Health exchange starts from scratch

By Katie Kerwin McCrimmon

Colorados new health exchange board meets for the first time next week and must immediately get to work.

This is a roll-up-your-sleeves, we-need-your-expertise kind of board, said Joan Henneberry, director of the Colorado health insurance exchange at the Colorado Health Institute. For the first three to four months, the board is going to be very busy. This board is building something from scratch.

Heres what is on deck for the new board and a summary of priorities for board members who returned calls to Solutions.

Among the first agenda items:

  • Evaluating and interpreting the regulations that the federal government is slated to release on July 7. The rules are expected to stipulate how health exchanges must work. Colorados board could decide to submit comments on the rules.
  • Hiring an executive director and staff for the new quasi-governmental organization.
  • Creating bylaws and policies.
  • Deciding whether to apply to the federal government by Sept. 30 for an operating grant.
  • Meeting with the legislative oversight committee in August and thereafter, five times a year.
  • Deciding by September whether additional legislation is necessary to create the exchange, and if so, starting to draft bills and build support for new measures.
  • Working with other states to consider joining forces on building necessary IT systems. All health exchanges must have robust computer systems that can generate real-time insurance quotes for customers.

Board members (in alphabetical order) and their goals:

Richard Betts, Telluride, owner of ASAP Accounting and Payroll Inc. and a board member for the Telluride Foundation and the Telluride Medical Foundation, appointed by Gov. Hickenlooper.

During 20 years of providing accounting services to several hundred clients, many of them in western Colorado, Betts has seen health care costs go from a relatively small expense for employers to the single largest line item.

Its much more than rent and overtime, theres been an inability to provide (health insurance) coverage, said Betts.

His company provides services to about 600 small businesses, nonprofits and government entities. Most are in Colorado, but he works with clients in 18 states.

Betts primary interest is finding a way to bring more health care to more people.

He also wants to spend health dollars more wisely and focus on preventive care, wellness and bringing value to consumers.

Betts said hes not concerned that other members of the board will put industry interests before those of consumers.

I have a lot of confidence in the governor and in his abilities. Hopefully, he has selected the right people who will adopt the mission (of the exchange) and will put the interests of the exchange ahead of their personal interests.

Dr. Michael Fallon, Denver, ER physician and Republican challenger to U.S. Rep. Diana DeGette in 2010. Appointed by Sen. Minority Leader, Mike Kopp, R-Littleton. (Not available for comment.)

Stephen ErkenBrack, Grand Junction,president of Rocky Mountain Health Plans, appointed by House Speaker Frank McNulty, R-Highlands Ranch. ErkenBrack served on the Colorado 208 Commission, which made recommendations on health reform prior to passage of the Affordable Care Act.

ErkenBrack was not available for comment, but released the following statement regarding his service on the health exchange.

I am humbled and honoredby my appointmentto the Colorado Health Benefit Exchange and would like to thank ColoradoSpeaker of the House Frank McNulty for selecting me to serve the state in this capacity.

The Colorado Health BenefitExchange will serve a critical role inrestructuringour states health care delivery system for individuals and small businesses. With that in mind,it is important all stakeholdersare represented and work together to create a viable, pro-business, pro-consumer exchange.I consider it a privileged to offer a WesternColorado perspectiveand to sharedetails about thecollaborative approach to health care deliverywedeveloped here. I alsolook forward to listening and learning from people withother points of view.

ErkenBrack also wrote an op-ed for Solutions after the health exchange bill passed. Read it here: Time is now to build a model health exchange

Eric Grossman, Englewood, vice president of TriZetto, appointed by Gov. Hickenlooper. (Not available for comment.)

Gretchen Hammer, Denver, executive director of the Colorado Coalition for the Medically Underserved. (Not available for comment.)

Robert Ruiz-Moss, Lone Tree, market segment lead for Anthem Blue Cross Blue Shield. In that capacity, Ruiz-Moss oversees Anthems individual insurance market in Colorado, Nevada, New Hampshire and Connecticut. Anthem Blue Cross Blue Shield has customers throughout Colorado with about 95,000 clients in the state. Appointed by Gov. Hickenlooper.

Ruiz-Moss considers Colorados health exchange a blank canvas.

First and foremost, my goal is to create an exchange that will work for the State of Colorado, Ruiz-Moss said. We want to build it so that its going to get more people insurance.

He is relatively new to Anthem Blue Cross Blue Shield, but has a long history in Colorado, having worked for several health companies, served on the board of the Colorado Health Foundation and studied accounting at the University of Colorado.

