Rosemarie Day Deputy Director and Chief Operating Officer Thursday, January 10, 2008 Fiscal Year 2008 Plan of Operations: Objectives, Strategies for Success and Critical Projects

2 Outline: FY 2008 Plan of Operations I.Overall Objectives II.Key Strategies and Success Criteria III.Critical Projects

3 I. Overall Objectives for FY 2008 A.Commonwealth Care: Solidify program and continue enrolling members. B.Commonwealth Choice: Begin attracting members and fully launch employer services. A.Health Care Reform: Work towards short and long term success of health care reform through outreach, website enhancements, program evaluation and cost containment. B.Operations and Finance: Enhance infrastructure and reporting.

4 II. Key Strategies and Success Criteria A. Commonwealth Care 1. Cover virtually all qualified uninsured people whose incomes are below 300% FPL. Key StrategiesSuccess Criteria & Metrics Status Respond effectively to any Health Safety Net (HSN) changes. Outreach to 100% of HSN eligible individuals by 12/1/07 

5 II. Key Strategies and Success Criteria A. Commonwealth Care (Continued) 2. Control costs of MMCO capitation rate. Key StrategiesSuccess Criteria & MetricsStatus Include incentives for MMCO bidding: lower costs, performance incentives and contract/utlization management ▪ MMCO audit for FY09 ▪ Auto-assignment proposal ▪ Re-insurance plan Included in RFR

6 II. Key Strategies and Success Criteria A. Commonwealth Care (Continued) 3. Refine program structure & operations to support continued growth & overall Connector objectives (e.g. S. 125 roll-out). Key StrategiesSuccess Criteria & MetricsStatus Overall: Develop premium billing measures and monitoring strategies 1. Develop automated reports 2. Document manual processes 3. Conduct internal reconciliation with MMIS and premium billing Overall: Billing inquiries/problems less than 5% per month For #1: Complete by 12/07 For #2: Complete by 2/08 For #3: Complete by 3/08 #1:  #2: Underway #3: Underway

7 II. Key Strategies and Success Criteria B. Commonwealth Choice 1. Enroll nongroup members quickly. Key StrategiesSuccess Criteria & MetricsStatus Continue aggressive marketing/advertising/outreach /PR Survey existing members to augment marketing Underway Simplify enrollment/more transparency/ease-of-use 1. 80% applications submitted online 2. 10% of total payments come from E-pay conversions 1.  2. TBD

8 II. Key Strategies and Success Criteria B. Commonwealth Choice (Continued) 2. Establish fully automated Voluntary Employer services by 10/1/07. Key StrategiesSuccess Criteria & MetricsStatus Identify, publish and implement all manual and automated methods for employers to enroll with Connector Establish 4 successful methods for Voluntary Plan implementation and administration 

9 II. Key Strategies and Success Criteria B. Commonwealth Choice (Continued) 3. Establish Contributing Employer services by 5/10/08 (updated). Key StrategiesSuccess Criteria & MetricsStatus Identify and leverage methods that were successful for individual/family and Voluntary Plan implementations Complete by 10/30/07 

10 II. Key Strategies and Success Criteria B. Commonwealth Choice (Continued) 6. Manage the trend in minimum creditable coverage premiums. Key StrategiesSuccess Criteria & MetricsStatus Specify target trend in renewals with health plans Trend is at or below 5% growth over FY07. Included in RFR

11 II. Key Strategies and Success Criteria C. Health Care Reform 3. Define and implement appeals process for individual mandate. Key StrategiesSuccess Criteria & MetricsStatus Coordinate w/DOR on standards (appeals, data exchange, etc) Complete documents required by DOR; appeals info moves back and forth freely Underway Bulk up appeals unit: training, materials, personnel resources Appeals are processed within 90 days, except for appeals with hearings Underway Enhance website materials on affordability and Certificate of Exemption Post revised materials on Connector website  for CY07

12 II. Key Strategies and Success Criteria C. Health Care Reform (Continued) 4. Define key measures of how Connector & health care reform will be evaluated and invite researchers to participate. Key StrategiesSuccess Criteria & MetricsStatus Convene multi-agency analytic working group Establish working relationship with other agencies to minimize duplication and coordinate research  Establish research agenda Have in place a research agenda by 3/08 to answer questions regarding success of health care reform Underway Establish Internal Review Board (IRB) to vet research proposals IRB established by 6/08Underway Identify sources of funding for research and evaluation Establish working relationship with researchers and funding agencies to support analysis of health care reform Ongoing

13 II. Key Strategies and Success Criteria C. Health Care Reform (Continued) 5. Develop cost containment strategies to ensure health care reform's longer-term success. Key StrategiesSuccess Criteria & MetricsStatus Communicate consistent message on need to contain costs 1. Engage strategic partners in dialogue on cost containment 2. Focus of Board retreat 1. Underway 2.  Coordinate cost containment efforts for CommCare with other state agencies under Healthy Mass Compact Build key elements into CommCare RFR  Specify re-procurement targets with CommChoice carriers Carrier proposals submitted that meet specified criteria Target specified

14 II. Key Strategies and Success Criteria D. Operations and Finance 4. Identify and implement operational efficiencies. Key StrategiesSuccess Criteria & MetricsStatus Establish E-pay for Commonwealth Choice E-pay established for current customers by 5/08 Underway Automate reporting for Commonwealth Care premium billing system Reports automated by 12/07  - 12/07 Simplify Commonwealth Choice enrollment for employers Eliminate employee census requirementUnderway Improve Commonwealth Choice member communications Require individual addresses  Automate transfer of appeals information from DOR to Connector Create appeals database and weblink by 12/07  - 12/07 Streamline marketing and outreach materials for Care and Choice Create a single platform for materialsUnderway

15 Commonwealth Care Commonwealth Choice Health Care Reform Operations and Finance III. Critical Projects To achieve objectives, we have initiated 35 critical projects, organized in those same four areas: 11 have been completed, and 24 are underway.