Kim Belshé's committee-of-one turned out to be extremely efficient.
It is a daunting task, applying for a federal establishment grant for the California Health Benefit Exchange -- it lays out the direction and scope of the entire exchange, so the board's plan was to complete it in September. That was complicated slightly by the fact that Belshé was the only board member on the committee supervising the grant application.
It became clear, however, that some of the work needed to get started -- particularly the health information technology work -- which means it needs federal cash sooner rather than later. So the exchange board announced at last week's meeting that it is applying for the grant now, with final approval of that grant being sought at next month's board meeting.
"This is phase one," Diana Dooley -- board chair and secretary of the state's Health and Human Services Agency -- said. "The Level II grant is going to be more robust."
The idea, Dooley said, is to get the nuts-and-bolts infrastructure started as quickly as possible, and to fill in some of the details about outreach and organization in the second phase.
"This is no easy undertaking," Belshé said. "This [establishment grant] represents an effort to lean forward, to be ambitious -- to create a business-friendly, consumer-friendly, operational exchange."
To do all of that without drawing money from the state's general fund is not easy, either, Belshé pointed out.
"We're very aware of the state budget, so we're grateful to get the federal dollars," she said, "for not just covering millions of Californians and improving the quality of health care, but for the potential to move forward and lower health care costs."
According to Joel Ario, the director of the federal Office of Health Insurance Exchanges at CCIIO (the Center for Consumer Information and Insurance Oversight at CMS), the push for California to apply earlier came, in part, from federal officials.
"You are our main resource for getting this done," Ario said. "I know I don't need to feed your ego, but the rest of the country really does look to California for your leadership."
Throughout the exchange board meeting last week, stakeholder involvement was emphasized, and input requested -- from both state and federal representatives.
"We think of the exchanges as competitive marketplaces, with insurers competing aggressively," Ario said. "It takes a somewhat opaque system and turns it into a transparent one."
There are 11 core areas of progress outlined in the establishment grant, according to Pat Powers, the exchange board's interim executive director. The board will be asking for input on everything that's in the grant.
"We will have stakeholder meetings around the rest of the state," she said, "and we will have board meetings occasionally around the state."
Beyond the initial hiring of about 75 people, there are some long-range planning discussions that still need to be held, Powers said.
"For instance, we do have some conforming legislation in place already, but there will be more," Powers said. "Strategic visioning is something we'd like to do this summer. We're starting discussions about what the exchange should look like, followed up by rules on eligibility and enrollment."
The first IT step, she said, is to complete a gap analysis of what's already in place and what needs to change. The board also is requesting federal money to plan the Navigator program, which is the consumer portal to the exchange.
At one point, consumer advocates questioned how low some funding request estimates were, and board members made it clear that they want to maintain a strong, long-term relationship with federal officials.
"We do have to be careful of our credibility here, as well," Dooley said.
This round of grant money, Belshé said, is for laying the groundwork to set up the exchange. "What do we need to do the planning work leading up to the Level II grant?" she asked. "We need to do that with an eye toward what do we need, not how much will they give us."