MEMBERS ABSENT:

Also Present:

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

Meeting Recorded:

CD HCRC 6/12/07, CD #1, #2 and #3.

Documents Distributed:

April 17, 2007

The meeting was convened by co-chairs Kitchel and Maier at 1:42 PM.

Rep. Maier acknowledges especially Sen. Cummings and Rep. Chen for their efforts on S.115, the Prescription Drug Bill, which was just signed by the Governor.

The co-chairs asked for a motion to accept the minutes from April 17. The motion passed unanimously.

2.         Implementation Updates                                                                              CD #1, TR 3

a.   Catamount Health filings, rates and timetable                                   

Christine Oliver, Rebecca Heintz

Commissioner Oliver: The are hoping that this week they could approve the MVP rates. Still working with Blue Cross/Blue Shield. This is the normal process. There is no special delay. They continue to move along, in usual negotiations. Feel very comfortable that they will meet the October 1 deadline. It’s in no jeopardy at all. Many issues, but not out of the ordinary.

Commissioners asked several questions re the deadline, re interim deadlines when they might worry re falling behind. Commissioner Oliver said they are fully confident. People have to recognize that rates should be approved as close as possible to implementation, to get the most accurate rates possible. Steps include rates, forms, printing, etc. They are ahead of their usual schedule for filings that are this complex.

Hester: Will get more details when we hear later on outreach and enrollment. There must be a direct connection between the two.

Oliver: We are in close contact; there may be some delays in-house in the two providers, with their marketing representatives. We know the importance of this matter.

b.   Catamount Health premium assistance                                             CD #1, TR 4   

Betsy Forrest, Susan Besio

Susan Besio noted that there are a lot of products to be developed, and timelines, re enrollment and outreach. They are having a big internal meeting with their marketing firm, re all the different products, the toolkit, to lay out timetables, staff, lead people, etc.     

i.              Waiver

Besio: Still optimistic re the Waiver from CMS.  They are in discussions right now with CMS and OMB. OMB is generally more difficult to work with re their questions. Still relatively optimistic.

If they don’t get a definite answer by mid- to late July, they will develop a contingency plan, just in case, and communicate and work with the Commission.

Sen. Kitchel: Some background: The Legislature put some contingency language in the Budget Act re the Waiver, if they don’t have a decision by July 31, the Commission will need to hear Susan’s recommendations, and is charged with making recommendations to the Emergency Board, such as changing income requirements, etc.

ii. Implementation status

Betsy Forrest: They are fully committed to having the premium assistance programs fully operational by Oct. 1. They are working on a variety of fronts. The system development work is over 50% complete at this point, so they are right on schedule there. Other pieces include forms, notices, and staff training plans. They are working with BCBS and MVP to set up that whole interface—who is eligible, how much for premiums, who on and off the program, etc.

There are a number of pieces that need to be in place for the program to be successful, including a well-tested IT system, also the Catamount phone line with expanded hours, an interactive voice response unit self-screening and information, 27/7, and the web site screening tool. And they need to hire and train staff to begin processing applications.

At the Outreach & Enrollment meeting, there was some disagreement on what “implementation” meant. OVHA has assumed that as when beginning any new assistance program or insurance product, there will be some application processing time involved. So they were aiming for a 10/1 date for doors open and processing applications to begin; but that means that the date when someone can be actually enrolled in the Catamount Health Plan will be November 1. So, if we want people actually be enrolled on Oct. 1, all the other steps will have to be in place by September 1. At this point, they just can’t do that. They want everything to be working and in place when they flip the switch.

Besio: An analogy: they do not want to repeat what happened on the federal level with the Medicare part D program. Our timelines have always been geared to processing enrollments on Oct. 1.

Rep. Chen: His understanding all along was that we would begin processing probably in August, so that we would have people covered—actually enrolling—by October 1. Obviously there has been some miscommunication or misunderstanding on that.

