MEMBERS ABSENT:

Also Present:

Legislative and Joint Fiscal staff, members of the Administration, and the public.

Meeting Recorded:

CD HCRC 4/17/07, CD #1 and #2.

Documents Distributed:

1. Convene                                                                                                    CD 1, Tr. 2

The meeting was convened by co-chairs Kitchel and Maier at 4:40 p.m.

a. Minutes

Review and approval of minutes from 3/14/07. Unanimously approved.

2. Blueprint for Health key staffing update.                                     CD 1, Tr. 2

                        Susan Besio and Sharon Moffatt

The Administration supports the exempt position in H.531 that reports directly to the Commissioner of Health: however the Administration now feels that the position should report to the Secretary of Administration in order to coordinate very closely with the health care reform implementation. A change is proposed to the language in H.531 to have that position report to the Secretary of Administration, but with shared responsibility with the Commissioner of Health for the oversight of the Blueprint for Health.

The language will say the person will report to “the Secretary of Administration or a designee” with the intent that the person will report to Susan Besio.

It was determined last fall by Susan Besio and Sharon Moffat that a point person was needed for Blueprint but they wanted someone already involved with Blueprint so as not to create an additional position.

During the past three or four months, it has become evident that the person chosen for this position should be a high status, commissioner-level individual with statewide authority, respect and visibility, who is leader and has the authority given by the governor and secretary of administration. 

The person will have two offices: one near Susan on the fifth floor (Pavilion Building) and the other near Sharon (Moffatt) at the Vermont Department of Health in Burlington. Also, a support person position will be added and shared by Susan and the person chosen to fill the new position as designated by H.531.

Sharon said leadership is critical and the need is to move aggressively toward hiring a high-level person who is capable of working across state government.

The challenge is making sure the person is grounded, knows the issues, can identify solutions, is nimble and has the ability to get through issues faster and better.

Q: Is there specific funding for this position? Is it in Appropriations? Exempt?

A: Funding in Appropriations with intent of being ready for July 1, 08.

$150,000 has been appropriated for someone with medical background; exempt position.

A bid is out now for two other individuals.

One is a communications strategy person with expertise in working with health care providers to tackle systems changes. A couple of names have been discussed and they are in the final week of the proposals coming in.

The idea is to bring in an outside expert and at the same time use three Vermont providers to implement communication strategies:

            Dr. Lisa Watkins – Blueprint staff

            Dr. Charlie MacLean – AHEC, internist and a specialist in diabetes

            Dr. Jerry Sable – internist and informatics specialist

There will be a three-person team to visit health care providers.

Another bidding process under way is for someone to help with payment reform, ideally someone with national expertise in addition to understanding Vermont payment reform. There have been a number of individuals invited to apply and the bidding process is available to anyone interested.

By the first week in May a decision should be made on who to hire for these positions. The goal is to have people on board, hopefully by mid-May.

An IT project manager is in place. This person has been involved with Blueprint and is now leading the team. There are two other staff members.

Sharon and Jim Hester have begun meeting with Vermont insurers to make sure they understand what the Blueprint and new requirements in H.531 will mean to them.

IT projects with GE and VITL are moving forward. From a technical point of view, Hans Kastensmith says he is “cautiously optimistic.” Things are in a much better place than one month ago.

3a. OVHA Chronic Care Management Program Vendor                           CD 1, Tr. 4

                        Joshua Slen

APS Health Care has been selected to provide critical care management services. It is a major national firm operated in 12 states and in a unified way. It uses Care Connect Software for care coordination population and fully integrated chronic care management protocols across not only the top 1% but down to the top 10% or 15% with prevention protocols.

It is expected that APS be onsite and operational by July 1. There are people coming this week to acquire space; 12 people are in the office of Vermont Health Access.  Everything is on schedule and the contract is expected to be finalized by mid-May. The biggest challenge is hiring staff and getting staff members trained to begin doing health risk assessments by July 1. By the end of August, those people will be under APS management.

The estimated enrollment is as many as 25,000 people but it will be less than that during the first year - significantly less that 25,000, perhaps 30-40% by the end of year one. No firm number yet.

