The Connector Board met Thursday morning for an in-depth discussion of both the Commonwealth Care and Commonwealth Choice programs. The Board voted to approve the sub-connector contract extension with the Small Business Service Bureau (SBSB) for an additional fifteen months. The Board also voted to release draft Commonwealth Care eligibility regulations for public comments. Meeting materials are available here.

Connector Board member and Administration and Finance Secretary Leslie Kirwan opened the meeting by announcing that the Connector was one of fifty finalists for a prestigious award for innovation in government from the Kennedy School of Government. Secretary Kirwan recognized that the third anniversary of health reform was celebrated at the State House this past Monday with an event releasing the results of a report on shared responsibility. The Blue Cross Blue Shield of Massachusetts Foundation report demonstrated that stakeholders (state, individuals and employers) continue to pay proportionately the same share of health care as they paid before health reform.

In his Executive Director’s report Jon Kingsdale prepared the Board for a “lot of thinking” about Commonwealth Care and Commonwealth Choice. The Connector is faced with the first full open renewal process for the CommChoice program since the program’s inception. Kingsdale contrasted the CommChoice renewal process with the CommCare reprocurement process by stating that the Board’s role in CommChoice is to serve as a retail outlet, invite new bidders to participate in CommChoice and scrutinize plans. Kingsdale laid out the process for granting the Seal of Approval to CommChoice plans; the Board will dig deeper into the data in May and vote on which carriers will be awarded the Seal of Approval in June. Kingsdale added that the Board will also vote on the amended CommCare eligibility and appeal regulations in June, following a public comment period. Click for all the details, in detail.

Commonwealth Choice
Sub-Connector Contract Extension – VOTE
Kingsdale stated that he was pleased with the successful negotiations for the sub-connector contract extension with the small business service bureau. Patrick Holland, Connector CFO, presented information to the Board pertaining to the contract extension. There will be a 22% reduction in per subscriber costs ($8.00 to $6.24). Holland explained that the current contract will expire in February 2010. The goals of the extension are to reduce costs, allow more time for the program to mature and minimize the amount of program disruption with the upcoming Seal of Approval. The SBSB contract extension will maintain current high performance standards, with respect to the call center and the application processing. The Board voted to approve the Sub-Connector Contract Extension with SBSE for an additional fifteen months.

Enrollment Update
Director of CommChoice Tricia Bull provided the Board with detailed information on CommChoice enrollment. Since December 2008 the CommChoice program has experienced a 12.6% increase in enrollment, which equals an additional 2,600 members. Bull reported that new applications outpace cancellations resulting in net enrollment growth. CommChoice enrollment grew modestly from July 2008 to December 2008, and increased more sharply from December 2008 to April 2009. Board members Nancy Turnbull and Dolores Mitchell asked if the Connector collected information about the type of coverage new members had prior to CommChoice; Bull responded that the Connector does not currently capture this information but will in the future. Bull stated that she suspects that the recent increase in enrollment is due to the deteriorating economy. Bull also added that the Connector surveys CommChoice members who cancelled their plans and most cancelled because they received offers of employer-sponsored insurance. Turnbull stated that she would like to understand trends outside of the Connector. Bull answered that she will provide the Board with more information on the non-group market. Bull informed the Board that CommChoice enrollment is growing at the same pace as the rest of the non-group market and CommChoice plans represent about 50% of the growth in the non-group market. Turnbull also asked if there were different enrollment patterns within tiers; Bull replied that enrollment in the young adult plans (YAPs) coincided with school cycles. Bull reported that almost half of the CommChoice subscribers are members for more than a year.

Bull described trends in CommChoice premiums and stated that premium increases for renewing plans are on a downward trend. Turnbull stated that there is volatility in premiums from month to month and asked if the Connector tracks this information; Bull responded that the Connector does track this data and is happy to share with the Board. Board member Celia Wcislo raised the issue of how to deal with this premium instability. Secretary Kirwan questioned whether the Connector can publish trends in premiums by carrier and Turnbull supported this suggestion as it would be relevant to consumers shopping for CommChoice plans and to the Seal of Approval process. Bull added that the Connector reaches out to CommChoice members whose premiums increase more than 15% to explain that they have other options.

Bull also provided the Board with information on enrollment by carrier and plan level. Bull explained that carrier enrollment is widely distributed as follows: Blue Cross Blue Shield – 30%, Harvard Pilgrim Health Care – 21%, Fallon Community Health Plan – 17%, Neighborhood Health Plan 23 %, Tufts Health Plan – 6% and Health New England – 3%. Forty-three percent of CommChoice members are in Bronze plans, 27% in YAPs, 23% in Silver and 7% in Gold plans. Bull noted that almost three-quarters of CommChoice members are in the lower-cost Bronze or YAP tiers. The Board inquired why enrollment in the Tuft’s plans is so low; Bull answered that this is because Tufts Health Plan has a select network and doesn’t cover the entire state. Board member John Gruber commented that the Connector should make sure that the CommChoice Bronze plans mirror comparable plans sold outside of the Connector in terms of benefits and costs. Kingsdale stated that the Board will receive additional information on CommChoice at the May board meeting.