Sen. Kitchel: Question: There are really two groups in Catamount Health: ones who are eligible for a premium subsidy, and ones who are actually buying a product. The person who is buying a product—they could purchase that product any time? By October 1?

Besio: We’ve had some discussions about that. Actually, the statutory language says that the product will not be sold until October 1. And then there’s a second sentence that says, “The Commissioner may give approval for prior marketing and sales geared toward an October 1 implementation.” So there is somewhat competing language. And if someone buys on Oct. 1 they would not be covered by Oct. 2. Generally, for anyone who buys health insurance—there is an application processing time—regardless of what product they are buying. You don’t just apply and get enrolled that day. The carriers have said that anyone who applies as of the 20^th of the month will most likely get covered as of the first of the following month. That’s the normal business practice. They need time to process applications.

Q: If enrollment (coverage) were to begin Nov. 1, would that adjust our financial models?

Besio: We will have to go back and look at that issue.

Comment: There’s a reason for the 30-day or so delay, aside from processing—to deal with pre-existing conditions, and people suddenly wanting coverage after a diagnosis?

Besio: Cannot respond to that—has not seen that be an issue. More of an issue re paperwork and checking all information. The carriers say they need at least ten days to process applications—that is how long they take now.

Re the premium assistance programs—a lot more complications—determining which premium assistance programs a person is eligible for, and how much assistant they are eligible for. There are also a lot of other issues, including citizenship documentation. So the assistance program applications will probably take longer to process. This is why the IT system must be up and running well.

Rep. McFaun: First, he had also assumed that Oct. 1 was the coverage date; second, is there a date when this whole system will be tested?

Forrest: We are testing as we develop each module; the “integration testing,” of the system as a whole, will take place in September.

Maier: To clarify, a person interested in enrolling in Catamount Health will not be able to start enrollment until the first of October?

Besio: They can submit applications earlier; the applications will start being processed Oct. 1.

Maier: This sounds more like what we had assumed.

Besio: Two things to consider: the information from people applying needs to be as current as possible; and we want to be able to process applications as quickly as possible, so a huge backload of applications before Oct. 1 could be problematical. Most likely, we will start accepting applications mid September, to make sure information is accurate and to be able to process applications quickly.

Forrest: And any applications we get in September we will screen immediately for eligibility for VHAP, since we suspect that some people applying for Catamount will be eligible for VHAP, so if they are eligible, there won’t be any delay in getting them coverage under VHAP.

Maier: It would be very helpful to get outreach and enrollment information to legislators: you have 180 ambassadors, and some of those legislators are already asking us about enrollment.

Kitchel: Also, please give us a timetable to share with legislators.

Comment: Actually, a backlog would be a wonderful thing—will mean that the marketing “frenzy” has been successful.

Besio: Yes, and we must remember: the one thing that can sink this is if we create a “marketing frenzy” but the systems aren’t ready.

2.c.      VITL Technology Fund status                                                                    CD #1, TR 5

                                    Greg Farnum, Susan Besio

Rep. Maier commented on the op-ed by Rep. Harry Chen, on how wonderful the pilot implementation has been for him in Rutland.

Chen: It has changed my practice. When I see a patient I now have a list of everything they have ordered from the pharmacy—all the medications they have used in the past month. There are so many things that people don’t think to tell you when you ask what medications they take. It has been invaluable to me. [Sen. Kitchel asked Loring Starr to send Rep. Chen’s op-ed to commissioners.]

Farnum: We’ve known all along that in order to make our central investment in our exchange really valuable, we need to enhance the adoption rate of EMRs in practices—so we have a place to deliver this electronic information to. This spring, Rep. Maier wrote a letter to all the major senior leadership at the payers, and to VAHHS and Medicaid. (Requesting financial support for the VITL technology fund).

Farnum reporting on three areas: progress on raising our million dollar target to start implementing EMRs; VITL’s 501(c) (3) status; and finally, their preparations for staffing and surveying medical practices re the state of EMR adoption in Vermont.

i.              Fundraising—payers are still considering. Concerns re competitive inequities; payers want VITL to ask a broader base for contributions, including public payers, and other stakeholders, including pharmacies and clinical labs. And concerns re precedents re national companies. Strong support already from VAHHS, they will consider this additional contribution. And Medicaid ahs said they will contribute if there are funds available at the end of the fiscal year. On July 1, VITL has the option / need to work with the administration on a better approach for generating more interest from the payers. VITL will work with Susan on that.

ii.             The 501(c) (3) status has been dragging on forever. They submitted their application in October of 2005. Still no answer from IRS. There are 20 RHIOs around the country (Regional Health Information Organizations), and the IRS doesn’t seem to know what to do with them. VITL has submitted hundreds of pages of documentation, answering many questions. VITL really needs this status to accept some contributions. Still working on it. Plans to work with the Administration; various ideas on how to get the attention of the IRS.

iii.            Data on EHR implementation in practices. VITL did a survey of 400 practices around the state. They see a 13% adoption rate currently. Of those surveyed, 30% said they will be adopting EHRs within the next 12 months. Out of that group, 74 practices, 41 of them have selected an EHR vendor. Most of the remaining would like some help in selecting an EHR. So there is a need for the help VITL is planning. They have added staff; and are looking at other groups around the country for ideas, including Massachusetts, for good strategies to make this happen faster.

Question: Status of the Plan? (Statewide Health Information Technology Plan)

A: They have a major draft, will present to the VITL Board tomorrow. There are 140 pages of rich documentation, for the strategy for health information exchange in Vermont. A number of issues, including vision, environment, privacy and security issues, standards and technology issues, as well as implementation steps.

On their website is a link to the work in progress, can also get a draft. Hope to have it delivered on time by July 1.

2.d.      Blueprint for Health key staffing update                                                   CD #1, TR 6

                                    Sharon Moffatt, Susan Besio

Besio: They are interviewing for the Director for the Blueprint for Health. They have 4 or 5 applications, and have a candidate here for the past couple of days for in-depth interviews. Will keep HCRC up to date. They are also getting a couple of consultants on board. One to help with the payment reform methodology: have selected a vendor, and are about to sign the contract. The same is true for the consultant around communications, which is another area they identified during the session as needing in-depth attention. Finally, re the IT director for the Blueprint: they have decided to move that position into the Agency of Human Services, to report directly to the CIO there (Margaret Ciechanowicz), so IT issues can cross AHS. Are recruiting, interviewing applicants. So re staffing, things are moving relatively quickly. Hopefully next meeting will have names and organizations to give the HCRC.

2.e.      Blueprint pilot in payment reform and care coordination: initial feedback     

                                    Sharon Moffat

Moffat: Noted that there is a real opportunity with the Blueprint IT coordinator being in the Agency of Administration: coordinate with some of the OVHA work, looking for all the opportunities.

Payment reform and care coordination:

Payment reform: this is one of the contracts where they are bringing in outside expertise. They have an RFP and selection process. In the meantime, Moffatt and Jim Hester have been meeting with each of the payers—private and OVHA, to talk about what is in statute, remind them of expectations, what additional work BISHCA is doing, and looking for opportunities around common ground; now plan to bring them all together, to get that common ground re payment reform; parallel discussions on care coordination.

Plan is for contractor to help them on payment methodology, facilitate / lead, do the background work, and continue to work with them; but they did not want to wait until the contractor was on the ground to get people “primed” on the issues. Discussions with payers have been positive and informative.

Jim Hester: Surprised at how much work on these issues the payers already have under way. Receptivity; BCBS has a pilot going on in Springfield; we can learn from this pilot.

Moffatt: They all have to be knitted together on care coordination. Are using one of the VDH nurse practitioners—a specialist in geriatrics, working on a PhD in care coordination—she is helping with best practice re care coordination; working with OVHA, APS, what they are doing in the area. And VAHHS has held a focused workgroup on what Dartmouth is doing re many different areas, including role development they have been doing, within funding constraints—changing roles in the practice setting to do more care coordination.

Research is under way; working on putting together a workplan on what all the next steps are, and presenting it to the Blueprint Executive committee a t the end of June. There is great excitement—need to do more work with the Visiting Nurse Association, who are already using some of this model. Re the University’s College of Allied Health and Nursing—maybe they would do some education; maybe a certification track—this is one of many ideas under consideration at this time. On-going discussions with payers.

Q: Some background on the hiring process for Director of Blueprint? Number and kind of applicants?

Besio: 4 or 5 applicants, some out of state, one is an MD, one interviewing now in state.

Q:  Re payment reform—so key for providers—very new area—getting a good response to their bid for this?

Moffatt: Dr. Lisa Dulsky-Watkins managed that.

Dr. Dulsky-Watkins: The Dept. had an open-bid process for both the communications and health systems analysis contracts; 6 proposals for communications, 5 for health systems analysis; each bid reviewed internally by groups of staff; a very clear choice, and the groups are very pleased with the contractors they have chosen. [Lisa Dulsky-Watkins, MD, is a Public Health Physician, Dept. Of Health, and is the Provider Practice and Health Systems Lead for the Blueprint.]

3.         Outreach and Enrollment plan and progress review                               CD #1, TR 7

                       Kevin Veller, Director of Outreach and Enrollment for Health Care Reform

a.  Short term activities preparing for 10/1

• Document distributed: Outreach Milestones: Catamount Health Outreach & Enrollment Campaign

Quick Q from Rep. Larson: re rules: what deductibles would be considered “substantially similar”?

Besio: Draft rules right now have $500 for an individual in-network. That is what the Commission had requested.

Kevin Veller: Will give an overview of key activities; has passed out a timeline. She is coordinating the Outreach & Enrollment Steering Committee. About 30 members, stakeholders including hospitals, physicians, insurance companies, advocates, business, and state folks. Coordinates closely the work of GMMB, the marketing firm, and their deliverables. Important to drill down and understand who the 8% who are uninsured are. Their work is built on the foundation of the research. GMMB has worked with Lake Research Partners. Inventory of existing information in Vermont, including BISHCA survey and other data. They have decided that they need to drill down into the “psychographics” of the various sub-populations: who they are, what they think,what they buy, what would motivate them to buy health insurance, etc. Need to understand the “triggers”. Are conducting small “triad” focus groups.  GMMB is also developing some sample TV ads, some sample press, so also testing messages at the same time.

Based on input from the steering committee, GMMB will go beyond population centers that have the most people who uninsured, to more remote and rural areas. This will cost more time and money—so they need help from us to find these uninsured folks. AARP is also conducting focus groups, and they want to closely coordinate the data that is collected.

Another area: Re the section in the legislation that required being proactive in outreach—getting in touch with people, helping them through the application process. Members of DCF, Bi-State, Campaign for Health Care Security—have outreach workers and / or are getting more. We need various levels of expertise to do this outreach.

Q: Is Dept. of Labor involved? Unemployment Insurance program could connect.

A: Has met with the Dept. of Labor, a lot of data there—but while they can more easily get data from large employers, they need to get information from the smaller employers—one and two employees—and this is where the DOL can provide data for the outreach workers.

So this raises the issue of training for the outreach workers. What will the layers of training look like—don’t want to duplicate that which is done within the eligibility unit, or Maximus.

Another area: Application Simplification. Are consulting with other organizations, other areas of the country, that have done this work. They have helped develop a job description; and a breakdown of the work—what would be do-able before October 1, and what would need to be longer-term. They need to look at our forms, notices, sequences of forms, interview eligibility workers within CDF, advocates and consumers, and make recommendations.

Timeline: Are having a strategy meeting later this week. Are developing an internal “war room”. Will review GMMB’s calendar of what they will need by when; and we will jibe our work with that. So we will have more details to present at your next meeting.

Q: Are there any particular roadblocks re Catamount coordination with the Blueprint?

Besio: The Blueprint is not necessarily on this Oct. 1 deadline. That is specifically for the new Catamount health plan and the premium assistance programs connected with it—getting more people to apply to VHAP and Medicaid; and marketing those new products in a way that’s effective. The Blueprint is a whole different strategy to change the way we deliver health care. It’s another major of health care reform, but not necessarily connected to the implementation of Catamount Health.

Q: What about coordination re chronic care management?

A: The goal is to have the chronic care management component of the Catamount Health plans eventually be totally aligned with all the Blueprint principles. For example, as we develop the payment reform mechanisms, within the Blueprint, and pilot those, then ultimately we would look to Catamount Health to reimburse all of its providers using that payment mechanism. But until we pilot that payment mechanism within the Blueprint community, we don’t want it to go statewide within the Catamount Health plan. So we are linking pieces as they become available—but trying to do it strategically.

Note: BCBS and MVP already have chronic care management programs, and have submitted these as part of Catamount Health—so have included these, and those programs will be up and running October 1^st. Those programs though use different payment methods to “incentivize” care providers to do chronic care management. (Note previous comments from Sharon Moffatt and Jim Hester.) So we need to consult on and test payment methodologies before making requirements.

Rep. Maier: Also note various mandates in the statute—such as no co-pays, no deductible for preventive care provided according to a chronic care management plan—and this is closely related to the principles in the Blueprint—that will take effect October 1.

Besio: And the Blueprint Steering Committee has been identifying evidence-based practices for the majority of the chronic conditions that will be implemented by the Medicaid program and the chronic care management programs within the MVP and BCBS Catamount plans.

Q: Re coordinating marketing with the two Catamount providers, BCBS and MVP? Need to make it universally available.

A: Veller / Besio: They are on the Outreach & Enrollment Steering Committee; she has met with them individually; are in regular communication with Betsy Forrest re premium assistance; re marketing, we are working with GMMB to align our marketing with the providers.

                                                                                                                                    CD #2, TR 1

Q:   When will the materials be produced? Need to back-plan to BISHCA schedule.

3. b. Overview of budget and plan                                                                          CD #2, TR 2

Q: Kitchel: Need copies of a Budget memo—re the Budget Adjustment Act—do all commissioners have this memo? Important to see the language.

A: Hester: Will distribute.

Besio: The budget includes a project manager (Kevin); it includes a marketing firm contract; it includes the enrollment process re-engineering—the administration simplification contract Kevin talked about; it also includes a big chunk for IT revisions to support eligibility enrollment: two different activities: screening tool (web based); longer-term to totally revamp the entire back-end eligibility system of AHS.  It is very old, closed architecture. So $2.6 of the total $4.3 million, budget adjustment 2008, is for that IT initiative, the initial first piece. This includes a MITA assessment re revamping, and the process flow. This will produce an application to CMS, to request 90-10 matching money to do the entire revision of the eligibility system. Required by CMS, needs to be done, and done well.     Will pay off in spades in a year or two.

4.         Blueprint Information System strategy and implementation                  CD #1, TR 3

                        a.         Update on status/progress report                                                      

                                                Sharon Moffatt, Susan Besio, Hans Kastensmith

Documents distributed:

• Vermont Blueprint for Health – CCIS Implementation Plan. Draft, June 8, 2007
• Improved Outcomes, Lower Costs: Chronic Care Information System (Vt. Blueprint for Health)
• CCIS Executive Steering Committee
• CCIS Timeline (from GE)

(Susan Besio noted that she has not had a chance to incorporate H.229 and H.531 into her spreadsheet, so has not prepared an update that would be missing that information. Will update soon.)

Besio: CCIS [Chronic Care Implementation system] is an Orion product, data being hosted at a GE facility, being overseen and transmitted by VITL.

Moffatt: Re the CCIS Implementation Plan: this is a draft, from the project implementation team at VDH.

Besio: The next document, Improved Outcomes, Lower Costs: Chronic Care Information System (Vt. Blueprint for Health), is a very good two-page overview.

Why this is on the agenda today:

Hester: the IT tools were identified early in the process as a critical item. We are now at a very important stage; there are a number issues we need to bring to the Commission.

Besio: This particular piece of the broader Blueprint is complex.

Re the CCIS Implementation Plan Draft:

Six areas that need to be happening simultaneously:

i.              Technical requirements

ii.             Education and training requirements

iii.            Legal issues

iv.           Operations and adoption at the local level

v.            Marketing and Communication

vi.           Evaluation

Each of these is broken down into state-level, local level, and policy issues. This document is being used to manage the process as they roll out CCIS, and to manage issues as they come up.

Moffatt: It is critical to be aware of the complexity. Not just a technology implementation. Includes what is happening to the provider practice, to the individual, how does it roll up at the community level.

A number of pieces are already in the works. (See the communications contract discussed earlier.)

Note: The earlier sheet passed out, Improving Outcomes, Lowering Costs, should also be considered a draft.  Blueprint Executive Team continues to refine that.

Also note: The “site Questionnaire”. Not copied for the Commission, but important to mention it: GE and Orion are helping with what has to be asked of individual practices. Questions re EMRs, systems. They are doing this survey now. Important to have this information to support and educate providers, and provide the proper technical support and training, but especially to integrate all the different systems. Very important, challenging.

The Plan represents the collective thinking and energy of the entire Blueprint staff, not just technology people. Includes policy issues, and decisions.

                        4. b.     Steering committee: purpose and agenda                                               

                                                Susan Besio, Hans Kastensmith

Besio: There have been some concerns re the project, including questions re Orion. So the Blueprint has created an executive-level steering committee. It deals with policy issues, other challenges.  See the document: CCIS Executive Steering Committee. They are meeting regularly. All are actively participating. Steering committee brings many side conversations together, brings out issues. Document includes a list of the key issues.

Each meeting starts with tactical updates.

Key issues:

• Orion Functionality
• User Account Management
• Interface of CCIS with Practices that have and do not have EMRs
• Legal Agreement Executions
• Branding of the CCIS

Primary issue: Orion functionality. Especially: ability to segregate data by patient, provider, site, and organization (for security; audit reporting; allowing/restricting multi-provider access; enabling patients to restrict access, etc.) Steering committee has reached agreement re this functionality.

This is the key issue holding up sign-off on the design phase. Orion and GE have agreed to go back, figure out how to implement this—in terms of cost, timelines. Also discussions re how to implement in one site at a time.

Hans Kastensmith: Real concerns—some of these are enterprise-level database design 101, and they are missing. So he feels it necessary to attend all meetings in person. Taking a hard look at their data structure. Sees problems—but they are fixable. But we need to make sure they are fixed. And we need to clearly understand cost implications—and this refers back to Susan’s discussion of cost-benefit.

Q: didn’t you research these providers carefully in the RFP and contract stage?

Kastensmith: Yes, we—all of us—did a great deal of discovery. Sometimes issues like these just don’t come out until you are getting into the design. We will be able to implement it. The system has some flaws that we want to fix. We want this fundamental functionality put into their system.

Moffatt: We actually requested and got independent review of the proposals during the RFP process.

Q: What role are present companies who already provide electronic patient records playing in this process?

Kastensmith: They are not involved yet. They will be involved in an individual basis in the provider community; contractor will address the various systems individually—when we implement, to get them to interface with the system.

Besio: CCIS will have to interface with each provider’s electronic health records. It is a registry re certain medical conditions—will have to interface with both electronic records, and doctors’ offices which do not have EHRs.

                  4.c.      Implementation strategy                                                                             

                                          Susan Besio/Hans Kastensmith

Susan referenced the document: CCIS Timeline (from GE). You can see we are a little behind schedule—but moving forward well, especially given the great complexity of this project. We are creating something new with a lot of different players; uncovering policy issues that need to be resolved as we go forward.

Kastensmith: Important to note: given big, complex IT projects, these kinds of issues are not out of the ordinary.  This project has had the opportunity to unravel several times, but it has not. This will be a success.

Jim Hester: Commended Susan Besio for pulling this steering committee together.

Hans Kastensmith: Commended VITL—their efforts to get this medication history pilot out—it is a great success, shows what this whole collaboration can get done. It is a very important piece of the Blueprint. We can gain a lot of ground with physician adoption, just by integrating that piece into the applications we put out in the CCIS. There is a results viewer—help with medication alerts re a patient, filling prescriptions, etc. Can use for some great outcomes. It is a great piece of work.

Q re timing: we were originally talking about mid-summer. Now late summer or fall?

Moffatt: Middle to late fall.

5.         Commission Workplan for Health Reform Strategy                                CD #2, TR 4

                        a.         Charge to the Commission from Speaker and President pro tem    

                                                Steve Maier/Jane Kitchel

• Document distributed: Memorandum to Jane Kitchel and Steve Maier, from Speaker Gaye Symington and President Pro Tem Peter Shumlin

Sen. Kitchel noted that the Commission has two large purposes:

• Monitor the implementation of the health care reform legislation;
• And recommend next steps—plan and design legislation.

Regarding next steps, she noted that there are five elements in this charge to the Commission from Speaker Symington and President Pro Tem Shumlin:

1.    How can we expand affordable coverage for Vermonters?

2.    How could we increase the effectiveness of primary prevention efforts to reduce chronic illness?

3.    What other options could be implemented to reduce the rate of increase of medical costs while improving the health of Vermonters?

4.    How can we use health information technology as a catalyst for achieving the objectives of health care reform?

5.    What investments do we need to make in Vermont’s health care delivery system and public health programs to ensure success in health care reform?

We need to make sure we are always moving forward.

Jim Hester introduced new HCRC summer intern Myra Sessions.  She is from the Harvard School of Public Health, and will staff various workgroups.

He also noted that Loring Starr is staffing the HCRC for the summer and fall and will return to the Health Care Committee for the Session.

                        b.         Work groups: composition and schedule      

                                                Jim Hester

• Document distributed: HCRC Summer Workgroups on Long Term Strategy: Composition and Charge, 6/12/07

Jim discussed the key objectives for the workgroups this summer and fall:

Objectives

1.            Make steady progress towards achieving the six health reform principles in Act 191

2.            Ensure that the health reform initiatives touch most Vermonters, if only in a modest way.

3.            Prioritize initiatives to ensure best use of limited state resources

4.            Leverage state resources through effective private/public partnerships

            General Questions for the workgroups:

1.            Are the major initiatives contained in Act 191 on track to achieve their objectives, or are significant modifications to those initiatives necessary?

2.            What new major initiatives should be recommended for legislative action in the 2008 session to achieve the objectives of health care reform?

Deliverables:

            A limited number of actionable recommendations for 2008 legislative session, which will move the health reform process to the next stage. Reminded group of the original Principles of Health Care Reform.

The workgroups will probably work independently; assemble ideas, initiatives and programs that work.  Then in the later fall, they will need to combine their work to prepare a package: a limited number of actionable recommendations for the 2008 legislative session.

The workgroup document lists members of each workgroup—some commissioners and committee members have signed up for workgroups; Loring will be following up with those we haven’t heard from. He has also revised the workgroup document to make it clearer.

