Office of Consumer Health Services, Avenue H

Avenue Health Insurance Marketplace

OVERVIEW

U.C.A. 63M-1-2501–2506 H Avenue H is Utah’s state-based approach to health reform It is designed to help small businesses in the state offer health insurance to their employees through an innovative defined contribution mechanism The system benefits both populations because it lets business owners contribute a flat dollar amount that their budget can bear, while employees use those funds to shop for insurance that perfectly fits their family’s needs This also helps employees become engaged with health care since many have not previously had insurance They will know how much it costs and they take an active role in selecting and purchasing what they need Small businesses are able to leverage group rating rules — just like in the wider traditional market — but with an increased focus on choice and value Avenue H’s defined contribution model gives employers control over health care costs and lets employees choose the policy that works best for them Three participating carriers currently offer 74 plans ranging from high-deductible options to comprehensive coverage

Utah’s Health Insurance Solution

Utah’s approach to health care is unique compared to the rest of the country When the Affordable Care Act (ACA) was passed, it gave states three options for compliance: state-based exchange, state-federal partnership or federally facilitated exchange In early 2013, Governor Gary R Herbert proposed a different approach to the U S Department of Health and Human Services The Governor proposed a bifurcated approach that would see the state continue to run Avenue H as a health insurance marketplace for small businesses, while the federal government would create and implement an exchange for individuals HHS accepted Governor Herbert’s proposal, and now “the Utah approach” is the official fourth option for compliance and is available for other states to consider as well

Utah’s option lets the state comply with the health reform law contained in the ACA, but also retain state control and flexibility in applying it For instance, the state maintains oversight of qualified health plans and administration of Utah’s Medicaid program through the existing in-state structure The federal marketplace will focus on individual consumers and will also manage tax credits and subsidies, participation reporting and overall compliance with the ACA The split has been considered to be a big win for the state

Small Businesses and Defined Contribution

Avenue H’s primary market is small businesses with one to 50 employees We have found that focusing on small businesses lets us help the greatest number of Utahns with the highest degree of efficiency This is because approximately 98 percent of the state’s business community is made up of small businesses — and those small businesses employ roughly half of all Utahns In addition, we have found much success in the small business market thanks to our innovative “defined contribution market,” which benefits employers and employees alike

The defined contribution model lets employers offer an extensive array of benefits and provider networks, from which employees make selections ranging from very rich plans to high-deductible plans, all with a pre-tax advantage At the same time, employers pay a flat dollar amount toward employee benefits, helping them remain within a predictable budget

When joining Avenue H, employees are able to choose from 74 benefit plans across three insurance carriers to meet personal budget and family needs Avenue H

works with insurance producers that specialize in small group policies to help them educate employers about the potential benefits of using a defined contribution arrangement and to facilitate the use of Avenue H as their enrollment mechanism

FY2014: Year In Review

Participation exploded in FY2014 after the ACA went into full effect on January 1, 2014

At the end of FY2010, its “beta testing” phase, the Utah Health Exchange had 11 small business groups offering health benefits and health savings accounts (HSAs) to their employees By the end of FY2011, its first full year of operation, Avenue H had grown to encompass 157 small business groups Reporting FY2014 results, there are now 11,400 members covered which comprises 481 small businesses offering health benefits and HSAs to their 4,203 participating employees

On October 1, 2013, Avenue H unveiled its online pre-quote tool, which allows brokers and employers to get anonymous quotes for their groups before committing to Avenue H We have seen tremendous response to the pre-quote tool, with nearly 16,000 unique visits to the tool itself from October 2013 through June 2014 One month later, in November 2013, Avenue H rolled out our online registration and enrollment system The system streamlined some of the processes required during registration and enrollment, and for the first time let employers enroll online without a broker Avenue H still recommends that employers use a broker to enroll and administer their group, but this direct option is available for employers who prefer to do it themselves

We also launched a new marketing campaign that included a major focus on television advertising, with a significant online presence and limited print advertising The campaign ran from November 2013 through February 2014 and resulted in increased visibility and online contacts for Avenue H For those four months, more than 54,000 unique visitors came to AvenueH com to get information about our program This is more than double our normal visitation rate

It is important to note also that Avenue H is the same

Dr. Scott Chidester visits with a patient at Intermountain Medical Center.

Photo courtesy of Intermountain Healthcare

program that was created by legislation in 2009 The ACA impacted some of the program’s activities in 2013 and 2014, but it does not govern them Among these impacts are modified community rating, essential health benefits and qualified health plans Avenue H worked to mitigate these impacts while focusing on Utah’s values Avenue H remains a state-run, state-centered program and it will continue to be so well into the future

Work in Progress

Avenue H relies heavily on health insurance producers to educate small business employers regarding insurance needs for their customers and the value of Avenue H The Office of Consumer Health Services (OCHS) offers instructional courses, taught throughout the state, to the producer community Curriculum includes information about Utah’s model, processes, roles and responsibilities, in addition to timeline requirements OCHS also produces a producer newsletter that highlights the latest marketplace initiatives, gives additional instruction and offers tips and tricks

The Right Approach for the Future

In FY2014, we improved our enrollment and eligibility system by contracting with a single technology provider to provide a solution that consolidates two system processes The new system has a more consumer-focused enrollment interface, as well as intuitive tools, simplified enrollment processes, real-time rate quotes and decision support tools It is also more robust and scalable to handle future growth We plan to continue making system and process improvements in FY2015 to further improve the consumer experience FY2015 will also see an expanded marketing campaign that will reach more Utah small businesses than ever before

For additional information about the Office of Consumer Health Services – Avenue H visit business.utah.gov or contact Patty Conner, at pconner@utah.gov or 801-201-0422