115 State Street |
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SEN. M. JANE KITCHEL, CO-CHAIR
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STATE OF VERMONT |
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GENERAL ASSEMBLY |
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COMMISSION ON HEALTH CARE REFORM |
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MINUTES |
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Tuesday, May 20, 2008 |
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State House, Room 10 |
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Montpelier, VT |
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115 State Street |
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SEN. M. JANE KITCHEL, CO-CHAIR
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STATE OF VERMONT |
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GENERAL ASSEMBLY |
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COMMISSION ON HEALTH CARE REFORM |
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MINUTES |
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Tuesday, May 20, 2008 |
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State House, Room 10 |
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Montpelier, VT |
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MEMBERS PRESENT: | SEN. M. JANE KITCHEL, CO-CHAIR, REP. STEVEN MAIER, CO-CHAIR, SEN. ANN CUMMINGS, SEN. KEVIN MULLIN, SEN. DOUG RACINE, REP. HARRY CHEN (via phone), REP. FRANCIS MCFAUN, JOHN BLOOMER, JR., REP. MARK LARSON |
MEMBERS ABSENT: |
WALTER FREED |
Also Present: |
Legislative and Joint Fiscal staff, members of the Administration, and the public. |
Meeting Recorded: |
Meeting recorded: CD HCRC 5/20/08, CD # 1, 2 & 3 |
Documents Distributed: |
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| Witness List: |
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1.
Convene, Review and Approve Dec. 4, 2007 Meeting Minutes
CD #1, TR. 2
Rep. Maier and Sen. Kitchel convened the Commission meeting at 1:35 PM.
The Commission approved the minutes from Dec. 4, 2007.
2.
Implementation Updates
CD #1, TR. 2 cont.
a.
Enrollment Update
Betsy Forrest
Document distributed:
Betsy
Forrest gave an update on applications and enrollment. They expect enrollment to
keep increasing. VHAP and ESIA enrollment has crept up. ESIA is at about 90% of
expected. Catamount Health with premium assistance added 600 in February, 600
more in March and 500 more in April. The pre-existing condition amnesty will
also bring in some more people. Discussion
of the amnesty re pre-existing conditions: it will run from when the bill gets
signed until November 1; and this includes those already enrolled. After that
there is a 12-month waiting period, unless the applicant is rolling over
coverage from another plan, within 63 days. However, remember that if a person
enrolls in the chronic care management program (if there is a program for their
condition) then there is no waiting period for coverage for the condition. Discussion
re low numbers for sign-ups for unsubsidized Catamount Health: the numbers are
much lower than the projections; and some people are dropping out. Carriers are
going to contact these drop-outs to find out why. The commissioners asked the
carriers and the state to report any data re why people are not signing up for
the full-cost program. (Premiums for a family plan are $13,224 a year; for an
individual they are $4,716 a year, and for two-person plan they are $9,432 a
year.) Commission asked for this for next HCRC meeting. Outreach
to graduating seniors: Efforts
are underway to encourage seniors to check out their health insurance options
under Green Mountain Care before they graduate.
The state is also reaching out to college faculty and staff, state
employees and the business community to encourage them to look into Green
Mountain Care options before their child ages off their current health plan. Colleges:
Public and private colleges have shown unprecedented support by allowing
outside marketing efforts to occur directly to their seniors.
State
Employees: About 6,240 state employees have received an email encouraging them
to check out health insurance options for their dependents.
Legislators: An e-mail was sent to
all state legislators asking them to include information about Green Mountain
Care in their electronic or hard copy legislative updates or other articles they
provide for local newsletters and newspapers.
Businesses: The Lake Champlain Chamber of Commerce has sent an email to 300 of
their members from the restaurant and hotel industry knowing that it will reach
employees who are students in the hospitality industry as well as a high number
of overall employees who are uninsured. Event
marketing is also being utilized to create advertisement promotional throughout
the month of May. BCBS’s own
efforts to reach this cohort are currently underway with very targeted outreach
to parents who have children about to age off their parents’ plans. Rep. Maier
noted that there are challenges re staff answering phones not fully prepared to
answer parents’ questions; also issues re getting original birth certificate if
needed.
b.
Blueprint Enhanced Community Pilots [postponed
until later in the meeting]
c.
Health IT Fund Implementation
Susan Besio / Rep. Steven Maier
Documents distributed:
Susan
Besio went through the various steps and target dates in the proposed process
for granting and monitoring the Health IT funds. She noted that this was a
preliminary draft. [They have already revised it based on discussions with Jim
Hester and a few legislators immediately following the Commission meeting.] VITL
(Vermont Information Technology Leaders) will need to apply for these funds, as
part of the process. Rep. Steve
Maier handed out and discussed copies of a May 7 letter sent to VITL, from
Michael Smith (Secretary of Administration) and three legislators: Susan
Bartlett, Chair of the Senate Appropriations Committee; Rep. Maier and Sen. Jane
Kitchel (as co-chairs of the Health Care Reform Commission). The letter raised
concerns and made suggestions re VITL’s structure and administrative capacity as
the organization continues to expand rapidly. Rep. Maier
and Sen. Kitchel reported on their cordial discussion that followed with the
VITL Board on May 14. VITL is already beginning to implement some of the
letter’s recommendations. Sen.
Mullin expressed concern that other HCRC members were not consulted or informed
about this letter before hearing about it in the press. d.
Implementation of 2008 Legislative changes
Susan Besio Very
briefly, People are already working on the various elements. Many will become
effective upon passage of the bill. Staff are working to get IT supports in
place; preparing for premium changes in Catamount Health, etc. e.
Overview of planned evaluations of health reform efforts
Susan Besio
Documents distributed: Susan
Besio discussed these initiatives; Back to:
b.
Blueprint Enhanced Community Pilots
Craig Jones
Document distributed:
CD 1, Tr. 3
Craig
Jones covered the following topics:
o
DocSite: a care support system, with many functions. Health maintenance and
prevention visit plans.
o
EMRs
o
Models for using various health IT products in models for health and prevention
3.
Ongoing Commission Responsibilities a.
Review of 2008 Legislative Session
Jim Hester
CD #2, Tr. 1
Document distributed:
This
document is attached as Appendix A to these minutes. Jim Hester
reviewed the HCRC recommendations which were adopted Dec. 4, 2007 and discussed
what happened with each recommendation in the legislative session. There were
two especially challenging issues this past session:
Commissioners suggested adding a third column to this report: for each
recommendation / issue, list pressure points / disagreements / stumbling blocks,
so that we can identify them and try to move forward. A key
element is payment reform. b.
Review of mandated commission reports through 2010
Jim Hester and Jennifer Carbee
Document distributed:
The full
text of this document is attached as Appendix B to these minutes. Jennifer
Carbee reviewed the new and continuing responsibilities of the Commission, with
especial focus on the new studies laid out in H.887. From H.887, An Act Relating to Health Care Reform: •
Sec. 2 – Building Block Studies The Commission should conduct studies to develop building
blocks for health care reform, including:
o
Feasibility of community-based payment reform and integration of care,
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Possibility of merging fragmented risk pools, and
o
Exploring health care financing options.
These studies should identify federal and other barriers to progress in
health care reform and determine how to position •
Sec. 5 – Reduction in Catamount Health/VHAP Waiting Period Upon receipt of approval from federal Centers for Medicare
and Medicaid Services of amendment to waiver to reduce Catamount Health and VHAP
waiting period from 12 months to six months, the Secretary of Administration has
60 days to make a recommendation to the Commission on whether to proceed with
reducing the waiting period. The
Commission must then consider:
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The availability of resources,
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Issues surrounding implementation, and
o
Potential benefits to the health care system.
The Commission must recommend to the Senate Committees on Health and
Welfare and on Appropriations and to the House Committees on Health Care and on
Appropriations whether to proceed with the waiting period reduction. •
Sec. 25 – E-Prescribing Study The Commission director and VITL project review committee are
directed to conduct a planning and feasibility study for a statewide
e-prescriber program. •
Report due: Commission
director to report the group’s findings to the commission, the House Committee
on Health Care, and the Senate Committee on Health and Welfare by January 15,
2009 From 2 V.S.A. § 903(b): •
Requires the Commission, no earlier than October 1, 2009, to evaluate the
Catamount Health market to determine whether it is a cost-effective method of
providing health care coverage to uninsured Vermonters, taking into
consideration the rates and forms approved by BISHCA, the costs of
administration and reserves, the amount of Catamount Health assistance to be
provided to individuals, whether the Catamount Health assistance is sufficient
to make Catamount Health affordable to those individuals, and the number of
individuals for whom assistance is available given the appropriated amount. From 2 V.S.A. § 902(a): •
From 2005 legislative interim through July 1, 2011, the Commission is
required to:
o
Monitor the development, implementation, and ongoing operation of health care
reform initiatives as defined in 3 V.S.A. § 2222a and the initiatives in Act 191
of the 2006 session;
o
Study areas of health care reform as required by the General Assembly; and
o
Receive input and make recommendations to the General Assembly regarding the
long-term development of policies and programs designed to ensure that, by 2009, 4.
Commission Studies for 2008 / 2009 a.
Review of inventory of potential studies
Jim Hester
CD #2, Tr. 2
Document distributed:
Jim Hester
reviewed the four studies under consideration:
Identifying who would be appropriate resources, how much the study might cost.
