This week, healthcare influencers convened in the nation's capital for the National Health Policy Conference, hosted by Academy Health. Speaker panels ranged from topics on the challenges for physicians and hospitals transitioning to a value-based health system to government efforts to curb opioid misuse. As part of our Healthcare Influencers series (check out our first and second installments with Rhode Island Sen. Sheldon Whitehouse here and Aledade CEO Farzad Mostashari here), Amy Dowd, CEO of New Mexico's state insurance exchange beWellnm, sat down with us at the conference to share insights into the exchange's challenges and successes.
Healthcare Dive: How does your state manage its relationship with insurers?
Amy Dowd, CEO, beWellnm: It’s very integral to the exchange. We have designated health insurance carrier seats on our board of directors and we have a number of workgroups and stakeholder groups that carriers participate in as well. For everything from our day-to-day operations to our overall policy decisions for the exchange in the state, there are carriers at the table. It’s been very valuable and one of the keys to our success.
Do you help negotiate the plan rates?
Dowd: In New Mexico, we are not what’s called an “active purchaser” model. The Office of the Superintendent of Insurance, with whom we have a memorandum of understanding to perform the Plan Management Function and sits on our board of directors, reviews the plans, rates, and core requirements to be a health plan and approves whether a carrier can offer a plan on the exchange. Prior to the start of the first open enrollment, that office made the requirement all plans on or off exchange had to meet QHB standards so there’s no incentive to push people off-exchange. The exchange itself doesn’t make those decisions directly but we’re part of the process to ensure timelines are being met, etc. Before we go live, we get an overview of what the plans are going to be.
What successes have you noticed?
Dowd: My prior role was the executive director of the Idaho exchange (Your Health Idaho) and I moved to the New Mexico exchange before the second year began. What we found and focused on for the current enrollment period is one-to-one contact with individuals. Last year, we opened up an enrollment center based in Albuquerque which was very successful so we attempted to roll out similar centers throughout the state this year. We were surprised with the amount of use they received. People were making appointments, meeting with enrollment counselors. Our enrollment counselors are dual-certified to assist Medicaid or exchange plan enrollment. This year, that was a big success factor.
In addition, there was a focus on retaining enrollment. While focused on growing, half of our enrolled population prior to this open enrollment had an exchange plan through Blue Cross Blue Shield of New Mexico which were discontinued. [The Office of the Superintendent of Insurance denied the insurer’s rate approval.] Somewhere between 15,000-17,000 individuals had to know their plan was discontinued (they were notified by mail). So we integrated into our marketing and message if an individual’s plan had been discontinued, they needed to go online to sign up for a new plan. We went across New Mexico all of October to meet with consumers who had concerns about their plans being discontinued alongside agents and brokers to help them understand the change in the marketplace. Insurance can be kind of dull but it was really exciting in New Mexico this year.
We didn’t have data on the individuals who lost their health insurance plan so finding, reaching, and helping them take action was a huge challenge for us. But we really focused on making free assistance more available across the state and residents used those enrollment centers. We’re still learning what’s working.
What were some of the challenges you faced?
Dowd: Exchanges are still very new. We’re only in our third year. In the first year, there were huge technology hurdles to overcome. Additionally in that first year, everyone was trying to figure out what the role was for an enrollment counselor or an ACA navigator versus an agent or broker. Most people were so focused on the technology that we didn’t spend much time engaging with the brokers. We turned our focus to stakeholder engagement in years two and three and that has done a lot to build public trust as well as confidence and good relations with all of our state stakeholders.
We also learned we have to sell the proposition of having insurance. It’s not a given people want insurance. We have to help individuals understand they can get preventive care free of charge. Helping people learn how to use their insurance is a focus we want in upcoming years. In addition to a large Hispanic population, we have a large Native American population who need to be educated that Indian Health Services isn’t health insurance and there’s a difference. Those are the next key areas.