MEMBERS ABSENT:

Also Present:

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

Meeting Recorded:

CD HCRC 7/17/07, CD #1, #2 and #3.

Documents Distributed:

1.          Convene; Review and Approve Minutes from:                             CD #1 TR 2    
             June 12, 2007

The meeting was convened by co-chairs Kitchel and Maier at 1:10 PM.
The co-chairs asked for a motion to accept the minutes from June 12. The motion passed unanimously.

2.          Implementation Updates                                                                      

a.   Blueprint for Health key staffing/consultant update                                       
Susan Besio                            
Document: Biography of Dr. Craig Jones

We have hired a Blueprint Director: Dr. Craig Jones from Los Angeles. He will start on Aug. 20. His programs in California are very impressive; he has helped design IT systems as well.

Both contracts (Communications, Payment Reform) are just about finalized. Both will start in early August.

b.     Catamount Health filings, rates and timetable                                   CD #1, TR 3   

Christine Oliver

Filings: Rate for MVP is $391.11; still consulting with BCBS re their rate. August 15 is final date for carriers, re their filings. They are planning trainings. She will send a document to HCRC when all is settled, comparing the two plans, or perhaps a document outlining each plan, instead.

2.c.  Catamount Health premium assistance               Betsy Forrest                            CD #1 TR 4

                                                  i.     Waiver

                                                 ii.     Implementation: Options for Catamount effective date

Implementation options:

Documents:

• Work Plan: The Phases for Premium Assistance Implementation
• Memorandum: Challenges to Early Implementation of Catamount Health

Are on schedule to begin processing applications Oct. 1. Last week at the meeting of the Health Access Oversight Committee, discussion of some options for earlier coverage. There were three proposals.

1. Allow individuals to purchase catastrophic (high deductible) coverage while their premium assistance application is being processed without disqualifying themselves as uninsured.
2. Allow individuals to purchase Catamount Health at full price, coverage effective Oct. 1, 2007, and then apply for premium assistance.
3. Require OVHA and carriers to cover people retroactively.

In the “Challenges” document, OVHA’s response is described. They have concluded that none of the three proposals can be done. Have also discussed this with the Outreach and Enrollment Steering Committee. So they recommend against implementing any of the three proposals.

Application materials will be available at the start of September, they will distribute. Will accept applications in mid-to end-of-September. Will have a team working over the weekend of Sept. 29-30. About 400 people in a list, who have requested applications.

Update on the Rule—Premium Assistance                        

There is an LCAR meeting next week; sub-group from HAOC and this Commission:

Jane Kitchel, Doug Racine, Lucy Leriche, and staff member Don Dickey.

Catamount Health premium assistance—Update on the Waiver Amendment         CD #1, TR 5                      Joshua Slen

Joshua Slen explained the Waiver with CMS (Center for Medicaid and Medicare Services); Vermont requested that we be able to cover up to 300% of the Federal Poverty Level. CMS now says they will pick up only up to 200% of the FPL. So this leaves out the population between 200% and 300% of FPL.  We will leave open our request; CMS will move forward with the 200% level. President Bush has made it clear that CMS will not go to the 300%. Governor Douglas recommends that we use state funding for the gap and that we continue with Catamount.  Will meet next week with the Emergency Board (E-Board). They are updating the financial projections: it appears to be OK for FY2008.  They foresee a possible shortfall of $700,000 in FY09. Need to do all updates in the Catamount balance sheets. Potential deficit in FY 2010: $10 million. Various factors, including changing political landscape, could affect this in the future.

Discussion: Level of communication with the Bush administration? Has the Governor spoken with President Bush? Joshua: Not sure of exact kinds of communication. Continue to hope for change in the future. Will continue to request amendment to the Waiver to cover up to 300% of FPL.

Concerns re the SCHIP debate in Washington; will funding for kids over 200% FPL be jeopardized? Will OVHA please prepare recommendations re funding options as they update their estimates. OVHA will work with the legislature re funding options for future years.

Concerns re these new deficits on top of the Medicaid deficits; discussion re cost containment, etc.

Rep. Maier: Expect to see a plan from the Administration on how to sustain funding for Catamount Health—at least until the 1^st quarter of 2011.

Sen. Mullin: Suggests that JFO also help—we’re all in this together.

Actual cost to Vermont of this denial?  About $25 million. Discussion of legislated caps.

Please get information to the HCRC on the revenue side, including tobacco tax, and assessments.

No current information yet, but Administration will get that to HCRC and JFO when available.

HCRC will need to set a special meeting, to make a recommendation to the E-Board.