HCRC has in its budget $150,000 in one-time money to support studies. There is
also ongoing HCRC oversight work: HCRC
evaluation and oversight of current health care reform initiatives:
ongoing:
Develop work plan and monitor
progress as part of HCRC ongoing process. Design
Catamount evaluation in collaboration with other evaluations e.g. Blueprint,
potential RWJ grant, etc. Continue
to follow up with VDH on prevention initiative.
Lead: Hester
Other resources: Dickey They have
changed the due dates for the studies to make them available to legislators
early next year. 1. Study
of public financing options: due 2/2009
Lead: Kappel
Other resources: Kavet
Estimated cost: $25-35K There was
a discussion of the Commission’s budget. It has been significantly reduced from
the original budget presented to the legislature. Kappel, re
Study of public financing options:
this proposal would build on the foundation of the Kavet/Rockler study produced
in 2007. Bulk of the work would be on defining the assumptions built into the
model. It is an input-output model, on the macro-economic issues. It is planned
to deal only with the revenue side—to start with a small question and build out
from that. [See
Appendix C, pg. 17.] 2.
Feasibility of pilot in community based payment reform and integration of care,
including ACO: due 2/2009
Lead: Hester Other
resources: KNG, Workgroup of major stakeholders, actuary support, legal support re
contracting/antitrust issues
Estimated cost: $50-65K 3.
Assessment of options for merging risk pools starting in 1/2010:
due 2/2009 Lead:
Wicks
Other resources: BISHCA
Estimated cost: $30-40K 4.
Electronic prescribing study: due 2/2009
Lead: VITL
Other resources: Mannat, HLN?
Estimated cost: $30-40K Total cost
of potential studies:
$130-180K. He asked
for commissioners’ feedback re these potential studies and the staff estimates,
re scope and the overall work plan;
goal is to take this feedback then finalize the work plan at the Commission’s
June meeting. Discussion
followed, concerning priorities; which ones are mandated by the legislation.
Commissioners reviewed the specific language from the legislation re the
studies. b.
Clarification of objectives and scope of potential studies i.
Public Financing of Health Care
Steve Kappel Sen.
Kitchel suggested that a small group of commissioners brainstorm with the staff
re the questions and areas for Study #1. The following commissioners
volunteered: Senators
Bloomer, Cummings, Mullin and Racine, and Representative McFaun. Rep. Maier
asked to be kept advised as well. Annie
Crowley and Steve Kappel will set up a meeting. They will notify other
interested parties re the meeting time and location. ii.
Merging Fragmented Risk Pools study
Jim Hester This
includes the non-group, small-group, and association markets. Elliot Wicks has
done a preliminary study on this topic; they have contacted him and he has
produced a proposal re doing this study. He could start the work in September. iii.
Feasibility of pilot in community-based payment reform and integration of
care, including ACO
Jim Hester The intent
is to produce a recommended for a pilot project, to be implemented in 2009.
Would be based on Elliott Fisher’s Accountable Care Organization design. This
will build on the medical home pilot, as being developed in the Blueprint for
Health. Discussion followed, of the public financing study compared and
connected to this study. iv.
E-prescribing
Jim Hester This is a
required study, in the bill. The funding is in the original HCRC budget as
prepared last fall.
Discussion: we need to refine the cost of this study before proceeding.
CD #3, Tr. 1 Sen.
Racine: We need an overall discussion re how we are going to finance the HCRC
and these goals—especially given the current economy. We need a
clear message and report: what is really feasible in health care reform in these
times; what our realistic options are. Whatever the results of all this work, we
need to be very clear, and confront this head-on. Costs are going up a lot
faster than our ability to pay for them. Rep.
Larson suggested going back a few years to the work of the Health Access
Oversight Committee and their report, as a basis for this discussion. That would
be a place to start. In addition, the Pay Act set up an accountability
commission—we could connect with their work. c.
Recommendations for Studies See
discussions above. 5.
Commission meeting schedule a.
Next meeting: June 24, 10:00 AM to 1:00 PM, b.
Visits to health reform communities Enhanced
Blueprint pilot: St. Johnsbury; Other?
Commissioners briefly discussed holding an offsite Commission meeting, most
likely in St. Johnsbury in the fall. The
meeting adjourned at 4:20 PM.
Respectfully submitted, Loring
Starr Appendices
follow.
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Appendix
A:
Comparison of Commission
Recommendations and Final Legislative Action Appendix
B:
Memorandum from Jennifer Carbee:
Responsibilities of the Commission on Health Care Reform Appendix
C:
Healthcare Financing Study—note
from Steve Kappel |