Market Research
Chief Marketing Officer Kevin Counihan presented the Board with highlights from member research conducted by the Connector. The Connector conducted research in March 2009 with 5 focus groups consisting of 50 members and non-members and 1,200 online survey respondents to evaluate plan design options and the value of plan choice. Counihan stated that he was comfortable with the credibility of the data. Board member and DOI Commissioner Nonnie Burnes questioned if the Connector contracted this research out; Counihan responded yes, but because of budget constraints he moderated some of the focus groups himself. The participants compared current CommChoice options to other alternatives. The participants showed the most enthusiasm for the option of 3 plans with 5 carriers. This was preferred over both the 1 plan/1 carrier and 1 plan/5 carriers option. The Board discussed the findings of market research and contemplated the goal of the CommChoice program. Board member Dolores Mitchell expressed concern that the results of this market research contradicted findings from earlier focus groups that suggested that consumers wanted very simple options. Counihan stated that these participants seemed to want plans with meaningful differences in benefits and prices and preferred standardized benefits with a choice of carrier. Secretary Kirwan stated that the Board would like to see more details on the survey used for the most recent market research. Board member Lou Malzone strongly advocated for minimal choices in plan options; Malzone stated that the goal of CommChoice is a consumer-friendly experience and simplification will lead to increased affordability.

Seal of Approval Plan for 2010: Review Carrier Specifications
Next, Patrick Holland updated the Board on the CY2010 Seal of Approval process for CommChoice. Holland reviewed the timeline and goals of the process. The Board is scheduled to receive an update on the RFR process at the May meeting, a detailed discussion of staff evaluations of carrier responses at the June 11th meeting and vote to award the Seal of Approval to selected carriers at June 23rd meeting. Board member Tom Dehner asked about continuity of coverage for members in plans which do not receive the Seal of Approval; Holland responded that the Connector will notify members and members will most likely stay in their plans but purchase outside of the Connector. The Board discussed finding the appropriate balance between the demand for choice and the pressure to contain costs. The RFR recommendations for the carrier contracts will require carriers include all of the proposed benefit designs and will continue to encourage carriers to offer select or tiered networks. If carriers are awarded the Seal of Approval they will be required to participate in all tiers and products. The staff recommendations for the RFR reflect the results of the market research with respect to greater transparency of price, a simplified purchasing experience, a limitation on the number of benefit designs but continuing to offer the level of choice expected, and minimized member disruption.

The benefit designs stipulated in the RFR recommendations also reflect consumer feedback received in the market research. Secretary Kirwan stated that consumers want more choice than they need. Turnbull commented that the Connector has the opportunity and obligation to help people understand the balance between choice and costs and suggested a marketing or messaging campaign to educate consumers. Turnbull added that the Connector was not only the only stakeholder responsible for consumer education about this issue. Holland reviewed the proposed benefit designs and cost-sharing in the Gold, Silver, Bronze and YAP plans and the Board discussed the structures. Wcislo urged the Connector to change the name of the Gold plans as they are not the richest plans available; Holland acknowledged Wcislo’s point but stated that the tiers were relative to each other. The Connector is proposing significant simplification for the Silver plans by moving from 11 unique benefit designs to 3 that reflect the most popular benefit designs.

Turnbull and Dehner commented that the Connector needs to clearly and simply explain the differences in plan options to consumers. Turnbull and Wcislo voiced opposition to co-insurance in Bronze and YAP plans. Gruber disagreed by adamantly supporting co-insurance. Gruber also criticized the Bronze plan design C as being too rich and too close to the Silver tiered plans. The YAPs will have two benefit designs: one with and one without prescription drug coverage. Turnbull asked about gender differences in YAPs with and without prescription coverage; Bull replied that a few more men are buying YAP plans with no prescription coverage but there is no significant difference. Board member Ian Duncan expressed concern with the annual benefit cap in the YAP plans and urged the Connector to consider eliminating the cap. Gruber requested information about the cost of YAPs with no benefit caps; Holland responded that the Connector is calculating this value. Secretary Kirwan stated that the Board has received good feedback on the CommChoice program and promised the Board that they will have “lots more bites at the apple” in the future.

Commonwealth Care
CommCare Eligibility Regulations
Jamie Katz called the Board’s attention to the revised CommCare eligibility regulations (956 CMR 3.00). According to Katz, the purpose of the Board vote for these regulations is to start the process – put the regulations out for public comment so that the changes can be in place by July 1st. A public hearing is scheduled for Friday, May 29th. Katz said staff is willing to discuss the changes in the regulations with all interested parties in between now and the hearing date. The Board will be expected to vote on the final regulations at the June 11th meeting.