While consumer advocates have criticized the board for tilting too far toward industry and Ruiz-Moss is one of the insurance executives named to the board, he said consumer needs are fundamental to the success of the exchange. He believes the board is fair and balanced and said he wants to build an exchange that promotes competition and serves all Coloradans, not just those living on the Front Range, where health services and providers are much more plentiful.

I think my company and the industry are serving the needs of people who are purchasing insurance, Ruiz-Moss said.

We are the biggest insurer (of individuals) by far in Colorado. Well have a unique perspective on what their needs are. I dont think our incentives are misaligned at all, he said. The proof will be in the outcome.

For me, it will be successful if were getting more people insured and meeting the needs of consumers and were keeping a vibrant insurance market.

Arnold Salazar, Alamosa, executive director of Colorado Health Partnerships LLC, appointed by House Minority Leader Sal Pace, D-Pueblo. Salazar served on Colorados 208 Commission.

Salazar is a name that evokes power in Colorado.

This Salazar hails from the San Luis Valley, but he is not related to Interior Secretary Ken Salazar or Kens older brother and Colorados Agricultural Commissioner, John Salazar.

Arnold Salazar is married to Marguerite Salazar, regional director for the U.S. Department of Health and Human Services and the former president and CEO of Valley Wide Health Services in southern Colorado, one of the largest rural community health systems in the country.

For 15 years, Arnold Salazar has run Colorado Health Partnerships, a conglomeration of nonprofit mental health centers that cater to Medicaid patients through the state. The group started in 1995 with four mental health centers in southern Colorado and expanded to eight in 2000. The centers provide mental health services to Medicaid clients in 43 counties serving rural Colorado from Colorado Springs to the south and throughout the Western Slope, including the San Luis Valley.

While Salazar is one of the health insurance executives named to the board, his passions align much more with the little guy.

Ive always seen myself as an advocate for the consumer, and quite frankly, for poor people, Salazar said.

His chief goal on the exchange board will be improving access, addressing health costs and improving quality.

Salazar is hoping that the exchange can help shake up the health system by fostering more public/private/nonprofit hybrids like his organization, and by changing the payment systems to better integrate care.

If you dont have services that are integrated, where you are treating the whole person (including) dental care, social services and employment, this things not going to work, Salazar said.

One of his primary interests is how to get disparate systems to work together.

A lot of times, we incentivize people to work separately, he said.

Hes also wants to stretch health dollars.

Im not convinced that the health care system needs more money. We need to spend the money differently to achieve the goals we all agree need to be addressed, Salazar said. Are we really satisfied with what were getting for what were paying? To a person, Id argue the answer is no. Then why do we keep doing it?

Elizabeth Soberg, Centennial, chief executive of UnitedHealthcare of Colorado, appointed by Gov. Hickenlooper. (Not available to comment.)

Nathan Wilkes, Arapahoe County,founder and principal consultant, Headstorms Inc., appointed by Sen. President Brandon Shaffer, D-Longmont.

Nathan Wilkes became an activist on health policy issues by necessity after his 7-year-old son, Thomas, was born with severe hemophilia.

Wilkes has had to fight for health insurance all of Thomas life. Thomas is doing well thanks to attentive care and expensive medication. This summer, hes on the swim team and enjoys riding his bike. But, hes already exceeded the $1 million lifetime cap for Colorados safety net insurance program. Wilkes estimates that Thomas health costs since birth have added up to more than $5 million. Nathan Wilkes had to leave his job and start his own company to get health insurance for his family.

Wilkes priority on the health exchange will be making sure it works for families, individual consumers and small business owners.

Its going to be about streamlining things, tearing down some of the roadblocks to finding insurance and doing what we can to make sure competition is there, Wilkes said. Im not necessarily convinced that the exchange will bring costs down to where they need to be. But, maybe it will make it easier to find and afford health insurance.

Wilkes wants to be sure that Colorados exchange offers the best prices. Studies have shown that costs rose in Massachusetts after its health care reforms were implemented. And Wilkes said insurance companies guaranteed the failure of exchanges in California, Texas, Florida and North Carolina when they offered better health insurance rates outside of the exchange.

How do we make sure the rules inside and outside the exchange (fit together)? We dont want to end up with adverse selection. If insurance companies can price (products) outside the exchange cheaper, then well be doomed to failure.

Wilkes also has a background in information technology and is eager to ensure that the online exchange works seamlessly, unlike the states notoriously troubled Colorado Benefits Management System (CBMS).

Im going to be asking the hard questions and doing testing and development. I know the state has had problems with some of their Medicaid systems, he said.

Wilkes is not convinced that Colorado will save money by joining other states to develop computer systems.

Well have to develop a system that works for Colorado. Its too early to tell what the savings will be. We would be remiss not to look at what other states are doing. Theres some potential there, but we could be a leader, he said.