Human services Change: Trade Choices Dialog In light of considerations of the controlling panel on wellbeing change.


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Government still stays in charge of completing ACA yet Legislature and ... May be better ready to connect with private part than government office ...
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Human services Reform: Exchange Options Discussion Based on thoughts of the directing board of trustees on wellbeing change Amy Lischko, Tufts University School of Medicine September 2010

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Today\'s Agenda Review of Exchange Provisions in ACA Key Functions of Exchange Timeline Preliminary Assessment of Current State Infrastructure Discussion of Problems Maine Would Like to Address with an Exchange Discussion of Goals for Maine Exchange Discussion of Early Considerations and a Framework for Future Planning

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What does the ACA require of states? States must build up American Health Benefit Exchange (AHBE) and Small Business Health Options Program (SHOP) by 1/1/2014 or HHS will set up one for them Exchanges might be controlled by a Governmental Agency or a non-benefit element Exchanges might be sorted out at a multi-State, State, or a provincial level States must choose the structure of their Exchange(s) by 1/1/2013 and

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What does the ACA require of states? HHS Secretary will choose whether noteworthy advancement has been made by 1/1/2013 Grants are accessible to states for arranging the AHBE and specialized help for SHOP State Exchanges must be fiscally self-supporting by 2015 Must counsel with pertinent partners in building up Exchange (In Maine: ACHSD and open gatherings and hearings arranged) In 2017 states may apply for waiver of numerous Exchange (and general change) highlights

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Key Functions of the Exchange Determine and Coordinate Eligibility Create institutionalized advantage classifications of medical coverage arranges Offer multistate plans Certify Qualified Health Plans Maintain a call community for client benefit and set up methods for enlisting people and organizations Establish site with similar expense and quality data Assign quality appraisals Reward quality Set up a "Pilot" program

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Timeline for Implementation Option for multi-state compacts Must permit firms up to 100 representatives in Exchange HHS Secretary chooses if state has gained enough ground 2010 2011 2012 2013 2014 2015 2016 2017 2018 States may apply for waiver Exchange must be monetarily self-managing Exchange dispatched Premium & Cost sharing sponsorships start Employer necessities/evaluations start Exchange arranging and executing

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Today\'s Agenda Review of Exchange Provisions in ACA Key Functions of Exchange Timeline Preliminary Assessment of Current State Infrastructure Discussion of Problems Maine Would Like to Address with an Exchange Discussion of Goals for Maine Exchange Discussion of Early Considerations and a Framework for Future Planning

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Current State Infrastructure

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Today\'s Agenda Review of Exchange Provisions in ACA Key Functions of Exchange Timeline Preliminary Assessment of Current State Infrastructure Discussion of Problems Maine Would Like to Address with an Exchange Discussion of Goals for Maine Exchange Discussion of Early Considerations and a Framework for Future Planning

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Problems Maine might want to address with Exchange High protection costs Small to medium firms dropping scope Part-time and occasional laborers have specific trouble bearing scope Underinsurance Limited straightforwardness in protection buy Difficult to look at items Confusing for purchasers Lack of coherence for people moving between medical coverage scope sorts Payment structures don\'t incent essential consideration and counteractive action Limited decision of transporter in non-gathering and little gathering markets Adverse choice

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Today\'s Agenda Review of Exchange Provisions in ACA Key Functions of Exchange Timeline Preliminary Assessment of Current State Infrastructure Discussion of Problems Maine Would Like to Address with an Exchange Discussion of Goals for Maine Exchange Discussion of Early Considerations and a Framework for Future Planning

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Goals of the Maine Exchange Improve the strength of Maine inhabitants. Give significant protection to more individuals. Enhance general fulfillment with and nature of social insurance framework through installment change, advantage outline, and quality motivations. Institutionalize and rearrange protection buy. Make a more powerful market for medical coverage through straightforwardness. Expand versatility and decision of medical coverage. Expand on current framework and base. Advance strategies which may lessen the rate of medicinal services cost development.

