Details of Exchange Begin to Emerge

California Health Benefit Exchange Board members yesterday heard presentations on a number of topics including stakeholder opinions on qualified health plans, potential exchange users’ opinions on what they need from the exchange and possibilities for creating call centers.  All of those discussions seemed to lead to the same two things: cost and service.

“If we drop the ball on service, we will drop the ball on everything,” said Peter Lee, executive director of the exchange board. “Service matters.”

Lee was discussing the results of a discussion group of possible users of the exchange, who articulated what they would want in an exchange. He was also referring to a report submitted yesterday on defining the parameters for qualified health plans that will participate in the exchange.

In both cases, the bottom line was the same.

“Affordability is really important,” said Andrea Rosen, staff counsel for the exchange. “That’s not the first time you’ve heard that, and it’s not the last time you’ve heard that.”

Among stakeholders, there is broad support for standardization of plan offerings, Rosen said. Stakeholders recognize the challenges and tradeoffs that must be struck between improving quality and access, Rosen added.

“We asked how many plans should be offered, and we got consistent response that too many choices will create confusion and make clear communication difficult,” Rosen said.

“Also, many people felt it would be good to reverse the dynamic of lower payments to primary care and higher payments to specialists,” Rosen said, “and that will be tricky to address, but we will try to do that.”

A similar overall message was voiced by Marjorie Ginsburg, executive director of the Center for Health Care Decisions, who presented the potential-user discussion group results, with an emphasis on opinions about cost-sharing.

The discussion groups were presented with three cost-sharing models, Ginsburg said, with varying deductibles, copays and annual maximums.

“Copayments were a major factor,” Ginsburg said. “About 80% chose Plan B because it had the lowest copays. People were not as worried about the annual maximum.” People had little understanding of co-insurance, she said.

In one of the discussion groups, not a single participant had ever had health insurance as an adult, and that raised a huge red flag, Ginsburg said.

“So the concepts and words [of health care insurance] are totally foreign to them,” she said. “The whole discussion was very difficult.”

The take-home message was summed up by board member Kim Belshé: “It’s clear,” she said, “we need to be applying the cost lens with every decision we make.”

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