget
Legislative Solution?
Commerce “jump-started and incubated”, then transitioning to role as insurance regulator
MMB brings experience in coordinating, facilitating and leading these kinds of projects
No final decisions will be made by the administration prior to the upcoming election. Legislators will have the opportunity thereafter to review options and participate in the final decisions.

12. Status of State Implementation

13. State Partnership Exchange
State operates all exchange activities; however, state may use federal government services for the following activities: Premium tax credit and cost sharing reduction, Exemptions, Risk adjustment program and Reinsurance program
State-Based Exchange
State operates activities for Plan Management, Consumer Assistance or Both
State Partnership Exchange
HHS operates; however, state may elect to perform or can use federal government services for the following activities: Reinsurance program and Medicaid and CHIP eligibility, assessment or determination
Federally Facilitated Exchange

14. Challenges Time Money Expertise Other Market Changes
Relationship to Cost

15. Value Proposition Consumer Engagement Competition Portability
Administrative Efficiency
Seamless Marketplace

16. Resources
mn.gov/commerce/healthexchange- for information on the work on the Exchange
healthreform.mn.gov- for information on the impact of the ACA in MN
healthcare.gov- for general information on the ACA
For other questions: