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, June 24, 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, June 24, 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, WALTER FREED |
MEMBERS ABSENT: |
None |
Also Present: |
Legislative and Joint Fiscal staff, members of the Administration, and the public. |
Meeting Recorded: |
Meeting recorded: CD HCRC 6/24/08, CD # 1, 2 & 3 |
Documents Distributed: |
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| Witness List: |
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1. Convene, Review and Approve Meeting Minutes from May 20, 2008 CD #1, TR. 2 Rep. Maier and Sen. Kitchel convened the Commission meeting at 10:15 AM. The Commission approved the minutes from May 20, 2008. 2. Implementation Updates CD #1, TR. 3 a. General Update: major progress/concerns Susan Besio and Kevin Veller Document distributed:
The obesity grant did not get re-funded. The Un-funded states have submitted letters to the Centers for Disease Control through their congressional delegations. The current funding goes through October. This affects several positions. They are also pursuing other sources of funding. The H.I.T. Fund: They are working on operationalizing this, with legislative staff. It may need a few technical changes. The want to get three documents out ASAP:
Update on payer participation with Blueprint pilots; discussions with CIGNA and IBM about whether to include these self-insured enrollees in the pilots. Community Care Teams: There is a lot of energy and excitement. Discussion of the packet of reports:
There was general discussion of the issue of people who are uninsured. About 9,700 new enrollees since October, in all programs. Q: Enrollments are substantially below projections—any analysis? A: They are working with the Joint Fiscal Office (JFO) to adjust estimates going forward. Their assumption re the low numbers at full cost: it’s the cost. BCBS and MVP will have more data on this later in this meeting. The original estimates were a best-bet consensus with the Administration and the JFO. They will be doing a survey this fall (BISHCA), including who is still uninsured and why. Survey results should be available in early January 2009. It will be a phone-based survey. Challenges: it is very hard to contact people who don’t have phones; they are also trying to figure out how to reach people who use cell phones only. The Commissioners asked for an update on the survey questions, and information on any adjustments re cell phones, etc. BISHCA manages the survey: they contract it out. b. Enrollment/Marketing Update CD #1, TR. 3 --Kevin Veller Documents distributed:
Brand Recognition: The TV ad caused 1-in-5 Vermonters to take some kind of action step: call the 1-800 number, visit the Web site, or tell a friend about the program. Also, a majority (58 percent) reported they were interested in Green Mountain Care. Most Vermonters strongly support the idea of Green Mountain Care. Knowing the state is offering such a program makes three-quarters of Vermonters (77 percent) feel more favorably toward the state. The umbrella brand is becoming recognizable. The TV ad “Healthy As a Horse” was especially effective. 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. Champlain College, the University of Vermont, Middlebury, St. Michael’s, Johnson, Lyndon, Castleton and VTC have emailed information directly to about 6,250 seniors and 3,600 facility and staff. State Employees: About 6,240 state employees have received an email encouraging them to check out health insurance options for their dependents. Lake Champlain Chamber of Commerce is sending the information to their hospitality industry members; the City of Burlington is contacting its employees. They did an event—concert with promotions—with radio station “99.9 The Buzz”. They are doing other outreach as well, including to employers who are lay-offs, etc. They are planning another modest TV ad buy, in the fall. There is also other outreach planned for 18-24 year olds. They have updated the website, and have redone the applications, with the latest changes from the recent legislation. They continue to push the web site button, as an add-on in other web sites. Q: The web-based screening tool may need to be updated, especially re high-deductible plans. Q: Overall, how are they getting the word out to people who have high-deductible plans, now that those folks may qualify for Catamount Health? And what about informing folks re the amnesty re pre-existing conditions? (There are actually two groups: those who have given up and not applied, and those who are already enrolled.) A: They are including this in the marketing. Q: Do we need OVHA outreach for those who did not complete the application process? What about an enrollment/marketing push before the amnesty deadline? Q: Are there plans for more large promotional events, especially in areas other than Burlington, such as Rutland? A: In April the legislature expressed interested in the state marketing to a younger cohort. Consequently there was limited time to plan events. Given that most students are in Chittenden County, we focused our efforts there. c. Marketing and enrollment effort by health plans – i. MVP -- Bill Little CD #2, Tr. 1 Documents distributed:
MVP has hired two outreach coordinators, to promote Catamount. Marketing materials include the two documents distributed. They are doing trainings and outreach—to insurance brokers, hospitals, and at community events—many around the state. They did a phone survey re “churn”—everyone who has joined then left the program. They are trying to reach over 100 people—but so have not been able to reach over 2/3 of them. They are still trying. So far the two main reasons cited for leaving are “too expensive” and “moved to VHAP”. Overall, MVP has about 1,300 enrollees in Catamount Health. Q: Re the low numbers signing up for unsubsidized Catamount Health: any data? A: Some (a very small number) are buying the unsubsidized Catamount Health coverage. Some (also a very small number) are buying the indemnity plans. Others are just not buying. There does continue to be interest and activity—staff are fairly busy. ii. Blue Cross Tr. 1 continued. --Beth Lewis, Director, Communications, BCBS Document distributed:
BCBS has done many kinds of outreach—to providers, to employers, at events, etc. They also did their own outreach campaign to graduates—high school, college, and their parents. Inquiries to their call center did spike. They do not know yet what the uptake is—they will have that data later. They are doing event marketing. Study of obstacles to enrollment: · Question posed: Why are Vermonters not enrolling in Catamount on a “direct pay” basis? · Other considerations:
3. Statement on cost trends and options --Steve Kappel /Don Dickey CD #2, Tr. 2 Document distributed:
[See Appendix A] Kappel and Dickey went through the outline. 4. Commission Studies for 2008-2009: a. Update - process, budget and estimated costs --Jim Hester CD #2, Tr. 3 Document distributed:
[See Appendix B] Jim Hester reviewed the revised Workplan, potential studies. b. Review of potential studies – i. Electronic prescribing feasibility --Jim Hester, Steve Larose Document distributed:
Discussion: timing of this information; what is the necessary authorization process for this particular study? After a motion to authorize the study, the commissioners voted to approve this recommendation to proceed with Point-of-Care Partners LLC, e-Health Management & marketing Consultants for a study costing $30 thousand of HCRC funds. Unanimous of the 8 voting members. Jim Hester thanked VITL for their analysis and input in the process. ii. Merging of risk pools --Jim Hester Document distributed:
Elliot Wicks did prior analysis of individual market, for BISHCA; Jim has consulted with Christine Oliver at BISHCA; Wicks is logical person to do this next study. $35 thousand is expected price. Jim Hester asked for HCRC approval to move forward with this study. The HCRC would contract with Elliot Wicks. After brief discussion, the commissioners voted unanimously to approve this. iii. Financing of health care --Jim Hester, Steve Kappel, Tom Kavet Document distributed:
(notes on Financing Study and on Community-Based Payment Reform) Jim Hester introduced the “Clarification of Scope of Studies” and reviewed the scope and limitations of the two proposed studies. CD #3, Tr. 1 He noted that neither study will delve into the issues of the structure of the Vermont insurance market, the overall capacity and design of the Vermont delivery system, or the diffusion and exchange of electronic health information. CD #3, Tr. 2 The staff recommends a team of Steve Kappel and Tom Kavet. Estimated cost: $30 thousand. Tom Kavet discussed the issues and challenges of the scope and questions. Comment: The study needs a statement re the limitations. Discussion re the challenges of the overlap between the two studies. Summary of discussion: Intention to move forward with Steve and Tom; to have a preface building on existing model, posing questions; develop questions as an iterative process with the commissioners—what questions can be answered, costs re research on various questions; possibly working on a sub-committee level, and sharing e-mail information; need other opportunities for more public input from other stakeholders; need to make clear limitations of this study. This study is critical to taking next steps in health care reform. iv. Community budget/ACO feasibility --Jim Hester CD #3, Tr. 3 Document distributed:
Jim Hester has prepared a revised description of the project. Includes objectives and key issues. Conversations with key stakeholders, to set the workplan. He has asked KMG Associates, who were advisors to Blueprint work, to help define the workplan. There will be a public meeting Thursday afternoon; plan is to revise a statement of key issues and scope after that. Will come back to HCRC with a recommendation on a process, probably to include a stakeholder group to work on it and a consulting process. He feels they are making good progress with this. Staff sent out a broad invitation to stakeholders to consult on this. 5. Commission meeting schedule CD #3, Tr. 4 Jim Hester: The plan had been to meet next in September; but the co-chairs suggest that there needs to be a meeting in the last week of August. Working date: Tuesday Aug. 26, probably at 1:00 PM. Part of agenda: full commission to review the VITL grant. Discussion: process, levels of commissioner involvement. Then the next meeting will be in late September in St. Johnsbury, visiting the Blueprint pilot. Following that, there will probably be a final 2008 meeting in November after the election. The meeting adjourned at 1:18 PM. Respectfully submitted, Loring Starr |
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Appendix
A:
Doc. #8: Proposed Outline for Healthcare Spending Paper – Steve Kappel Appendix
B:
Doc. #9: Health Care Reform Commission: Summer Workplan 2008, Revised Draft 6/23/08 |