Katz noted that the changes in the regulations are not intended to be substantive: “They are modest changes not intended to differ from what the Board has already approved regarding processes and operations.” Celia Wcislo noted that she wants to pass on comments and meet regarding the changes. Katz responded that he already considered some changes, and is more than willing to discuss others. With that, the Board vote unanimously to approve the draft regulations to be released for public comment.

The ACT!! Coalition will be weighing in on these regulatory changes with testimony at the May 29th hearing, and we encourage other organizations to do the same.

CommCare Quarterly Program Update
Melissa Boudreault provided the Board with an update of the Commonwealth Care program, focusing on two areas: member experience/open enrollment and caseload. She reported that things are going very well in the program and policy arenas.

Member Experience
According to Boudreault, this time of year that CommCare has the most contact with members via phone, outreach, and mail. Staff is trying to use lessons learned from last year’s open enrollment to make this year’s process run more smoothly.

Call Center
CommCare’s customer call center receives an average of 10,000 calls a week, with a less than 1% call abandonment rate. They have moved their overflow center – which operates the same as the main customer call center – from Texas to Canton, MA.

According to Boudreault, there was a higher call volume the week of March 9th because invoices had been sent out that week; there has also been an uptick in enrollment. Boudreault said staff will continue to focus on clarifying invoices, but noted that same month billing has made a huge difference for members. CommCare has also implemented 100% call monitoring, which has enabled staff to troubleshoot more effectively. .

As of March 2009, the majority of calls continue to be regarding enrollment. Calls regarding invoices decreased by 4% since December due to same-month billing, which made the premium payment process more understandable. Boudreault is proud to announce that there have been no invoicing errors for January, February, March, and April.

Member Communication – Open Enrollment
Commonwealth Care open enrollment is May 25-June 25 this year. Boudreault said that this is a passive open enrollment, “If we don’t hear from you, we assume you want to stay in your current plan.” CommCare staff will focus heavily on member outreach through the end of June. Niki Conte has been going out into the community to get feedback on the proposed process and updated open enrollment materials.

Boudreault went over the materials CommCare is planning to send out to members. All the materials have been redesigned from last year, and information will be customized to each member (options by region, plan type, etc.), which will make the process of choosing a plan less confusing. Babble cards will be included. Celia Wcislo asked if materials are printed in other languages besides English. Boudreault responded that printed materials are only available in Spanish or English; folks who speak other languages need to call customer service.

Boudreault is pushing folks to use their website, as it contains the most updated information and a comprehensive provider directory. CommCare program staff have been going statewide to communicate open enrollment changes to different groups: community-based organizations; Mass League of CHC’s, MassHealth outreach grantees, and MTF. Melissa Boudreault and Niki Conte also plan to present at the Western Massachusetts Health Access Network (HAN) and ACT!! Steering Committee meetings in May. Celia Wcislo suggested presenting to the Community Health Worker network.

Next, Boudreault presented the Connector’s website, which includes enhanced screens and information on open enrollment. Staff have updated the website so that members can research providers and plan costs; they are particularly encouraging members to explore the provider directory in order to understand what plan their providers are in. Nancy Turnbull asked if the provider directory only shows the panel of PCPs. Boudreault responded that CommCare receives weekly updates from providers; staff regularly updates the website with this information. Lou Malzone asked how many people are using the website. Boudreault said that many folks work with outreach workers to explore the website; they used to require an email address but have since lifted requirement to encourage people to go online. All in all, about 4,000-5000 go through web; Boudreault wants to increase this number.

Rick Lord inquired as to whether the new entrant (CeltiCare) is on track with their network and DOI licensure to be ready for open enrollment. Boudreault said that she cannot speak to the provider contracting process, but all plans have had network activity. CommCare staff plan to send out materials in April including information about all approved plans; members will be informed later of their specific options.

Caseload Overview
According to Melissa Boudreault, enrollment trends have gone upward since January. Closings due to redeterminations are slowing as there is an increased response rate from members and the outcome of the redeterminations is increasingly affirmative (i.e. members are still eligible). Boudreault said that can also be attributed to the fact that people are more familiar with the redetermination process because they have been through it before.

Programmatic Solutions
Boudreault quickly ran through some programmatic solutions she had touched on in previous meetings.

According to Boudreault, CommCare is making a lot of progress on program integrity and member experience by:

• Creating a CommCare-specific insert for ERV forms;
• Using pre-populated ERV forms (in pilot stage);
• Improving initial data collection;
• Improving eligibility processes related to ESI (changing the system for part-timers and enrollees)
• Enhancing the exceptions process (directing all exceptions calls to CommCare; removing part-time workers from the ESI decision-tree).

According to the last slide in her presentation, CommCare is also working with DUA and EOHHS to figure out how to help people best navigate the MSP and CommCare programs.
Suzanne Curry and Catherine Hammons