He is looking for volunteers for Workgroup #5. The document also lists people and organizations that are staffing and providing support and resources; also interested parties. The document is a work in progress.

We want to get workgroups established; agree on questions; then 6 weeks or so when technical staff and resources doing the homework. Then possibly in late August, actually convene the members. There will probably be several meetings to process the information. So the main time demands on members—latter part of summer and September. We will need to have the recommendations from workgroups by the end of October so the Commission can digest and consider them.

There is enthusiasm from various organizations who have offered staff and help; in addition to the Commission staff and consultants. These are excellent resources.

Q from Sen. Kitchel: In the area of costs and cost savings, we need to examine the administrative burden on medical practices. Can this fit into a workgroup? Perhaps the legislature should examine and modify our administrative and regulatory requirements.

Jim: There is the administrative simplification workgroup that was established earlier; but that is focused more on health plans. But we could certainly add this—a good addition.

Re Workgroup #2, primary and prevention, he suggests focusing on obesity.: In each workgroup: need to sharpen the broad initial questions—make them more specific.

Overall, we are inventing process as we go along, so he is very open to suggestions.

Rep. Chen: The questions are very good.

Rep. Larson: Re Workgroup #1—Expanding Affordable Coverage—this is so important. There is a high-income group that can afford coverage; there is a low-income group for whom we have worked to help with paying for coverage; but there is the great group in the middle—for whom health care coverage is increasingly unaffordable. He cited a study: an increasing number of taxpayers are paying over 7.5 % of their income on health care. Consider the discussions we are having re property taxes—but health care for many people is a higher burden. And increasing, taxpayers are questioning why the teachers they support through property taxes are getting much better and cheaper health care.

Jim: Ken Thorpe is identifying ideas on this; Steve Kappel will do impact modeling and analysis re various options.

Walter Freed: But these are the same questions you were asking yourselves three years ago—it seems like the discussion is coming full circle.

Rep. Larson: The questions haven’t necessarily changed, but we have a new perspective—and our job isn’t done.

Jim Hester: This is a key question in the memorandum for the Speaker and the President Pro Tem. Re the underinsured, Catamount is designed to address this, but we must test and refine. And the second question is the under-insured. The under-insured aren’t addressed by Catamount—so there are important issues, and questions—we need to drill down—our work isn’t done.

Sen. Kitchel: One example: in the budget—re addressing the individual group market.

John Bloomer: We need to see the overall picture. Just making coverage more affordable for an individual does not mean the health care system is more affordable. Be careful of trying to tweak current programs or models. We need to see the big picture, look at it systemically.

Kitchel: And this goes back way more than three years. Back to when Edgar May was chair of Senate Appropriations.

Jim Hester: So how we can look at this, is: Given where we are and what we have put in place—what are the next steps?

                        c.         Future Commission Meetings                                                 CD # 3, TR 1

Jim Hester: The staff is trying to schedule the next commission meeting—for the weeks bridging the end of July to early August. But we do not have specific dates yet. Scheduling is a great challenge, especially setting meetings in the pilot communities. We do have the date for the end of August: August 30, in Bennington.

There is also the issue of the Waiver request to CMS. If it does not come through, there may have to be a special meeting of the Commission to make recommendations to Emergency Board. The Commission might need to meet in August July to review this.

6.         Other

Health care staffing:

1.            Rep. Maier noted that Steve Kappel is officially leaving the Joint Fiscal Office—he thanked Steve for his long-term, incredible work on health care. But Steve will be consulting, and will be doing some work with the HCRC.

2.            Also, he sent thanks to Cassandra Edson, who is leaving the Legislative Council. Bill Russell is recruiting for a new staff member.

3.            The Leg. Council has just filled the position vacated by Robin Lunge: the new person is Jennifer Carbee. She will start July 2^nd. Rep. Maier reviewed her extensive qualifications.

The meeting adjourned at 4:10 PM.

Respectfully submitted,

Loring Starr