Connector Considers CommCare, Consumers, and Carriers: 4/11/13 Board Report

Today (April 11, 2013), the Connector Board discussed the Commonwealth Care member survey, the FY14 Commonwealth Care MCO renewal, and efforts to enhance consumer health plan selection and decision support tools on the Health Connector’s website.  Materials from the meeting are here, and our full report is after the break.

Jean Yang started the meeting with her Executive Director’s report:

  • Program Enrollment: As of April 1st, Commonwealth Care enrollment is 205, 475, up by about 4,000 people from March, and Commonwealth Choice enrollment is 42,208, up about 1,700 from March.  Many small businesses renew health coverage in April, including about half of small groups purchasing through the Health Connector.  Business Express renewal is at about a 98% renewal rate, and the Health Connector brought in 70 new groups to the program.
  • Navigators: The Health Connector released their RFP for the Navigator program, which will fund grants to community organizations to help residents navigate their new health care options under the Affordable Care Act (ACA).  Connector staff plans to come back to the Board in early summer with information about the grantees selected.
  • Seal of Approval: The non-premium portion of the carriers’ responses to the 2014 Seal of Approval was originally due on April 1st.  Due to several factors – including the uncertainty around ACA rating factors and the delay in readiness of the federal SERFF system used for carrier form and rate filing – the Seal of Approval response deadline is extended to May 1st.  The Health Connector plans to hold another Q&A session with carriers this month and come to the Board for initial approval in June.  The remainder of the SoA timeline should remain intact.  The Health Connector and the Division of Insurance (DOI) are confident that they will be ready for ACA open enrollment, which begins October 1st.

Commonwealth Care Member Survey
The Health Connector contracted with an outside vendor to conduct their annual Commonwealth Care member survey.  The FY13 survey targeted individuals who have been enrolled with Commonwealth Care for at least 2 months, and used a random sample weighted by plan type and carrier mix. A total of 857 surveys were completed.

The survey showed a high level of member satisfaction, based on factors including choice of health plans, broad range of services covered by plan, broad choice of doctors and other providers, affordability, customer service and quality of care.  Some 86% of members reported being satisfied or extremely satisfied with the program overall.

The survey also highlighted areas for improvement.  An increased number of people reported experiencing a loss in coverage since becoming a Commonwealth Care member, resulting in gaps in coverage, and slightly fewer members indicated that the application process was easy.  The Health Connector plans to leverage opportunities through ACA implementation – such as enhanced customer support and new technology – to help minimize gaps in coverage, simplify the application and renewal process, and maintain access to a broad range of affordable, quality health plans.

Board members Celia Wcislo and Nancy Turnbull suggested that the Health Connector use these survey results as a baseline as they transition to new ACA coverage options.  Nancy also suggested that it would be informative to get information from carriers about levels of satisfaction for all their members, not just those enrolled in Commonwealth Care.

FY14 Commonwealth Care Contract Renewals
In the last six months of the Commonwealth Care program, the Health Connector sought a renewal strategy that would minimize disruption in coverage and maintain enrollee premiums.  Each MCO was asked to accept their FY13 base capitation rate with a 1.4% inflationary increase.  The administrative capitation rate remained at $27.50 per member per month (PMPM).  The renewal did not change any eligibility rules, but MCOs were given the option of proposing a discount for their Plan Type 2 and 3 members.

All five current MCOs agreed to the new contracts for FY14 – BMC HealthNet Plan, CeltiCare Health Plan, Fallon Community Health Plan, Neighborhood Health Plan, and Network Health Plan.  CeltiCare proposed a 7% discount to their Plan Type 2 and 3 rates, which puts them on level with BMC HealthNet.  Thus, CeltiCare’s premium-paying members will see a decrease in their costs.  Enrollee premiums for all other MCOs will stay the same.

The Board voted to approve the FY14 Commonwealth Care contract renewal.

