Exec optimistic about state health exchange fix

Bruce Gilbert has held a lot of jobs.

But none of those jobs — criminal defense attorney, benefits administrator for 200,000 Ohio teachers, chief operating officer for an insurance administrator — likely came with the challenges Gilbert, 60, faces as the new executive director of Nevada Health Link.

The state’s health insurance exchange, the marketplace through which Nevadans can buy coverage to comply with the Affordable Care Act, has struggled with technical problems, sub-par enrollments and lawsuits over failed coverage.

It’s now Gilbert’s task to right the ship for open enrollment in November. Gilbert will oversee the state’s temporary transition to the federal healthcare.gov exchange, and spearhead the search for a permanent replacement for Nevada’s flawed system.

The post won’t be Gilbert’s first foray into Nevada. He and his wife, Laura, the parents of two grown children, have visited Las Vegas several times and “like it very much,” he said. Gilbert hasn’t determined whether he’ll be stationed in Southern or Northern Nevada, but he and his wife are relocating from Texas with his father-in-law, who’s in his 90s, and that will play into their decision, he said.

Gilbert is set to start sometime next month, possibly as soon as Aug. 1.

Question: Congratulations on your new position.

Answer: Thank you! I guess that’s better than condolences.

Question: Well, speaking of that, are you out of your mind taking this job?

Answer: You wouldn’t be the first person to ask me that. One of the questions the board asked was why do I want this job. I explained that I saw this really as a legacy opportunity. You don’t often get a chance to really impact people’s lives, and this is an opportunity that’s almost unparalleled. With health insurance and the (Affordable Care Act), you can watch from the sidelines, or you can get on the field and be involved. I wanted to be on the field.

It doesn’t matter what you think of the law. Once you commit to creating an exchange and expanding Medicaid, it’s everybody’s obligation to make it as successful as possible. Nevada has decided to walk down this road. I want to help the state reach its goals.

Question: What’s the first thing you’ll do on the job?

Answer: I’ll spend time with the board and staff to get my arms around where we are in setting up a transition (to healthcare.gov) for open enrollment. Until I truly understand that, I can’t tell you where we’re going.

Question: What went wrong with our exchange?

Answer: From an external perspective, it’s difficult to say. I can see the results, but I can’t tell you what led to those results. There are a lot of moving parts and different parties. The bottom line is, for whatever reason, it didn’t operate the way it should. I can’t tell you why, but the lesson has been learned. The board is interested in ensuring (the problems) never recur. It’s not a great yardstick for success — “don’t mess up too badly and we’ll like you.” But the bottom line is, that’s my charge: What cannot happen is what has happened.

Question: How can we fix it?

Answer: The thing that makes an enterprise work is execution — paying attention to details and making sure you have your arms around everything. By moving forward and really keeping our eye on the ball, and by accepting responsibility and accountability and owning the exchange and its operation, I think we can make a tremendous difference. I don’t think the issue is technology, because we’ve had enrollment technology for a long time. The two main issues are public perception and execution. If we pay attention to execution, the public perception issue will abate.

Question: What experience has best set you up to lead the exchange?

Answer: I served as executive director of a state board in Ohio that identified, evaluated and adopted best practices that would be included in health insurance plans for all of the state’s public-school employees. I reported to a 12-member board of hospital administrators, academics, union officials, teachers, administrative personnel and school financial officers. I had an advisory committee that was even larger, and which had its own set of constituencies, including (insurance) brokers and union officials.

That was an excellent training ground in how to deal with competing influences. It taught me that you have to unify people. You also have to be very respectful, because everybody pays great attention to whether you step on their turf.

Question: What’s your biggest accomplishment?

Answer: At each step in my career, I’ve done something I’ve been proud of. It would be difficult to point to a pinnacle. Besides, I would like to think the pinnacle is going to be helping the Silver State Health Insurance Exchange succeed.

Question: How long do you see yourself staying? Is this a fix-it-and-move-on thing?

Answer: I don’t foresee leaving at all. The expectation is that I will be there for a long time, and that we will have the opportunity to make the exchange into something like Connecticut’s, where people talk about its success. The idea is to come in, get it to where it should be and work with the board to make it a long-term success.

I know there have been problems. I can’t tell you everything is going to be perfect. I can tell you we will do our absolute best to make sure the outcome is better than it was.

Contact reporter Jennifer Robison at jrobison@reviewjournal.com. Follow @J_Robison1 on Twitter.