Presentation on theme: "Rosemarie Day Deputy Director and Chief Operating Officer Thursday, May 8, 2008 Operations Report Current Priorities and Future Plans."— Presentation transcript:
Rosemarie Day Deputy Director and Chief Operating Officer Thursday, May 8, 2008 Operations Report Current Priorities and Future Plans
2 Outline Operations Report I.Current Priorities A.Open Enrollment Highlights: Commonwealth Choice B.Open Enrollment Highlights: Commonwealth Care C.Contributory Plan D.Commonwealth Care Customer Service Contract E.MMCO Contract Audit F.Mandate Appeals Process II.Future Plans Long-term Policy and Strategy Issues
3 I. Current Priorities A. Open Enrollment Highlights: Commonwealth Choice Non-group coverage: July 1 st is one-year anniversary of coverage. Renewal letters sent to ~1,600 subscribers in April and early May. Members are renewed in their equivalent Seal of Approval (SoA) plans and are also given option to choose another SoA plan. Ongoing process: renewal letters will be sent each month to correspond with coverage anniversary dates. Future state: renewals will be done online.
4 I. Current Priorities A. Open Enrollment Highlights: Commonwealth Choice Working with 6 carriers to collect new and old rates Developing new forms and procedures Drafted letters to members Meeting DOI guidelines Updated website Adjusting billing procedures and systems Training call center staff
5 I. Current Priorities A. Open Enrollment Highlights: Commonwealth Choice Voluntary Plan: Working with employers to promote open enrollment in Voluntary Plans. Contacting many of our VP employers (~1,100 have 7/1/08 anniversary date) Renewal letters being sent to currently enrolled VP employees Making it easy for employers: Web tutorial Sample open enrollment materials (posters, letters, etc.) Offer to participate in health fairs Ongoing process corresponding with S. 125 Plan anniversary dates.
6 I. Current Priorities B. Open Enrollment Highlights: Commonwealth Care Renewal letters are being sent to all Commonwealth Care members this week. Includes notice of premium and co-pay changes. Premium-paying members will receive new invoices with premium changes by end of May. Health Plans sent marketing materials last week. Call center is staffed to handle peak loads.
7 I. Current Priorities C. Contributory Plan On-track to launch on July 1 st for coverage effective September 1 st. Working with carriers, brokers, SBSB and CSC to develop and implement the product. Phase I of launch will be limited to 100 employers/1,000 employees so that product can be evaluated.
8 I. Current Priorities C. Contributory Plan – Timeline Part I: March - May
9 I. Current Priorities C. Contributory Plan – Timeline Part II: June – Sept.
10 I. Current Priorities D. Commonwealth Care Customer Service Contract New Vendor Procurement: Request for Proposals issued in March Proposals received in mid-April Procurement team of Connector staff is evaluating proposals (technical, programmatic and price) Interviews will be held in early June Will negotiate with recommended vendor Board vote in July
11 I. Current Priorities D. Commonwealth Care Customer Service Contract Transition Planning: Goal is for new vendor to be fully operational by 12/08. Work closely with Maximus and EOHHS to coordinate the transition to new vendor New call center platform Premium-billing data conversion
12 I. Current Priorities E. MMCO Contract Audit Key components: Claims payment and reporting Management of provider network Effectiveness of care management programs Timetable: Solicit vendor (May – June 2008) Conduct audit (July – September 2008) Review results (September – October 2008)
13 I. Current Priorities F. Mandate Appeals Process Connector is working closely with DOR to process mandate appeals DOR collects appeals info from taxpayer DOR shares info with Connector via secure website Connector staff review the appeals and make a determination Connector has contracted with independent hearing officers to hold hearings for denied appeals Officers have been trained Hearings process will be fully underway by June
14 II. Future Plans Long-term Policy and Strategy Issues Staff will conduct analysis and work with Board members to address issues such as: Affordability Schedule proposals Value-based benefits design Timetable: summer to fall 2008 Will present more detailed proposal at June Board meeting