Yesterday was Patrick Holland’s (Connector CFO) last Connector Board meeting; today is his last day at the Connector. Jay Gonzalez began yesterday’s meeting by recognizing Patrick’s incredible work: “Patrick Holland is one of the reasons the Connector has been as successful as it has.” Jon Kingsdale echoed Gonzalez’s comments.
And we agree. Thank you, Patrick, from all of us at Health Care For All, for your amazing commitment and excellent work at the Connector! We have enjoyed your forthrightness, compassion, wit, and humor. It has been a privilege and a pleasure to work with you. Best of luck in your next venture.
The meeting discussed next year’s Commonwealth Care program, including the procurement of health plans, auto-assignment of CommCare members to plans, and copayments, and next year’s Commonwealth Choice program. Details below – click for more.
CommCare RFP
Patrick Holland reviewed issues emerging from FY09 and FY10 that informed the decision to increase the capitation rate and enrollment assumption in FY11. In FY09, many of the budget issues were claims-based, whereas in FY10 they were programmatic – a result of the discontinuation of auto-assignment and the removal of “special status” legal immigrants from the program.
As noted in our last Connector Board meeting blog, the Connector plans to offer the MCOs a capitation rate of $425.67, which is at the bottom of the Actuarially Sound Rate Range (ASRR), while taking on some of the risk the MCOs had been bearing. The Connector is using a “take-it or leave-it” approach with regard to the medical portion of the capitation rate ($393.67) in FY11. In response to the Board’s request to create the ability for MCOs to competitively bid, the Connector will allow the MCOs to propose a lower administration fee. The current administration fee is $32.
Celia Wcislo asked if the cap rate will still meet the Actuarially Sound Rate Range if MCOs propose lower admin fees. Holland responded that if an MCO offers a lower rate, they will need to justify their ability to accept the lower rate; in other words the MCO has to prove their proposed rate is actuarially sound for their organization. Nancy Turnbull agreed and stated that the Connector needs to be judicious about the basis for an MCO to bid lower, to make sure they’re not sacrificing long-term sustainability for short-term savings.
Holland presented the Connector’s plans to resume auto-assignment for the last quarter of FY10. According to Holland, there are currently about 10,000 people who are eligible but unenrolled in CommCare. They plan to phase-in enrollment by auto-assigning 3,500 people in April, 3,500 in May, and the rest in June.
Dolores Mitchell expressed her concern with paying for people who are not using services. She requested that the Connector track utilization for people who are auto-assigned. Holland reminded Mitchell that they are already doing that; he referred her to the memo he gave the Board in September. Two-thirds of these folks are auto-re-enrollees and one-third are new to the program. The Connector will determine whether they can continue auto-assignment in FY11 based on the budget. Gonzalez stated that the Connector should be clear in the RFP about whether auto-assignment is likely in FY11, making sure to mention that there is no guarantee it will continue.
In addition, the Connector plans to phase-in the prescription drug carve-out in FY12 to ensure enough ramp-up time to make it work effectively. The prescription drug carve-out is being driven by MassHealth, and is contingent upon what happens on a federal level. The national reform bills include provisions that would allow MCOs to get the same rebate as states, thereby making the prescription drug carve-out unnecessary financially.
For FY11 procurement, the Connector is also assuming that the change in co-pays and dental benefits for Plan Type 1 members, which are necessary to align with MassHealth changes, will happen.
Next, Holland provided a comparison of private market and CommCare cost sharing, as requested by Jon Gruber at the last Board meeting. Gruber thanked Holland for the information, and requested that the Board have a more in-depth conversation about this prior to FY12 procurement. Gruber believes that CommCare cost-sharing should be more in line with market prices; he raised particular concerns around the $0 CommCare co-pay for high tech imaging (MRIs, CT scans, PET scans).
Dolores Mitchell commented on the Emergency Room co-pays by sharing an anecdote from the British health care system (her son lives in London). In England, if you call the ER on the weekend, they assess the person’s condition, and either give him/her an appointment to come into the ER or ask him/her to make an appointment with his/her doctor on that coming Monday. Mitchell commented, “Now that’s simplicity!” Turnbull said she hopes the Connector will not only look at co-pays themselves but also consider studies that show the impact of imposing co-pays, particularly the New England Health Institute study on Emergency Department use and the lack of available primary care providers.
The timeline for the FY11 procurement is very short. The Connector will issue the RFP today, and MCOs need to get their responses in by March 12th. The Board will vote on April 8th on the Connector’s recommendations regarding the RFP responses.
Moving to the bigger picture, Mitchell asked what the main take-away from this meeting is so far. Gonzalez responded that the message is: “Even in this tight fiscal climate, the Administration is continuing to fully fund health reform, and provide subsidized coverage for those who would otherwise go without coverage. The Connector will provide a cap rate to the MCOs that will enable the MCOs to continue to provide benefits for this population in a sustainable way.”
2011 Seal of Approval
With recognition for Holland’s past work on CommChoice Seal of Approval (SoA), Jamie Katz and Kaitlyn Kenney presented the 2011 SoA process and timeline. The main goals of SoA are to maintain a simplified product structure, minimize carrier disruption, and encourage carriers to participate in both CommCare and CommChoice. Another goal is to work with carriers and SBSB to outreach to employers and promote their Business Express products.
The Connector is taking a similar approach to previous SoA processes, in that the Connector will continue to require carriers to participate in all product tiers (Gold, Silver, Bronze, YAP) and CommChoice programs (non-group, Voluntary Plan, Business Express).
A few changes include:
- Two tiered RFR approach: If a carrier already has SoA approval for their products, they don’t have to go through the SoA process again this year. According to Kingsdale, the contracts last time around had an automatic one year renewal; there is a review for carriers every two years. New entrants will have to go through the process.
- If a carrier offers a select (limited) network product, they must also offer a broad network product.
Turnbull commented that these changes are very important in the context of carriers selling products in and out of the Connector; the changes will help to level the playing field. Wcislo asked if the Connector has thought about getting rid of any carriers; continuing to add new plans will result in some carriers with very few members. Turnbull agreed. She likes the streamlined products, and thinks the Connector still has too many products and needs to simplify. Turnbull also requested data on premium trends in CommChoice plans; she wants to understand the Choice products outside of the Connector better.
The Connector plans to issue the CommChoice RFR in April; the Board will vote to award the Seal of Approval to selected carriers in July.
-Suzanne Curry
