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ACA Implementation: Adequacy and Sustainability of Coverage for Cancer Survivors

ACA Implementation: Adequacy and Sustainability of Coverage for Cancer Survivors. Mark McClellan, MD PhD The Brookings Institution. Overview. Key Implementation Steps: What Happens When Lessons from Part D Experience Clear Policy Goals Intense Education and Enrollment Support Systems

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ACA Implementation: Adequacy and Sustainability of Coverage for Cancer Survivors

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  1. ACA Implementation:Adequacy and Sustainabilityof Coverage for Cancer Survivors Mark McClellan, MD PhD The Brookings Institution

  2. Overview • Key Implementation Steps: What Happens When • Lessons from Part D Experience • Clear Policy Goals • Intense Education and Enrollment Support • Systems • Implementation Flexibility • Next Steps for Affordable, Innovative Cancer Care

  3. Health Insurance Marketplaces Implementation Timeline General Guidance & Regulations Plan Management Outreach & Enrollment

  4. Health Insurance Marketplaces Implementation Timeline General Guidance & Regulations Plan Management Outreach & Enrollment

  5. Lessons from Part D: Policy Decisions • Just because a market doesn’t exist, doesn’t mean the market can’t succeed • Have desired policy outcomes squarely in mind (requires dealing with tradeoffs) • Provide reliable information sufficient for decisionmaking by all major parties, particularly health plans and states • Convey confidence through step-by-step progress with milestones identified in advance • Ensure extensive communication for answering technical questions clearly and consistently: industry workshops, open door forums, FAQs, subregulatory guidances, etc. • Protect vulnerable populations • Risk adjustment, reinsurance, risk corridors • Meaningful but flexible coverage requirements (e.g., oncology drugs) • Auto-enrollment • Take other reasonable policy steps to make potentially risky patients attractive to health plans

  6. Lessons from Part D: Operations • Seek accurate and timely data flows – even the best laid plans and testing for systems won’t end up working without data • With any complex system involving multiple data feeds, there is the potential for problems • Pilot test systems with actual data to the extent time permits • Identify metrics to enable tracking of data availability and throughput (for example, individuals enrolled, prescriptions filled, measures of consumer experience) • Expect to devote teams to work proactively with states, health plans, and health care providers to address data flow problems • Make systems robust – do not depend on any single pathway for critical tasks to be accomplished • Identify best-practice solutions in plans, enrollment activities, states – cannot anticipate let alone figure them out centrally – and spread them

  7. Lessons from Part D: Outreach and Collaboration • Find friends in unlikely places – build and leverage relationships with multiple stakeholders • Extensive effort to build broad-based local outreach efforts involving health plans, pharmacies, state agency officials, community organizations, and other stakeholders was crucial • Interagency cooperation in outreach and education also led to essential support – requires strong and ongoing support from the top • Overcoming awareness and enrollment inertia: free isn’t cheap enough in many cases • Multi-faceted outreach campaign enlisted the help of pharmacists and physicians to steadily address the “eligible but not enrolled” gap • Many mechanisms to find personalized information and enroll as easily as possible: web tools, phone customer service, community outreach events and enrollment hubs

  8. Lessons from Part D: Maintain Flexibility to Ensure Successful Implementation • Mistakes will happen and problems will arise – allow for administrative flexibility and have contingency plans in place • Example: What if someone believes they are eligible for coverage and/or subsidies (and has some evidence for it) but their relevant electronic data cannot be found in coverage systems? • Assistance from plans and states can avoid frustrations from consumers • Make sure people who are counting on the program and need care can get it • Have metrics and support teams ready for potential problem areas • Expect the need for regular media updates and outreach about any problems and steps to correct them – nationally and especially state/local

  9. Oncology Reform • Measures • Provider Payment • Benefit Design • Plan Choice

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