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

Key element of MA Health Care Reform Share the responsibility

Government’s Role Multiple State Agencies Involved

Health Connector Organization 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).

Health Connector Key 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

Health Connector Rapid 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 Connector Strategic Outsourcing

Health Connector Role in insurance market Young Adults Small Biz. Voluntary Plans Indiv.& Families Making the market work better: Set standards Increase transparency Simplify consumer experience Create more affordable options Standardize benefit plans

Health Connector State-of-the-art Website

Results Broadened 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

Results Steady Growth in Commonwealth Care As of 1/1: 168,924 members - 42,114 premium paying - 126,810 no premium

Results Steady Growth in Commonwealth Choice

Health Connector Implementation 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

Health Connector Implementation Lessons Specifically, Commonwealth Care implementation was facilitated by: Existing MassHealth infrastructure Uncompensated Care Pool “members” Auto-assignment Virtual Gateway infrastructure Outreach grants

Health Connector Overall 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”