Q: What’s the return on the investment and who assumes the risk?

A: For the first 18 months, the contractor will be held to deliverables not to specific ROI. Contract terms have been left open in order to hold them to health outcomes. They are also working with the University of Massachusetts to develop ongoing monitoring software and ROI protocol.

Not sure yet what the contract will total; it is still in negotiations. It is anticipated that it will cost more than $3 million but less than $5 million. Last year three new state employees were hired to administer the contract.

Outreach and Enrollment Program Update                                                CD 1, Tr. 5

                        Kevin Veller

The 10 people on the vendor selection team conducted an extensive review and scoring process of four proposals and although they were hoping to hire a Vermont firm, all 10 members of the search committee agreed that the best is GMMB (doesn’t stand for anything) in partnership with Lake Research Partners.

They have gotten feedback from the Robert Wood Johnson Foundation, the states of Maine and Illinois and the Auto Coalition for Traffic Safety. All feedback has been extremely positive about GMMB’s work including a vendor who worked with them for 10 years and reported never having any contracting discrepancies.

RWJ said “clearly GMMB knows more than anybody around about the uninsured.” 

Another reference, the Auto Coalition, said its campaign lasted 10 years and resulted in successfully educating the public to insist children ride in the back seat of cars rather than the front seat. This was done without legislation. GMMB also designed the “Click It or Ticket” campaign.

Negotiations with GMMB are under way and a successful outcome is expected.

The key issues / deliverable:

Messaging can’t be developed until after the hard work of figuring out who is uninsured, and why, is completed. Then GMMB will create advertising, branding of material development, stakeholders partnership outreach. They will also help develop training materials, media and press launch information as well as a web site launch. The timeline for this is to begin is May 1 for completed contract and focus groups to start.

An overview will be presented at the next commission meeting.

People are wondering when they can sign up and how. Need to make sure the web site is ready ASAP.

3c. Policy Issues in ESI Catamount Premium Assistance Rules      CD 1, Tr. 6

                        Betsy Forrest

Premium proposed rule ran up against four issues to reach consensus on with the committee before rules were filed with the legislative committee on administrative rules.

At the April 6 meeting those issues were discussed and the conclusions reached were as follows:

1. Approval criteria for ESI plans.

            VHAP-eligible people enrolled in ES will receive a full VHAP wrap; people enrolled in ESI and not VHAP-eligible will receive a chronic care wrap. To consider an ESI plan for approval, it must be substantially similar to Catamount health in terms of benefits.

Many or most plans have deductibles higher than Catamount. The Administration had proposed do a deductible wrap to bring down costs to make it substantially similar.

It was determined that it was not legislative intent to support a high deductible therefore the deductible wrap proposal is now being taken off the table. Instead, it has been suggested that the rule be put in plans will not be considered with deductibles higher than a certain amount – the amount suggested was $1,000. Plans with deductibles lower than $1,000 would be let in the door but would still be required to have benefits that would compare to benefits covered under the other plans. They would also have to pass the cost effectiveness test.

2. Methodology for cost effectiveness test.

            This primarily pertains to people who are VHAP eligible and have an ESI plan available to them for comparing potential costs under VHAP to potential costs under an ESI plan.

Three different methodologies were laid out and a proposed middle ground was chosen as the most preferable. The cost of the individual’s ESI plan (premium and deductible) would be compared to a per member, per month cost, for age and gender cohorts. For example, if a 25-year-old male would have a per member, per month cost to compare against that individual’s ESI costs.

3. How to provide the ESI chronic care wrap.

            For people on ESI Plans who are not VHAP eligible, the legislation says the state will wrap all chronic care cost sharing. It has been determined that it was not legislative intent to include all chronic illnesses and all treatments. Therefore, only chronic conditions included in the Blueprint and prevention and management services should be included in the wrap. It has been decided that the change will need statutory language. The Administration will be asking for language to be added to reflect this.

4. Reimbursement rate for wrap services

            This would apply on the VHAP side and on the Catamount ESI side also.

It is proposed to pay claims at Medicaid rate and not at the rate at which ESI plan would have paid the claim had the deductible been met.

