Chini Krishnan, CEO of GetInsured, spends some time with Heather Korbulic, executive director of the Silver State Health Insurance Exchange, to talk about transitioning off HealthCare.gov, working in government during a pandemic, and life in general.
Interview text:
Chini Krishnan:
Well, good morning, everyone. This is part of the series of interviews I hope to have with leaders and public service, who serve with dedication, meaning and purpose every day. Our guest today is Heather Heather Korbulic. Welcome, Heather.
Heather Korbulic:
Hi, thanks for having me, Chini.
Chini Krishnan:
Of course. Now, you’ve recently taken on a new role as Senior Policy Director for the State of Nevada, in addition to your existing role as sort of the executive director of Nevada’s health insurance exchange, which is called Nevada Health Link, so congratulations.
Heather Korbulic:
Yeah, congratulations, condolences. Yeah, there’s a combo factor going on there. But I appreciate that. So yeah, the the role with the governor’s office is the policy director. And and when we put the senior on the front of it, it makes it seem like there are others that are doing it. And that’s not actually the case. So it’s, it’s a pretty heavy lift. And to do it at the same time of our as the executive director of Nevada Health Link is intense.
Chini Krishnan:
Absolutely, this is a momentous year for healthcare in so many different ways. This COVID is also the Biden administration, evaluating all of the changes to the ACA just raises questions about health care; health care is on the mind of all Americans in general. Nevada, now, of course, was one of the very first states to transition of healthcare. gov, or what’s called the FFM to a state-based marketplace. So as other states begin to contemplate the switch to a state-based exchange, we wanted to chat with you about sort of your journey, the successes, challenges, the policy changes you have seen, and you know, still expect to see, but we’ll get to all of that in a minute. Before we dive in, tell us tell our listeners a little bit about yourself. Where did you grew up? What keeps you sort of going outside of work? What’s your favorite show on Netflix?
Heather Korbulic:
Okay, so again, Heather Korbulic, and I am originally from Portland, Oregon. And that’s where my parents still live in the house that I grew up in. I went to the University of Oregon — go ducks — and became got interested in civil service because both of my parents were — and retired from — public service. My mom worked for the State of Oregon with the Commission for the blind, and my dad worked for the water treatment plants. So I grew up in this sort of mindset. And then I moved to New Mexico for several years, with my husband, while he was getting his degree, had all sorts of crazy jobs there, and then ended up landing in Reno for him to get his PhD. And I got connected to the state as, originally, as a state Long Term Care Ombudsman, so an advocate for people who live in nursing homes and assisted living facilities, which is just such an empowering job because you’re helping people daily, but you’re also helping them at a systems level. And so I really got into the way that the sausage is made, understanding how law works, and how it practically applies to people. And so from there, I spent many years doing that. And then I became the exchanges COO, and then the exchanges, Executive Director, and all of that is then just probably the time of my life. I honestly I do have hobbies outside of my job, but I actually really love the work that we do. And I love Nevada, because there’s a mindset of independence in Nevada, where it’s like, keep your government claws off my, you know, my work, but working for the government and being in that independent mindset really lets and allows for fluidity and creativity. And when you’re in a state that’s as small in terms of population and budget as Nevada, you really have to be scrappy, and creative. And so that’s kind of why we got to make that change with the exchange. But just to answer a couple more questions about what what keeps me going, I read a lot of books. I hike, I have two children. I have a dog now which is a wild thing to get in the pandemic with two other jobs. And I pretty much love the outdoors. So I’ll leave it there.
Chini Krishnan:
Thank you. So it sounds like your your parents were very seminal influences and sort of your road to public service. Is that a fair thing to say?
Heather Korbulic:
I would say absolutely. And I think where they’ve taught me more than anything, and what I value, really the most from what they’ve taught me is about work ethics, and about never dropping a ball or letting other people sort of hang based on you not fulfilling your responsibilities. They’re pretty phenomenal people.
Chini Krishnan:
Beautiful. And I also I thought I heard that somewhere in there that Nevada has sort of frontier men or frontier person types that sort of appeals to you because you get to exercise a lot of creativity everyday in your job. Is that also a fair thing to say?
Heather Korbulic:
It absolutely is. And I would say sometimes, governments get pigeonholed as being bureaucrats. And I think one thing that I’ve been privileged under Governor Sandoval and under Governor Sisolak now is a real support for practical creativity, right. So when we transitioned the exchange, we didn’t just say, well, this seems like a good idea and just did it. We spent a lot of time researching and thinking through the risks and planning. And all of that really is kind of a testament to being in a state that really focuses on creativity and frontierism, I guess, and blazing new trails, but also being really thoughtful about the way we do it.
Chini Krishnan:
So but let’s dive into that. Tell us a little bit about, you know, Nevada Health Link. So, you know, the Silver State exchange, as I recall, it used to be called like, how did it come about? Who’s the brain behind it? Who were the people behind it? You know, tell us a little bit about the story of how and when you came on board to take things over? Like, you know, draw us a little history lesson here.
