District officials have announced an important plan to involve community members in key decisions over the city’s Health Exchange, which will start offering health plans to DC residents in 2014. The city is creating a number of policy workgroups to deal with important issues, such as ensuring that health plans have an adequate number of providers in their network, and each workgroup will include a diverse range of volunteer stakeholders and community members.
If you care about the future of health reform in DC, this is your chance to get involved. The DC Health Exchange has many decisions to make in a short period of time. Because enrollment in health insurance through the Exchange begins in October, these workgroups must make decisions quickly — with meetings taking place in a two- to four-week period by the end of February.
Each group will be chaired by a member of the Exchange’s governing body. Group members will be balanced among consumer/patient advocates, providers, insurers, brokers, and other community members. Consultants and staff will assist the workgroups and conduct background research as requested. The workgroup meetings will be open to the public, but the decisions will truly be member driven. The goal is to reach consensus, and where consensus cannot be found, to provide a pros and cons analysis to the Exchange’s executive board.
The initial workgroups and the issues they will address are below. Exchange staff are accepting volunteers this week and will make appointments ASAP.
- Essential Health Benefits Package – How will the District define mental health parity? To what extent will the District cover habilitative services, such as speech therapy? Can insurers substitute benefits in and out of the essential health benefits package proposed by the District?
- Network Adequacy– How can we ensure plans have enough primary care doctors, specialists, and other providers to serve enrollees? How can we ensure that provider directory information is accurate and up-to-date?
- Quality Data Reporting– What quality data should insurance companies have to collect, share with the Exchange, and post online for the public?
- QHP Carrier Certification Process– What should DC’s process be for assessing insurer compliance with all Exchange requirements and certifying them to sell plans in the Exchange?
- Premium Billing and Collections – Should the Exchange collect premiums on behalf of residents and deliver them to insurers, or should consumers pay the insurers directly?
- Employee and Employer Plan Selection– For small businesses using the Exchange, how many and which plan choices should their workers have?
- Financial Sustainability – How should the Exchange’s ongoing operations be financed?
- Plan Number/Standardization – How many different plans should consumers have to choose from? Should there be a standardized plan that all insurers must offer? What mix of plans in the Exchange provides sufficient choice while not being overwhelming?
Unlike past workgroups, members of this group will make key policy decisions, so it is important that community members, consumers, patients, providers, and advocates be represented. If you have any interest and/or expertise in any of the areas above, please consider signing up by contacting: Bonnie Norton at firstname.lastname@example.org or Linda Wharton Boyd at email@example.com. Again, workgroup appointments will be made as soon as possible, so sign up soon!