1. Connecticut Department of Social Services
HUSKY Transition:
Brief Overview/Update
January 9, 2009

2. Voluntary transition began 9/08
Voluntary transition of HUSKY member households began Sept. 1, 2008, from departing Anthem BlueCare Family Plan and Traditional Medicaid.
State’s 3 contracted health plans receiving members: Aetna Better Health; AmeriChoice by United Healthcare; Community Health Network of CT.

3. Over 106,000 members have switched
To date, households representing nearly 86,000 HUSKY A members have voluntarily left Anthem BCFP
Households representing more than 20,300 HUSKY A members have voluntarily left Traditional Medicaid.
93,000 enrollees who were already in Community Health Network in September 2008 were not affected by the transition.

4. Key points: Migration from Anthem, Medicaid
Most households voluntarily switching so far have chosen incumbent health plan Community Health Network of CT, which has long-time provider network in place. Enrollment in CNHCT has grown from about 93,000 to about 158,000.
Provider networks in new health plans Aetna Better Health & AmeriChoice by United Healthcare have made significant gains and continue to develop.

5. Next Steps: Transition nears completion
State of Connecticut and federal government have approved the process to move forward.
U.S. Centers for Medicare & Medicaid Services has approved Connecticut’s managed care contracts with Aetna Better Health, AmeriChoice by United Healthcare & Community Health Network of CT.
CMS has authorized mandatory enrollment. This will take effect Feb. 1, 2009, for households in Anthem BCFP & Traditional Medicaid that have not chosen new plan by Jan. 30.

6. Next Steps: Member notice process
Approximately 56,900 HUSKY A member households were mailed notices at the end of December. These were the households in Anthem BCFP and Traditional Medicaid that had not chosen a new plan by that time.
[HUSKY B note: 4,475 households of HUSKY B member children in Anthem BCFP were also sent notices. By 1/6/07, the number of HUSKY B Anthem households had dropped to 3,170.]
Since the notices were mailed, several thousand members have changed plans. The number of individuals self-selecting one of the 3 managed care plans is increasing daily.
DSS is scheduling a second notice that will remind remaining Anthem BCFP and Traditional Medicaid members about changing plans by January 30.

7. Migration from Anthem BlueCare Family Plan & Traditional Medicaid by the numbers
Comparing HUSKY A enrollment from transition beginning on 9/1/08 to this week
September 1, 2008:
January 7, 2009:
Health Plan
Individual
Members
Households
Anthem
BlueCare
Family Plan
189,230
94,360
41,309
Traditional
Medicaid
42,598
36,006
18,304
Community Health
Network of CT
93,359
158,240
73,364
Aetna
BetterHealth
N/A
36,665
16,531
AmeriChoice
By United
Healthcare
7,790
3,622
Totals
325,359
333,061
153,130

8. Summary: Transition almost complete
Of the total HUSKY A population of about 153,000 households, the number still in Anthem and Traditional Medicaid at the end of December 2008 was about 56,900. 
This number drops incrementally each day as families pick new plans. Consequently, the number of families subject to having DSS pick a new plan for them because they have not done so by the end of January will be considerably lower than the 56,900 receiving notices at the end of December.
Customer service support is in place to mitigate any problems for families changing plans.  This includes the long-time 2-1-1/HUSKY Infoline service, which also will make outbound calls to families over the month. Customer service points at health plan membership services and ACS (HUSKY enrollment center) also assisting.

9. Capacity
Formulas are based on pre managed care ratios of providers to members
And utilization of services by members of various categories of PCPs
The three PCP groupings used for capacity are:
Adult
Children
Women

10. Capacity Adult providers include:
Family practitioners, general practitioners, internists, and NPs and PAs working in those areas
Child providers include:
Family practitioners, general practitioners, internists, pediatricians, and NPs and PAs working in those areas
Women providers include:
OB-GYN, Nurse Midwife, and NPs and PAs working in those areas

11. Capacity
General practitioners, family practitioners, internists, and NPs and PAs who work in these areas are split between adult and children’s capacity
i.e. One family practitioner = .67
providers for adult capacity
and .33 providers for children

12. Capacity Ratio of PCP to total members enrolled:
Adult providers 1 to 387
Children providers 1 to 301
Women providers 1 to 835

13. HUSKY Enrollment & Capacity
Fairfield
Hartford
Litchfield
Middlesex
New Haven
New London
Tolland
Windham
Enrollment currently for HUSKY & Tmed
71,345
100,608
13,963
9,782
102,747
24,909
7,916
14,208
Total
345,478
Physician Network Capacity by County
AmeriChoice
38,004
40,897
2,068
7,515
66,912
5,745
3,315
8,909
Aetna
40,071
56,659
8,721
79,102
11,608
8,307
5,904
CHN
58,829
113,136
10,424
20,327
130,046
19,268
12,333
8,199
136,904
210,692
21,213
35,357
276,060
36,621
23,955
23,012
Network Capacity Summary
11/14/08
1/6/09
PCPs
3,758
7,485
Specialists
5,790
10,289
Enrollment
343,771
345,478
Enrollment Capacity
417,972
763,814

