Rosemarie Day Deputy Director and Chief Operating Officer Commonwealth Health Insurance Connector Authority Organizing Health Reform Early Lessons from Massachusetts
Organizing Health Reform Early Lessons from Massachusetts
Dec 31, 2015
Organizing Health Reform Early 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. - PowerPoint PPT Presentation
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Rosemarie DayDeputy Director and Chief
Operating OfficerCommonwealth Health Insurance
Connector Authority
State Coverage Initiatives National Meeting
Nashville, Tennessee
Thursday, February 7, 2008
Organizing Health ReformEarly Lessons from Massachusetts
Residents:▪ Individual mandate
Government:▪ Connector▪ Regs & oversight▪ Premium assistance
Employers: ▪ Make "fair" contribution▪ Set up Section 125
Key element of MA Health Care ReformShare the responsibility
Government’s RoleMultiple State Agencies Involved
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).
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
Health ConnectorKey Tasks
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.
Health ConnectorStrategic Outsourcing
Young Adults Small Biz. Voluntary Plans Indiv.& Families
Health ConnectorRole in insurance market
Health ConnectorState-of-the-art Website
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 > 300,000
Enrollment (000's) as of the first of the month
0
60
120
180
Feb '07 Mar '07 Apr '07 May '07 J un '07 J ul '07 Aug '07 Sep '07 Oct '07 Nov '07 Dec '07 J an '08
P remium paying
No premium
As of 1/1: 168,924 members- 42,114 premium paying- 126,810 no premium
ResultsSteady Growth in Commonwealth Care
Members (subscribers and dependents)
15,938
8,306
5,095
2,799
7,241
10,199
14,350
0
6,000
12,000
18,000
J ul '07 Aug '07 Sep '07 Oct '07 Nov '07 Dec '07 J an '08
ResultsSteady Growth in Commonwealth Choice
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
Health ConnectorImplementation Lessons
Specifically, Commonwealth Care implementation was facilitated by:
– Existing MassHealth infrastructure
– Uncompensated Care Pool “members”
– Auto-assignment
– Virtual Gateway infrastructure
– Outreach grants
Health ConnectorImplementation Lessons
Be a “virtual organization” (buy, don’t build)
Take incremental steps (“walk before run”)
Over-prepare for every Board meeting
Be a “learning organization”
Health ConnectorOverall Lessons
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