3.          Options for Expanding Access to Affordable Coverage                             CD #1 TR 6    

Ken Thorpe

a.          Uninsured

b.          Underinsured

Document: Expanding Catamount Health

Three issues:

• Expanding eligibility for the existing Catamount health product and increased participation
• Developing larger risk pools by merging the small group, association and individual markets
• Developing a Catamount HealthPlus Plan for the currently insured populations

Options for expanding eligibility:

·       Reduce waiting period to 6 months

·       Make Catamount Health available to the underinsured (defined as those where the premium and out of pocket spending exceed 10 percent of income)

Additional Cost Containment Options:

Facts about the rise in spending

·       Two-thirds of the rise in health care spending is associated with a rise in the prevalence of treated disease

·       Nearly 30% of the rise in spending is associated with the doubling of obesity (i.e. rise in diabetes, hypertension, and other obesity-related conditions)

Cost Containment:

·       Universal prevention benefit based on design of the diabetes prevention program

·       RCC showed that this approach reduced the incidence of diabetes by 58% and 71% (for those 60+) among adults aged 25+ who were overweight, pre-diabetic, pre-hypertensive

Current Insured Markets and their Future?

Potential for merging the small group, association and individual (non-group) markets over time

·       Small group = 21,651 lives

·       Association  = 101,099 lives

·       Individual    = 9,422 lives

Catamount HealthPlus Options:

• Employer-based models
• Eligibility: Employer pays at least 70% of premium
• Workers pay 30% of the premium limited to the individual contribution rates in the current Catamount Health program
• Phase in by firm size
• Reinsurance available for firms under 25/50 FTE
•  Benefits include current CH plan and $500 deductible plan. Cost sharing waived for chronically ill enrolling in care management model
• Provider payment rate increases indexed to growth in Medicare updates (same as current Catamount Health product)
• Provider payment rates reduced by reduction in cost shift linked to those newly insured in Catamount Health
• Young Adults
• Included in parents’ policies through age 25 regardless of college enrollment
• New young adult higher deductible ($2000) policy marketed through Catamount HealthPlus  (premium target about $120-$150 per month)

Discussion:                                                                                                                         CD #2 TR 1

Continue to focus on key issues: 75% of health care spending is on chronic disease. Need to reduce growth in spending.

Need to incorporate these ideas into the Workgroup process this summer and fall.

Discussion of several promising programs re reducing costs: Safeway, Pitney Bowes; most aggressive program: Veterans Administration in the 1990s.

Overall:

1. Need to have health IT diffused universally
2. Need to have payment reforms
3. Need to have financial incentives

4.          State Health IT Plan                                                                   CD #1 TR 3 (TR 2 is blank)

--Greg Farnum/ Hans Kastensmith

             a. Overview                                                        

             b. Relationship to Blueprint IT strategy

             c. Follow up by commission 

Documents:

• Cover letter from VITL re statewide health information technology plan; plus PowerPoint presentation: Vermont Health Information Technology Plan: Strategies for Developing a Health Information Exchange Network
• The Vermont Health Information Technology Plan: Strategies for Developing a Health Information Exchange Network

Link to Plan on VITL website: http://www.vitl.net/interior.php/pid/7

The plan is based on a shared vision "for a healthier Vermont, where shared health information is a critical tool for improving the overall performance of the health care system. The health care community will work together to achieve new efficiencies through the use of information technology in order to deliver better overall value and care to our citizens.”

Five Principles:

I. Vermonters will be confident that their health care information is secure and private and

accessed appropriately.

II. Health information technology will improve the care Vermonters receive by making

health information available where and when it is needed.

III. Shared health care data that provides a direct value to the patient, provider or payer is

a key component of an improved health care system. Data interoperability is vital to

successful sharing of data.

Vermont Health Information Technology Plan

IV. Vermont’s health care information technology infrastructure will be created using best

practices and standards, and whenever possible and prudent, will leverage past investments,

and will otherwise be fiscally responsible.

V. Stakeholders in the development and implementation of the health care technology

infrastructure plan will act in a collaborative, cooperative fashion to advance steady

progress towards the vision for an improved health care system.

Core Objectives:

I.           Encourage and enable the deployment and use of electronic health record systems within the state to increase the amount of health information that exists in electronic form.

II.          Establish and operate the infrastructure necessary to promote secure electronic health information exchange to achieve the plan’s vision.

III.         Empower consumers to take an active role in electronic health information initiatives in Vermont.

IV.         Enable public health agencies to leverage health information technology/health information exchange investments to monitor and ensure the public’s health more transparently and quickly.

