DSRIP Opt Out Update

  • Presentation also available in Portable Document Format (PDF, 190KB)

Carlos Cuevas
Senior Policy Advisor
Office of Health Insurance Programs
New York State Department of Health

April 8, 2016

Opt-Out Mailing Status to Date:

Oct 2015 → Phase I: 509,000 letters sent → Nov 2015

Feb 2016 → Phase II: 4.7 million letters sent → Mar 2016

  • Letters sent to the "good addresses" meeting USPS standards
  • Eligibility as of 9/25/15 in Phase I
  • Eligibility as of 2/2/16 in Phase II
  • Total sent 5.2 million and additional clean up volume remains

Undeliverable to the "good addresses"

  • Letters that met USPS address standards considered "good addresses" but returned as undeliverable
  • Attempt additional updated or address cleanse options
  • Rerun eligibility
  • Resend any updated found addresses 1x
  • Important because members not notified of DSRIP data sharing are automatically opted out

Member files held because of "bad/maybe" addresses

  • Addresses do not match to USPS standards
  • Attempt address cleanse options and rerun eligibility
  • Resend 1x to those found with updated "good" addresses
  • If not able to be mailed, will be processed as automatically opted out

Implication of Undeliverable and Bad/Maybe Addresses

  • These members expected to be the bulk of opt out
  • Not the same as those who have chosen to opt out of data sharing
  • Attempt to minimize through address cleanse and remailing
  • Currently the clean up from both Phase I and II is about 900,000
  • Where possible letters are being re-mailed
  • This will be completed by late May (30+ 5 days)
  • May be flagged differently in rosters

Maximus call volume & trends

  • The DSRIP call center number is 1-855-329-8850
  • 64,000 calls to date: 67% general and 33% opt in/out decision
  • General Questions:
    • Why did I receive this letter?
    • What is DSRIP? (Consumer Education)
    • Who would get access to my information?
    • Do my benefits or doctors change?
    • Do I have to pay for this program?
    • Translation needs

Member Opt Outs to be processed against:

  • Member Roster
  • Dashboard (removed from drill down PHI View; included in aggregate)
  • Comprehensive Provider Attribution(CPA) [but are included in the aggregate Individual Provider Attribution (IPA)]
  • Claims/Encounters Extract
  • Supplementary monthly PHI Discontinued/Shred Roster

Official Opt outs processed

  Roster Dashboard
Drill down
CPA Claims/Encounters PHI Discontinued
Cycle #1
33,210 January
Yes Yes Yes Not yet available n/a
Cycle #2
late April 40,000 estimate
        In development
Cycle #3
late May All new call center activity
and the bulk balance of undeliverable &
bad/maybe addresses from Phase I & II

Monthly process

  • Beginning May 2016, newly and re-eligible will receive the opt out mailer.
  • Estimate approximately <200,000 a month
  • Undeliverable and bad/maybe addresses will have tight timeframes for address cleanse options, redistribution, and applying opt outs to the Rosters/Dashboards/CPA /Claims within a 60 day timeframe.
  • PHI Discontinued/Shred Rosters
  Roster Dashboard
Drill down
CPA Claims/Encounters PHI Discontinued
Cycle #4
Begins monthly cycling
Cycle #5
July and so on

Thank you.


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