A National Conference on Health Care Reform in Massachusetts How to Organize Exchanges and Other Lessons Learned: Commonwealth Choice January 22, 2010 Eric H. Schultz President and CEO Fallon Community Health Plan

Overview Health plan perspective Preparing for implementation Successes and lessons learned Fallon Community Health Plan /

Fallon Community Health Plan Not-for-profit regional health plan with a complete range of products and health care services –An insurer and a provider of care Consistent rankings as one of America’s top health plans (U.S. News/NCQA) –“Honor Roll” in all products (Medicare, Medicaid and Commercial) “Excellent” Accreditation by NCQA in all products Mission: Making our communities healthy Fallon Community Health Plan /

Mass. legislation highlights Health care reform in Massachusetts: –Created the Commonwealth Health Insurance Connector Authority –Created new programs –Merged the small group and individual markets –Created individual and employer responsibilities Fallon Community Health Plan /

How FCHP responded Dedicated internal resources –Company-wide effort Established partnerships Communication, communication, communication Fallon Community Health Plan /

Our partners Fallon Community Health Plan / FCHP Health Connector Carriers Legislative/ Government agencies ProvidersMembersBrokersEmployers Sub- Connector

Procurement process 2007, 2008 and 2010 procurements –Evolving specifications from year to year Plan designs –SIMPLICITY - Gold, Silver, Bronze –Actuarial ranges –Prescribed plan designs Limited networks Market channels –Individuals –Employer: Contributory Pilot, Business Express Fallon Community Health Plan /

Successes/lessons learned Using an existing administrative organization for implementation Consistency in policy definitions Communication –Need for information –Simplicity Fallon Community Health Plan /

Successes/lessons learned Eligibility /underwriting guideline consistency crucial for all distribution channels Participation within all Health Connector levels important to maintain equal risk pools Analysis and evolution important Fallon Community Health Plan /

Fallon Community Health Plan