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ACA Implementation Fund Project: Navigating the Colorado Exchange

 

The ACA Implementation Fund was established through a collaboration of national foundations that include; the Atlantic Philanthropies, the California Endowment, the Nathan Cummings Foundation, Ford Foundation, the Jacob and Valeria Langeloth Foundation, and the Rockefeller Foundation to ensure effective and consumer focused implementation of the Affordable Care Act. CCHI's Project aims to bring consumer voices to the table in the design and implementation of Connect for Health Colorad, our state-based insurance marketplace, to ensure that the marketplace increases access to affordable, high-quality health insurance and to maximize the impact consumer advocates have in the implementation of the ACA. CCHI is currently in the 3rd year of this project, and has secured local matching funds for the project from the Colorado Health Foundation, Rose Community Foundation, Caring for Colorado, and the Gill Foundation.

2013-2014:

This year's project builds on first and second year collaboration and success among CCHI, CCLP, and COPIRG in providing C4HCO with credible information in developing the tools and model for consumer assistance with Adelante con la Salud: Latino Healthcare Engagement Project joining the collaboration. Continuing the arc of that work through the October 1st launch of C4HCO, this project will provide immediate feedback about how C4HCO is working and where improvement is needed. Partners will seek to evaluate, for example, how consumers use the plan comparison tools are understood and whether they have difficulties understanding health terminology. The target population is low-income and vulnerable populations, the likeliest marketplace users during the first year of operation.  

The Project Partners use a survey to collect data about the consumer shopping experience, both at health assistance sites and at feedback sessions convened by CoPIRG. Our goal is to collect information across the state during the six-month open enrollment period. Using the collected data, the Project Partners will prepare a series of mini-issue briefs identifying areas of success and areas for improvement, which will be shared with C4HCO and policymakers. We anticipate preparing 4-6 such issue briefs during the course of the open enrollment period.

The timeline for this project spans pre-enrollment through open enrollment in Colorado’s marketplace. Over the summer of 2013, we established a diverse steering committee, hired a subcontractor to assist with survey design and data analysis, developed a survey, and began identifying locations for feedback sessions. In October, we began collecting data on real time enrollment experiences of consumers, developing recommendations, and collecting stories. The final narrative will be completed late May /early June 2014. (Click on the images for the full issue briefs)

Brief 1:

 

Brief 2:

Full Issue Briefs presented to the Connect for Health Colorado Board of Directors: 

 

2012-2013:

The Affordable Care Act (ACA) requires states to develop a Navigator program to educate and assist consumers in purchasing coverage through the health insurance exchanges established by the federal law. The three Project Partners, the Colorado Consumer Health Initiative (CCHI), the Colorado Center on Law and Policy (CCLP), and the Colorado Public Interest Research Group Foundation (CoPIRG Foundation), have undertaken research and analysis to develop consumer driven recommendations for Connect for Health Colorado's (formerly Colorado Health Benefits Exchange) Navigator program.

This year's project consisted of five stages:

  • Research state models for Marketplace Navigators
  • Develop consumer-oriented guiding principles for the Navigator program
  • Survey community based organizations on their knowledge, capacity and interest in the Navigator program
  • Convene a series of community discussions to seek perspectives from likely Marketplace users about supports and Navigator needs
  • Develop recommendations for Colorado’s Navigator program

 

Research state models for Marketplace Navigators

The Project Partners looked both at what has been done in Colorado in terms of various Navigator programs and undertook a survey of what other states are considering in developing their exchange Navigator program. The analysis focused on four major areas:

  • Proposed structure and selection of Navigators;
  • Financing and compensation;
  • Licensing, training and certification (including cultural competency); and
  • Navigator duties and functions.

In addition, Project Partner members contacted advocacy groups in several states, including New York, California, and Massachusetts, and national health care consumer advocacy groups for their perspectives and input. The information collected from other states is contained on a matrix here “Other State Navigator Program Models.”

Develop consumer-oriented guiding principles for the Navigator Program

The Project Partners worked with CCHI’s 50 organizational members and the Health Advocates Alliance (HAA), a coalition of approximately 20 consumer and provider groups convened by CCLP, to develop a set of Navigator guiding principles. The Project Partners brainstormed the principles at the July and September 2012 HAA meetings and held a webinar in August 2012 with CCHI members. A draft set of guiding principles was circulated to HAA, CCHI members and the project Leadership Steering Committee for comment and endorsement. At this time, 20 organizations have signed on.

Survey community based organizations on their knowledge, capacity and interest in the Navigator program

The Project Partners contracted with JVA Consulting (JVA) to develop a survey and related tools for this phase of the project. The survey was conducted on-line using Survey Monkey. CCHI sent the survey directly to over 100 organizations. Although the exact number of recipients is unknown (because recipients were encouraged to forward it to interested groups and relevant listservs), recipients/respondents included CCHI member organizations, Senior Health Insurance Program (SHIP) sites, counties, and medical assistance and presumptive eligibility/certified application assistance sites. Over the course of the survey, 137 responses were received from 109 different organizations. Here is the survey.

The Project Partners also convened three roundtable discussions with representatives from organizations that had some level of interest in the Navigator program. The same individual, using a format and guide developed with the assistance of JVA, facilitated all three roundtables. Read the results of these three roundtables here “Community Based Organization Roundtable Discussions: Organizational Questions and Needs on Navigators.

Convene a series of community discussions to seek perspectives from likely Connect for Health Colorado users about support and Navigator needs

Using a discussion guide developed with the assistance of JVA, CoPIRG Foundation convened 20 community meetings with groups of anywhere from 8 to 44 people over a two-month period (August and September 2012). The following questions were covered in the discussion groups:

  • What questions do you have when shopping for insurance?
  • Who helps you make insurance decisions now?
  • At what stages in the process might you have difficulty shopping for insurance?
  • Who would/wouldn’t you turn to for help and why?
  • How long have you spent/are you willing to spend shopping for insurance?
  • When shopping for insurance, did you feel you found the right plan?

 

JVA was also responsible for developing the database for the discussion groups. The analysis of the data is here “Community Discussions: What Supports Do Consumer Need When Shopping For Insurance?”

Develop recommendations for Colorado’s Navigator program

Using the data collected from all the previous project phases, the Project Partners developed a set of recommendations for Colorado’s Navigator program.

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