14. Charter Oak Enrollment & Capacity
Fairfield
Hartford
Litchfield
Middlesex
New Haven
New London
Tolland
Windham
Enrollment 1/1/ for Charter Oak
653
874
256
162
984
187
146
112
Total
3,374
Network Capacity Summary (were DSS to apply the DSS Medicaid ratio)
11/14/08
1/6/09
PCPs
3,758
4,134
Specialists
5,790
6,280
Enrollment
1,780
3,374
Enrollment Capacity NA
398,661

15. Specialists by Plan HUSKY Aetna Better Health AmeriChoice CHN Total
Allergy 49 28 43
120
Cardiovascular Disease
289
183
132
604
Endocrinology 89 56 78
223
General Surgery
168
122
298
588
Hematology/Oncology
171
201
494
Neurology 83 66
105
254
Orthopedics
104 95
178
377
Otolaryngology 52 41 16
109
Other Specialists*
3,848
1,587
3,215
8,650
Total Specialists
4,853
2,300
4,266
11,419
*Includes Dermatology, Gastroenterology, Geriatrics, Infectious Disease, Neurosurgery,
Podiatry, Pulmonary Disease, Rheumatology, Thoracic Surgery, Urology, Vascular Surgery, Other

16. Specialists by Plan Charter Oak Aetna Better Health AmeriChoice CHN
Total
Allergy 45 25 14 84
Cardiovascular Disease
269
126 44
439
Endocrinology 75 35 16
General Surgery
160 48
292
Hematology/Oncology
148 60 76
284
Neurology 79 38
131
Orthopedics 94 43 70
207
Otolaryngology 49 3 77
Other Specialists*
2,345
1,125
956
4,426
Total Specialists
3,264
1,561
1,241
6,066
*Includes Dermatology, Gastroenterology, Geriatrics, Infectious Disease, Neurosurgery,
Podiatry, Pulmonary Disease, Rheumatology, Thoracic Surgery, Urology, Vascular Surgery, Other

17. Plan Assignments
Members who do not choose a plan by 1/30 will be assigned into one of the two new plans.
This is done to develop sufficient critical mass in the two new MCOs more quickly to ensure viability, and
So as to not overwhelm CHN administratively.
Automatic plan assignment will occur up to 85% of a new plan’s capacity. If that should occur, CHN will then begin receiving default enrollments again.
Arizona, Delaware, Illinois, and New Mexico also did this for their new plans when they re-procured their contracts

18. Transition Care Coordination
MCO Medical Directors’ input was solicited as to what data should be sought from the prior plan for transitioning members
Bimonthly data exchanges include information for members who:
Are in case management, including pregnancy
Are in disease management
Are inpatient
Have existing prior authorizations
Members transitioning from TM to a plan receive data for members who:
Pregnant
Receiving home health care
Have a recent inpatient stay

19. Transition Care Coordination, continued
In addition, all plans will routinely be receiving dental, behavioral health and pharmacy activity data of their members.
Protocols for referrals between the plans, and the Behavioral Health Partnership and Benecare are in place.
The Behavioral Health Partnership and the plans refer members requiring co-management (medical and behavioral health services) to each other.

20. Members switching from Anthem to Aetna or AmeriChoice:
Coordination for HUSKY members with prescheduled ongoing trips (e.g. dialysis, therapy)
Members switching from Anthem to Aetna or AmeriChoice:
will continue to receive NEMT from LogistiCare
Anthem members switching to CHNCT      
Logisticare is passing prescheduled trip information to CTS, CHNCT’s NEMT vendor
TM clients switching to the MCOs
Logisticare will continue to provider services for those in their service area that switch to Aetna or AmeriChoice
Arrangements are being made with FirstTransit to transfer info to LogisitCare or CTS   

21. PCCM Pilot Areas Waterbury: 4 practices, including: 16 Pediatricians
8 Internal Medicine physicians
6 Internal Medicine / Pediatric physicians
7 Nurse Practitioners (family, children, and obstetrics)
1 Certified Nurse Midwife
4 Physician Assistants included in these practices
Mansfield/Windham: 3 practices, including:
5 Pediatricians
2 Family Medicine physicians
4 Nurse Practitioners (for adults and families)

22. PCCM Member Mailings
Member mailings are being sent to households of existing patients of participating PCPs
Waterbury area: 6,153 households
Mansfield/Windham area: 2,229 households
Mailing to include January 30, 2009 date of deadline for BCFP and TM member switch
No deadline for PCCM enrollment for targeted households
Remind members of available customer service
Remind members of ongoing ability to change between plans or PCCM (No Lock-in)

23. PCCM Provider Advisory Group
First meeting was Tuesday, January 6
Included providers from the pilot areas and applicants from other areas
Regular meetings to occur
Subcommittees include:
Care coordination
Disease management
Program evaluation