Heather Korbulic:
Sure. Sure. So the the nutshell history for Nevada Health Link kind of starts back in 2011, I want to say, when the first Republican governor, Governor Sandoval decided that he would expand Medicaid for the state of Nevada. And in doing that, it also allowed the state to set up a state-based exchange. So we went live Nevada Health Link went live as a state-based exchange in 2014. And we had what is just, you know, I guess, a textbook fail, in terms of everything that could go wrong went wrong. And it became a bit of a nightmare. And thankfully, I didn’t work there, then. But I did get to inherit that, that when I came over to the exchange.
So when I came over, we had transitioned to becoming one of the the only one of the few state-based exchanges that use the federal platform. So we were operating in a hybrid way. And in that hybrid capacity, used healthcare.gov as the eligibility engine and for a lot of the customer service. Unfortunately, there were a lot of limitations to that there’s no specific way to be flexible and dynamic and responsive to your individual state needs when you’re using a platform that is massive, and is really meant to service the whole country. So that combining the factor the limiting factors that existed with healthcare.gov, in terms of, you know, flexibility, and also insight into who our customers were and what they have what their activity look like, along with the fact that the feds or healthcare.gov decided that they would start charging almost the entirety of the exchanges budget to use on their services.
We started investigating and researching companies that had successfully worked on exchanges and launched exchanges in other states. We did a road tour, went to Idaho and Washington in Minnesota, and we really looked under the hood of what made a successful exchange. And what we walked away from because, you know, most of most state-based exchanges set up in 2014. And they have their own, you know, concerns and issues. And they had to do it in a scattershot way where they had all of these different contracts, some of them doing some parts, some doing others and they had to sort of make them all work together. And when we saw that, and we recognized how few people we had on the exchange, how limited we were in terms of you know, contract management, monitoring, and then and then how limited we were in terms of finances, we really had to put together an RFP that I know has become a model for other states that are following behind and that request for proposal was really to have a one-stop shop, one contract to take care of all of our needs. So it was call center, it was eligibility and it was, you know, all of the outside things that happen in terms of compliance with the federal regs. So all of that is under one, one contract. It is, you know, a big contract. And it requires a lot of time and intensive work. But we’re very pleased that GetInsured, of course, Chini you and your team, won that. And that that’s been a really successful endeavor. I mean, having come off of a failed state-based exchange endeavor the the road to convincing the state lawmakers and stakeholders and people who had been burned by that experience, that we could do it, and we could do it right. And taking that risk was massive, and I’m pleased that it was a success.
Chini Krishnan:
Absolutely. That’s such a lovely story. Now, how have you seen, Heather, sort of in a practical way has healthcare access or outcomes or, you know, improved in a practical way in Nevada, after the state took things over? Is there — are you able to share a vignette or, you know, some color on, you know, how you’ve been able to improve outcomes in the state after you guys sort of took things over?
Heather Korbulic:
Yeah, I can give you so the argument that we built to, to convince all of our stakeholders that this was a good idea to transition away from healthcare.gov and become our own state-based exchange was really three parts. The first was all about the Benjamins. So the dollars, how much was it going to cost, we can do it cheaper, and we can do it better than the federal government. So we had to build out that argument. And I’m very happy to say that we are doing it cheaper than it would cost to have paid the federal government to continue to use their their limited services. And that’s been born for you know, it has played out for our carriers or insurance companies and our consumers, because the exchange has been able to reduce the amount that we charge our insurance companies to, to be on our exchange. So that has offered you know that trickle down to customers has allowed for some some savings, which is great.
The second thing that we really based our argument on was flexibility. Right now, you know, using healthcare.gov, if we decided we needed to do and here’s here’s how it played out, we need to do an emergency special enrollment period, because there’s a freaking pandemic and we need to respond to it, we need to get people insured. So we launched a special enrollment period from March to May of 2020. In response, we enrolled 6,000 more Nevadans — all the big success. Meanwhile, all of the states that were using healthcare.gov, were not able to do that. They were not able to be responsive to the needs of their state. And that’s a real limiting factor. So that’s just one of many. And I’ll just give you one other option that we’ve kind of flexed on in terms of flexibility. This last year, we decided that we would have a full 90 days of open enrollment rather than the healthcare.go, limited 45 days. That’s such a terrible timeframe to be getting people enrolled during that November 1 or December 15. People are thinking about holidays; there’s two holidays happening right around the end. And so it’s a tricky time. So I think it made a huge difference for Nevadans to take it another couple of, I think it was 30 extra days.
And then the last argument has been one of the most powerful and we’re still really wrapping our arms around it and trying to figure it out and how to use this information. But the best thing that has come in my opinion, aside from the savings and all that good stuff, is knowing our customers. So knowing who they are, where they are, and having an opportunity to do a better job than what’s happening at the federal government to manage the churn back and forth between Medicaid. So people roll off of their Medicaid eligibility and get over to the exchange and we have this great opportunity to make sure they don’t fall between the cracks. And I think we’re still working that out. Understanding who our population is, but that’s been powerful.
