Commonwealth Care Program Update

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Commonwealth Care Program Update

• May 10, 2007

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Agenda

• Enrollment
• Outreach Communications
• Program Design
• Demographics
• Program Financial and MCO Contract Update

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Enrollment Update
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Enrollment Breakdown

• 69,000 enrolled as of May 1
• 53,768 enrolled in Plan Type 1
• Plan Types 2, 3 4 (15,560)
• Type 2 12,171
• Type 3 (low premium/higher co-pay) 2,398
• Type 4 (low copay/higher premium) 991
• Almost 4,000 new members were enrolled in PTs 2,
  3 4 in the month of April

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CommCare Enrollment
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CommCare Enrollment
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CommCare Membership Churn
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Commonwealth Care Enrollment
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Commonwealth Care Enrollment
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Commonwealth Care Enrollment

• Analysis recently completed by Kennedy School
  interns identified geographic variance in
  CommCare take-up rate for lt100 FPL
• Variance especially pronounced in Southeastern
  Massachusetts
• Connector staff beginning to perform additional
  research and analysis

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Commonwealth Care Outreach Communications
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Member Outreach and Communications

• Program will be moving into a new phase of
  outreach
• Recognizing the fluid nature of the uninsured
  population
• Message will focus on individual choice and
  benefits of insurance
• Outreaching to all Comm Care eligibles
• 200-300 will be targeted
• Focused messaging
• New tools and methods

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Messaging Why Comm Care?

• Expanding the messaging
• Importance of making decisions about insurance
• Will begin to focus on universal obligation
• Emphasize benefits of program over UCP or no
  insurance
• Already starting to benefit from larger Connector
  marketing efforts
• Focusing on the Member
• Commonwealth Care - Health insurance through
  health plans for eligible services provided to MA
  low-income uninsured
• Why Insurance?
• Preventive and acute care
• Quality Control
• Disease Management
• Access to a broad range of benefits

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Outreach - Expansion

• Utilizing tools and technology
• Help expand the information network
• Ensure program changes are communicated
• Strengthen web presence
• Empower individuals

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Outreach - New Methods

• E-learning development
• 45 minute web based module
• Training plan focuses on audience, learning
  styles, and goals
• Spoken Powerpoints (Macromedia Breeze)
• Used during April MTF (MassHealth Training
  Forums) with positive feedback
• Train-the-trainer sessions
• Instructor led sessions will be offered
• email distribution tool
• In process / development

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Outreach / Marketing Specifics

• Utilizing new methods
• New, more robust, Flyer
• Exploring wide translation Spanish, European
  Brazilian Portuguese, Vietnamese, Chinese
  (traditional), Haitian Creole, Russian, Kamir,
  Lao
• Disseminating to grant recipients, health
  centers, hospitals and school nurses
• MMCOs will partner with Connector in a more
  comprehensive way
• Will partner in blind direct marketing to
  eligible individuals
• MCOs will be able to use their own marketing
  materials for outreach

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Commonwealth Care Program Design
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Program Design Overview

• There are a number of elements that we will
  address as part of this effort
• Looking at what will impact plan design, and
  providing data and analytics to facilitate
  discussion and decisions

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Program Design Fundamentals

• There are five main elements to the Commonwealth
  Care program design
• The elements are interdependent
• Program/Financial Elements
• Benefits (e.g. dental, non-emergency
  transportation)
• Co-pays
• Enrollee Contribution (member premium)
• Eligibility
• Program Costs/Bid Process

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Commonwealth Care Demographics

• May 10, 2007

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CommCare Demographics
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CommCare Demographics
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CommCare Demographics
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CommCare Demographics
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Projected Expenses SFY 2007
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SFY 2008 Budget - HCR

• Commonwealth Care premium assistance payments is
  budgeted for each fiscal year as part of the
  larger State budgeting process
• As such, projected cost for CommCare is balanced
  among the following
• Federal Budget Neutrality
• Safety Net Care Pool (SNCP) Cap
• Funding level of HSNTF (formerly the UCP)

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Commonwealth Care Financial MCO Contract
Update
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CommCare Data Needs

• Actual claim cost is the most relevant data for
  analyzing unit cost and utilization patterns
• MMCOs are required to provide raw claims data
  quarterly
• Due to inherent claims lag, credible CommCare
  specific data will not be available until
  February 2008
• December 2007 paid data available February 2008
• Data will be essentially 10 months complete for
  PT I and 7 months for PT II-IV
• Other claims-based data which can supplement
  CommCare-specific data
• MassHealth Managed Care program
• MassHealth PCC fee-for-service data
• CommCare Enrollment data for gt150 FPL
• Ability to determine take-up rate for gt150 FPL
  cohort
• Dependent on HSNTF/UCP eligibility changes
  effective in Fall07
• Full effect of individual mandate in December 2007

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MMCO Contractual Obligations

• Functional Area Status
• Provider Network
• Adequate Hospital Network
• Submit geo-access report
• Marketing
• Submit Marketing plan
• Schedule of all marketing activities

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MMCO Contractual Obligations (contd)

• Functional Area Status
• Operational
• Enrollee Handbook
• Enrollee outreach materials
• Financial
• Stop Loss reporting
• DOI Licensure
• BMC HealthNet
• Network Health