SustiNet Board of DirectorsRecap of Board Decisions Summary of Survey Reponses on “Additional Questions”December 15, 2010

Recap of December 2 Meeting

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Key agreements from 12/2 (1 of 3)

Structure and governance• Independent authority, governed by board• For a time-limited period, use existing agency staff• Maximize administrative resources outside the General Fund (e.g.,

federal Medicaid dollars)

Enrollee populations• Medicaid/HUSKY, state employees and retirees• As soon as feasible, offer to municipalities, small firms, non-profits

Can start with municipalities (building on MEHIP experience)

• By 1/2014, offer to all firms and individuals, inside and outside exchange Before that date, take such steps as developing business plan demonstrating

feasibility To prevent adverse selection, can experience-rate employers large enough to self-

insure

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Key agreements from 12/2 (2 of 3)Delivery system and payment reforms• Specific reforms

PCMH – strongly encourage, provide incentives and technical assistance HIT – implement, in coordination with broader efforts, using leverage and

federal dollars (not General Fund resources) Incentives for evidence-based care that leave room for individual clinical

judgment Payment reforms - refocus incentives on promoting better health outcomes

• Structure Flexibility to modify reforms, based on evolving evidence Important for SustiNet to retain savings Support multi-payer initiatives May need to modify licensure laws to increase permitted scope of practice

for advance practice nurse practitioners, etc. Focus on reducing disparities

• Multi-year campaigns to achieve measurable objectives related to disparities, chronic disease, and other strategic issues

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Key agreements from 12/2 (3 of 3)

Coverage/access policies beginning before 1/1/2014• State agencies and legislature work together to find resources

• Through HUSKY, cover childless adults up to 185% FPL Starting 7/1/2012, provided funding source can be identified

• Re-align and restructure Medicaid and HUSKY payment levels Re-align to Medicare payment levels, where appropriate. Exceptions:

With some services, Medicaid payment does not need to increase With some populations and services, a benchmark other than Medicare is

needed (e.g., pregnant women and children) Begin on 7/1/2012, gradually phase-in over time. Full implementation requires

identifying funding sources.

Coverage/access policies beginning on 1/1/2014• HUSKY up to 133% FPL, implementing Medicaid expansion in federal law

• HUSKY from 133-200% FPL, implementing Basic Health Program (BH) option Increase payment rates to reflect excess of federal BH funding over general

HUSKY capitated rates12/15/2010 5

Board Survey Results

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Areas of agreement: more than 2/3 support (1 of 3)

• Who should be added to the Board? Individuals with specific expertise Consumer representatives

• Advisory committees should include topics recommended by advisory committees and task forces

• Board should have authority and flexibility to merge committees and to establish new committees as circumstances change. Suggestions include: Outcomes, including quality, safety, disparities Delivery, including medical home and prevention Prevention, including obesity, tobacco Payment

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Areas of agreement (2 of 3)

• Board should have the authority to appoint an Executive Director

• Board should have the responsibility and authority to establish and monitor key metrics and to update these over time. Suggested topics include: Access, provider participation Cost, efficiency Quality, safety, health outcomes; disparities reduction Enrollee and provider satisfaction, patient experience

• Board should have authority to implement benefit design changes and delivery system reforms within broad framework established by legislature; legislature should weigh in on substantive changes to that framework

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Areas of agreement (3 of 3)

• Malpractice safe-harbor for those who follow practice guidelines

• State should spend $ on disparities reduction, overall wellness and prevention, workforce enhancements

• Offer SustiNet to new employer groups as soon as is feasible before 2014 (e.g. to municipalities, small businesses, not-for-profits) Determine cost, funding, pricing Resolve operational and logistical issues, licensure, underwriting, etc. In analyzing feasibility before 2014, basis for determining whether

state should offer a “competitive product”: provides value, underwriting losses don’t increase deficit

• Value of employer role

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Areas of some disagreement (1 of 2)

• Interest groups or elected officials on board? e.g. Community Health Center Association of CT (CHCACT) Primary Care Coalition of CT

• Who should appoint board members? Governor and legislative leaders appoint specific members,

similar to appointments of current Board, or Current Board with nominating committee appoint new members

• Consumer representation on Board? Consumers sit on Advisory Board only Consumer Advisory Board elects a member to sit on the

governing Board Consumer representative selected by: Board, consumer

organizations, CHCs, labor leaders, small business leaders, elected official(s)

Include consumer representative from each county

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Areas of some disagreement (2 of 2)• Whether committees should be established in

legislation

• Whether state should spend $ on obesity, tobacco cessation or other public health initiatives Board members expressed concerns about funding Several Board members felt they had insufficient

information to set priorities

• Whether, when the Board is preparing to offer a “competitive product” to firms and individuals: It may incur start-up costs that could affect the state’s

budget deficit, or It must identify alternative funding to cover start-up costs

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