Chini Krishnan:
Cool. And Heather, during this journey, like what are the things you encountered or challenges that you perhaps didn’t anticipate; is that anything you would have done differently like for some state that you know, looking to take this journey on now with the benefit of hindsight, is there sort of another aha moment that you’d like to share with others? Give us some color on that.
Heather Korbulic:
I mean, I think every gray hair on my head could tell a story about what we should have done differently, or what we could have done differently. And I think every state that’s followed behind us using our model has really improved that model. And so you know, I’ll just first say, to those other states, it’s absolutely worthwhile endeavor. And that there are, there are tons of lessons that have already been learned if you take and use this existing model. I think one of the things that, you know, Nevada had to be a pioneer here, and we were not probably fully prepared for things that keep popping up; like we knew we were going to get through a full year and have to be responsible for 1095 forms, tax forms, for people, but that did for for whatever reason, it didn’t strike us that that was suddenly going to be our responsibility, and there was going to be work associated with it. So there’s a lot to you know, digest, there’s a whole bunch of things that go on with the state-based exchange that are not really well known. But really kind of thinking through your manpower needs. And staffing appropriately is probably the biggest lesson that we’ve learned.
Chini Krishnan:
Cool. And and, you know, let’s shift a little bit to this year. I mean, it’s been a crazy year for the world. But in some ways, especially so far, Nevada as sort of the tourism industry, you know, collapsed under the weight of the COVID-19 pandemic. You know, the state, of course, and the governor then tapped you on the shoulder to help manage the unemployment office. And so how did all of that feel like it was, as I understand quite an adventure, like, how was that experience? Tell us a little bit about that. And, of course, now you’re back at the exchange. So walk us through these, this very tumultuous and crazy year called 2020.
Heather Korbulic:
Yeah, I mean, I wish I had enough time yet to kind of digest it. I’m still working on that. But I think 2020 in terms of pandemic and implications for the state, I mean, Nevada does not have a state income tax, we rely heavily on tourism. So the pandemic has disproportionately hit this state in a way that has been devastating. We went from, I think, enjoying probably the lowest unemployment numbers in our history, I think we were down in your 3 percent to a whopping I think, at our highest 26 percent, within just two months. So that really tells you about the system hit that we had when I was tasked to go help out at the Department of Employment Training and rehab and work through the issues that were happening with the backlog of unemployment claims. So we went from about 10,000, managing 10,000 claims a month to managing what I want to say was 100,000 claims a week; it was literally the the 1,000 year flood happening to this system that was not at all ready or staffed to be ready for something like that. So it’s been it’s been wild.
And at the same time, as working at that department, I was still helping to manage the exchange, then I get to go back to the exchange. And then I’ve come back to now being tapped again, which is an honor and a privilege to help the governor with policy direction for the legislative session that started on February 1. So it’s been a bit of a year. I think, when we really think about prioritization of policy right now, it is all focused on keeping Nevadans healthy and safe. And you know, eventually getting people really focused on new and innovative ways to keep people in the workforce. And I think, you know, as a bit of an optimist, who’s also very much a pessimist, I would say that there are silver linings, and the silver lining that I can see already is that this disruption from the pandemic has created the most enormous amount of positive change in terms of the way in which we work and the way in which we can have a diverse workforce. So all of these people who previously got left out of the workforce because they were a family caregiver and they couldn’t get to an office for the normal eight to five, or they have a disability and couldn’t get there now are finding themselves employed in meaningful and engaged ways that I just I see that as such a plus.
Chini Krishnan:
That’s, that’s wonderful. And so what do you what are you looking forward to this year? Do you foresee sort of policy changes? Or legislative priorities you’re working on? You know, that would impact health care for Nevadans? Are you excited about all the changes on the ACA being considered sort of more of a congressional level? Tell us about, you know, your hopes and dreams for this year and your objectives for what you’d like to see get done this year.
Heather Korbulic:
I mean, okay, I’ll take it from a state and then a federal level, because I’m super enthusiastic about what we’re seeing. So we’re right in the middle of a legislative session within a devastated budget and an emergency. But what we have seen is that our state has been woefully underfunded, and woefully unsupportive in some pretty significant ways. When it comes to public health and public health infrastructure. So I really look forward to this legislative session being focused on setting up infrastructure that allows for us to be in the right place, should we have something like this, when we have something like this happen again. And then in terms of the federal changes, and I’ve been narrowly focused on federal changes as they relate to the exchange, but my god, how exciting to have an administration who is engaged in helping people get covered and expanding coverage options, and in allowing more people to get into the system, rather than finding little nuanced ways to keep them out of the system. Does that mean a lot of work? For sure. And Chini, you know, that better than anybody else, right now. We are all working through these policy changes. But I gotta say, it makes me feel a whole lot better about this work, when I know it’s going to help more people than hurt more people. And that’s what’s really exciting.
Chini Krishnan:
Heather, thank you so much. We are, you know, there’s a lot of work ahead of us, all of us here and in 2021. But, you know, thank you for taking your valuable time and speaking with us, and good luck to you and everybody in Nevada as we embark on these next set of journeys together. Thank you.
Heather Korbulic:
Thank you, Chini. Cheers. Have a good year.
Chini Krishnan:
Thank you.