Commonwealth Care Open Enrollment
As in past years, the Health Connector will hold open enrollment from June 3rd-21st to allow Commonwealth Care enrollees to switch plans for any reason.  Of course, this year’s open enrollment is different in that coverage only spans from July 1, 2013-December 31, 2013, at which point the new ACA coverage options will be available.  Due to the shortened plan year, Commonwealth Care out-of-pocket maximum amounts will be reduced.

In preparation for open enrollment, the Health Connector will directly communicate with members via mail, email, website and social media; increase call center staff; and engage in stakeholder communication and training.  Members will receive packets in the mail during the last week in May.  There will be limited messaging around new ACA coverage options and responsibilities to minimize confusion.

Nancy Turnbull emphasized the importance of working with community partners, including Health Care For All, to make sure the Connector gets two levels of messaging out there: broad, coordinated messaging and awareness, and individualized outreach.  Both levels of communication are important, given that Commonwealth Care members are most affected by the ACA transition.  Secretary Glen Shor agreed with Turnbull’s statement and reiterated the importance of macro-communications to create a positive environment for ACA implementation within a changing environment.  Health Connector Deputy Director Ashley Hague added that the Health Connector plans to push out messaging to all community members, especially for open enrollment, as part of a broader outreach campaign.  Along with MassHealth, they are working with Maximus Center on Health Literacy and also plan to involve HCFA in their messaging strategy.  Jon Gruber also suggested that the Health Connector coordinate with Enroll America.

Out-of-Pocket Cost Calculator
As part of the transition to “Connector 2.0,” Health Connector IT staff are building new consumer decision support and plan selection tools.

The Health Connector currently offers several decision support tools, including:

  • Provider search, including information about narrow and limited networks
  • Annual deductible filter, hide plans that fall outside a consumer’s acceptable range of deductibles
  • Co-insurance filter, to show or hide plans that include co-insurance

The Health Connector will add educational materials in the new Health Insurance Exchange/Integrated Eligibility System (HIX/IES), including materials on Advanced Premium Tax Credits (APTCs), State Wrap, Cost-Sharing Reductions (CSRs), and dental insurance.  In addition, the Health Connector is integrating an Out-of-Pocket Cost Calculator within HIX/IES.

Here’s how it works: Consumers anonymously provide basic demographic information (e.g. age, zip code, anticipated health care usage or health status).  They can also provide information about expected services (e.g. pregnancy, surgery) to get a more exact estimate.  Information is de-identified and send to the vendor, which returns data in real time and displays the results in an easy-to-understand format.

After a thorough procurement process, the Health Connector chose Consumers’ CHECKBOOK to provide the Cost Calculator.  The Board voted to approve the Health Connector’s choice to enter into a contract with Consumers’ CHECKBOOK through June 30, 2014 to provide this service.

Dolores Mitchell noted that there is a lot of information for people to keep track of as they use these tools – premium, deductible, co-insurance, out-of-pocket maximum.  How do they keep track of it all?  George Gonser, the broker representative on the Board, jokingly responded, “Brokers!”  In response to Turnbull and Gruber’s question about testing the tools with members, Health Connector staff said they are not doing field tests, but are working with HCFA on the eligibility system, including the decision support tools, and they are learning from the vendor.

Turnbull suggested that the Health Connector make it clear that the information provided for the Out-of-Pocket Cost Calculator is anonymous.  Mitchell emphasized that the Health Connector needs to include a disclaimer that the cost calculator results are not exact, and that the Health Connector is not responsible for costs that could exceed the estimate.  Turnbull added the out-of-pocket cost limits should be clearly stated as well, with a warning that costs could be as high as the out of pocket limit.  She also reiterated the importance of a robust risk adjustment program, as people may choose their plans based on their conditions and associated costs.  Jean Yang acknowledged the Board’s concerns and shared a related concern about people buying lower-level coverage that may not meet their needs, particularly in the new coverage construct, making clear information and education even more important.
Suzanne Curry

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