Rosemarie Day

1
Organizing Health ReformEarly Lessons from
Massachusetts

• Rosemarie Day
• Deputy Director and Chief Operating Officer
• Commonwealth Health Insurance Connector Authority
• State Coverage Initiatives National Meeting
• Nashville, Tennessee
• Thursday, February 7, 2008

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• Key element of MA Health Care Reform
• Share the responsibility

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Governments RoleMultiple State Agencies Involved
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Health ConnectorOrganization

• Health Connector was established by the law as an
  independent public authority overseen by a board
  of ten directors.
• Many key policy decisions left to Connector Board
• Organization was free from some state agency
  constraints (e.g. hiring, procurement).

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Health ConnectorKey Tasks

• Launch and administer Commonwealth Care program
• Launch and administer Commonwealth Choice program
• Define minimum creditable coverage
• Establish Affordability standards
• Promulgate regulations on S. 125 Plan requirement
  for Mass employers
• Administer waivers and appeals related to the
  individual mandate

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Health ConnectorRapid Ramp-up

• Law passed April 2006.
• Executive Director was hired in June 2006.
• First Board meeting was held on June 7, 2006.
• Core staff was hired during the summer and fall
  of 2006.
• CommCare implemented October 1, 2006.
• CommChoice implemented May 1, 2007.

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Health ConnectorStrategic Outsourcing
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Health ConnectorRole in insurance market
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Health ConnectorState-of-the-art Website
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ResultsBroadened Access (as of 1/1/08)
Net new commercial insurance
100,000 (includes almost 16,000 with coverage
through Commonwealth Choice) Commonwealth
Care 170,000 Medicaid enrollment growth
70,000 ________ TOTAL gt
300,000
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ResultsSteady Growth in Commonwealth Care
As of 1/1 168,924 members - 42,114 premium
paying - 126,810 no premium
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ResultsSteady Growth in Commonwealth Choice
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Health ConnectorImplementation Lessons

• Overall, implementation has been helped by
• Tight deadlines
• Continued stakeholder support
• Flexibility in the law
• Board of Directors
• Partnerships with existing state agencies
• Sufficient start-up funds

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Health ConnectorImplementation Lessons

• Specifically, Commonwealth Care implementation
  was facilitated by
• Existing MassHealth infrastructure
• Uncompensated Care Pool members
• Auto-assignment
• Virtual Gateway infrastructure
• Outreach grants

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Health ConnectorOverall Lessons

• Be a virtual organization (buy, dont build)
• Take incremental steps (walk before run)
• Over-prepare for every Board meeting
• Be a learning organization