1. 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

2. Overview Health plan perspective Preparing for implementation Successes and lessons learned Fallon Community Health Plan / www.fchp.org

3. 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 / www.fchp.org

4. 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 / www.fchp.org

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

6. Our partners Fallon Community Health Plan / www.fchp.org FCHP Health Connector Carriers Legislative/ Government agencies ProvidersMembersBrokersEmployers Sub- Connector

7. 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 / www.fchp.org

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

9. 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 / www.fchp.org

10. Fallon Community Health Plan www.fchp.org