Scope:

• Improved HC quality
• Better control of costs
• Improved health outcomes
• Lower HIT investment risk
• Improved efficiency
• Enhanced value of health information
• More informed policy

Privacy & Security:

1. Security: Vermonters are concerned about the ability of consumer systems to protect their health information.

2. Authorized access: Vermonters are concerned that their information may be inappropriately accessed even if the computer systems are secure.

3. Control: Vermonters are concerned that they will lose control of their health information in an electronic environment where physicians, specialists, and hospitals share their records.

Standards: The intent is eventually to have every health care organization abide by minimum

interoperability standards such that all can take advantage of the HIEN as well as achieve the

vision stipulated at the beginning of this plan.

Architecture: There are many issues to consider when developing a statewide HIT plan. In the end,

however, the recommended technology is essential to fulfilling the objectives of the plan. HIT

– and its corresponding HIE components – is complicated. Many stakeholders are looking

for recommendations for new investments or for assurance that existing investments will be

compatible with Vermont’s technical direction. The objective of this section of the plan is

to identify the technical architecture necessary to support the plan’s objectives while being

consistent with the standards.

Education: Three-Phase Approach

• Basic outreach and education
• Local campaigns to achieve optimal opt-in
• Follow-up opt-in drive

Education campaign themes:

• Security and privacy
• Benefits to patients and practitioners
• Good governance

Continuing Investments; potential sources of funding; summary of costs.

Discussion: communication with medical practices; next steps. VITL expressed appreciation to al professionals who have volunteered their expertise.

CD #2, TR 5

Hans Kastensmith:

Congratulates VITL; has some concerns re the standards. Should we make some core standards a “should,” rather than just “use if you want”?

Challenges to adoption; interoperability; costs to retrofit.

VITL is now writing an implementation guide.

5.          Other Business                                                                                        CD #3, TR 1                

Concerns re the CCIS: Chronic Care Information System

                          --Hans Kastensmith                           

• Some pieces they requested are not in the CCIS. Related to care plans, follow-up
• No automatic population view, re chronic care patients. Care coordinators need to be able to see these views. This is basic, but is not included in the system now.
• Decision support is watered down. The Vermont guidelines are not fully included.

Due to be signed off on soon; Hans recommends delaying this.

Motion, Sen. Mullin:

Request that Hans put his concerns in writing, and request a response from the Administration.

Motion seconded.

Discussion followed.

Susan Besio: CCIS steering committee meets every two weeks; have discussed these issues. They don’t want to stop implementation. Are committed to dealing with these issues; deliverables will be paid for as produced—not in a lump sum.

All in favor: Unanimous.

6.          Commission Workplan for Health Reform Strategy                                                    CD #3, TR 2                              --Jim Hester               

a.          Work groups: timeline and process                                                    

b.          Workgroups: Progress report on each workgroup

c.          Future Commission meetings

The workgroups are on track for having their research done, gathered for each group.

Workgroup # 1:Expanding Affordable Coverage to More Vermonters

Main work being done by Ken Thorpe and Steve Kappel

Workgroup #2: Primary Prevention of Chronic Illness by Reducing Prevalence of Obesity

How could Vt. Become a national leader? Health Dept. is contribution major resources. Group is identifying a full range of options.

Workgroup #3: Reduce the rate of increase in costs while improving the health of Vermonters 

This group is identifying a long list of possibilities; are soliciting additional input.

Workgroup # 4: Using IT as a catalyst for reform

New we have the VITL Plan. Will review the plan, how translate this into impact? What action steps could/should the Legislature take?

Workgroup # 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?

1. How can we ensure that Vermont has an adequate capacity to provide primary care services?

2. How can we ensure that the state has an adequate supply of nurses and allied health services staff?

3. Are changes to the state’s Public Health infrastructure needed to meet the needs of the epidemic of chronic illnesses?

4. How do we leverage the primary care capacity that we do have to meet these changing needs?

In the fall, we will bring these five silos together—the recommendations from each workgroup—and combine them into recommendations. Will need to balance, trade off ideas and effort. Will craft an overall package of recommendations, taking into account the financial resources of the state.

The first formal workgroup meetings with the legislators will probably take place in September—after the staff and resources have assembled each group’s recommendations. Currently staff and resource people are meeting mostly electronically.

The next regularly-scheduled meeting of the HCRC is Sept. 30, in Bennington; we will also need to set up the special meeting to make the Waiver recommendation to E-Board.

The meeting adjourned at 4:20 PM.

Respectfully submitted,

Loring Starr