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Today\'s Agenda Review of Exchange Provisions in ACA Key Functions of Exchange Timeline Preliminary Assessment of Current State Infrastructure Discussion of Problems Maine Would Like to Address with an Exchange Discussion of Goals for Maine Exchange Discussion of Early Considerations and a Framework for Future Planning

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Discussion of Early Considerations and a Framework for Future Planning Stakeholders comprehend this is a developing procedure Preliminary investigation of advantages and disadvantages recommend a specific way yet as new information get to be accessible preparatory structure will be returned to Difficult to push ahead in arranging without a "strawman" proposition The following arrangement of inquiries shape Maine\'s underlying arranging process Areas for extra request will be recognized

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Discussion of Early Considerations and a Framework for Future Planning Should Maine a) deal with its own Exchange, b) work with different states to make a provincial Exchange, or c) let the Federal government run it? Should Maine make separate trades for people and organizations or only one Exchange serving both people and organizations?

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Discussion of Early Considerations 3 Should Maine have one or more trades to serve geologically unmistakable locales? Should Maine team up with New England states on some Exchange capacities? Where ought to Maine\'s Exchange be housed, in an/an: a) non-benefit b) semi state or autonomous organization c) existing government office?

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Pros: Maine will have more control and adaptability Exchange will concentrate on Maine\'s needs and objectives Maine has existing state foundation with center capabilities More productive for state organizations to facilitate with each other than to independently arrange with a government or local trade Implementation courses of events are extremely goal-oriented; takes more time to facilitate with different states Maximizes authoritative oversight Federal arranging and usage gifts accessible to state Cons: Resource escalated for state to regulate (time and staff) Difficult to appraise the managerial expenses and whether the Exchange can be maintainable May not understand economies of scale that could conceivably be acknowledged through a territorial or national Exchange Planning Framework Issue 1: Maine Should Manage its own particular Exchange

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Pros: Individuals move amongst boss and non-bunch scope, having one Exchange will make it less demanding Economies of scale in having one Exchange Administrative costs more costly with two trades All secured lives in one Exchange (versus 2) considers bigger pool and capacity to have more effect on quality & cost One Board/oversight body Cons: May be troublesome for one element to adjust contrasting needs of Individual and SHOP Exchange Different informing and client benefit requirements for people and organizations Planning Framework Issue 2: Maine ought to make one Exchange serving both Individuals and Businesses

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Pros: Maine\'s populace can be secured inside one Exchange Insurance bearers are statewide Administrative efficiencies might be acknowledged with brought together Exchange Could arrange with neighborhood workplaces of state government Cons: Will require outreach in rustic territories of Maine Will require techniques other than the Internet for remote zones and populaces without access Will require administration intelligent of geographic and other differences of the state Planning Framework Issue 3: Maine ought to have one Exchange serving the State

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Pros: Procurement of IT and different assets may bring efficiencies and/or economies of scale Allows for joint effort on particular issues given the tight execution timetable States can share best practices and realize what works Cons: May be hard to facilitate crosswise over states, especially given on-going exercises Each state has its own particular acquirement rules which may make cooperation troublesome States may have distinctive objectives that effect capacity to team up on particular issues Cost of multi state gatherings/travel Planning Framework Issue 4: Maine ought to team up with New England states on Exchange capacities

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Pros: Least affected by political environment Most deft as it won\'t be obliged by state obtainment and HR controls Potentially better ready to go after profoundly talented staff It\'s not government so some may believe it all the more Traditionally private capacities might be less demanding to convey out* Cons: Hardest element to guarantee that state needs are completed May be hard to facilitate crosswise over state and elected offices Difficult substance for sharing secret data Government still stays in charge of doing ACA yet Legislature and Governor have minimum responsibility here Planning Framework Issue 5: Maine\'s Exchange ought to be housed in an Independent or Quasi-state office. 1 of 3 Nonprofit Discussion

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Pros: Better site for state needs Easier to arrange with elected and state organizations Better responsibility and more straightforwardness Can delegate representing board made out of individuals with specialized skill Board selected by Governor and Legislature Executive Director to serve at delight of the Board Flexibility from some state acquisition and HR laws May be better ready to cooperate with private segment than government agency Cons: Sharing of secret data might be risky May convey shame with devour

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