3d. Update on BISHCA Review of Catamount Filings                     CD 1, Tr. 7

                        Christine Oliver

Late last week MVP rates were disapproved by BISHCA and BCBS rates were disapproved today. This is not uncommon. The next step is to meet with each to discuss the letter that was sent explaining where BISHCA expects changes to be made in order to reach an acceptable rate.

A meeting with MVP will be set up this week.

There is no strict timeframe but BISHCA will push to get carriers to move as quickly as possible since it is understood that people need to know by summer what the rates will be.

Some rates are denied because of technicalities that can be easily fixed. Technical revisions usually bring the rates down, which is believed to be the case with MVP.

BCBS is at a fundamental starting point and needs more work.

BISHCA staff is reviewing in depth the actual forms, certificates, applications, plans, reimbursement plans, chronic care plans--as required by statute to be reviewed. Responses will be technical; carriers will have to make adjustments but nothing huge. Review of actual filings and forms can be responded to within a week.

Insurers have the right to appeal and request a hearings but that is unusual. Negotiations are usually successful.

4. Progress Report on Key Blueprint Issues from Last Commission MeetingCD 1, Tr. 8 and CD 2, Tr. 1

                        Don Dickey

Systems changes proposed – evidence-based guidelines for high value for prevention and management services that will support better outcome in patients and payment changes. Also, common definitions of care management especially across Catamount Health, OVHA and state employees.

Handout: Focus on timelines.

The handout represents a series of building blocks of critical tools to be integrated in the two pilot communities.

Beginning at the bottom of the handout is health IT, which has already been discussed at this meeting.

The next is evidence-based guidelines or prevention protocols worked on by OVHA and Blueprint staffs. Guidelines and summaries are now completed for six conditions and related measures are in place for outcomes to be tracked. By July 2007, we can expect complete guidelines and measures similar to national measures that Medicare is moving ahead with. That means they have been vetted with the medical community. Adoption and integration in Blueprint communities will be part of pilots going forward.

Also in the pilot communities, there are changes in payment and delivery. H.531 provides a model building on the Blueprint strategic plan. The concept is to have pilots in two Blueprint communities with payment changes at the practice level. At the community level, the concept is to have supports there in the form of self-management and care coordination and health and wellness programs. That is the challenge for the summer.

Per H.531, the Health Systems Workgroup will work with Blueprint. The key here is the leadership of Blueprint.

Multi-state insurers have issues about Vermont handling payment differently than the procedures in other states.

5. Commission Organization and Outreach between Sessions      CD 2, Tr. 2

                        Jim Hester

Plans for summer work.

Handout – framework identifying five major themes for assessment of long-term strategy.

Among the five major themes relating to long-term strategy is reducing the rate of cost while improving quality. A part of that is prevention and wellness, which will give more “oomph” to that initiative.

Jim has been talking to the commissioners about which of these groups/themes each would be personally interested in and also trying to identify other resources outside the commission. After the session adjourns, groups should be established and a work plan ready to move forward in early June.

Commission members have been asked to identify from the handout list the issues they would like to address in work study groups this summer.

Monthly commission meetings will probably alternate between Montpelier and going out into communities. Meetings in other communities will be full-day sessions meeting with stakeholders normally not reached, doing commission business and  possibly holding public hearings as well.

The focus will be on Blueprint pilot communities to see first-hand the progress that has been made. The first meeting should probably be one of the original two communities, which are Bennington and St. Johnsbury. But first, Jim would like to speak to Susan Besio and Sharon Moffatt about where those two communities are in their schedules and discuss the pros and cons.

A survey will be sent to commissioners to get their input on work groups and “adopting” communities for ongoing relationships. Adopting a community might involve establishing a longer- term relationship where a commissioner might check in every month or six weeks to get a sense over time of how things were going. It’s another opportunity to give commissions another hands-on feel for what’s happening.

The goal is to have workgroups in place by the time the session adjourns.

Meeting adjourned at 6:15 p.m.

Respectfully submitted,

Dale Schaft

Health Care Reform Commission

Staff Assistant