Rosemarie Day Deputy Director and Chief Operating Officer Thursday, July 12, 2007 Assessing the Connector’s Progress: Fiscal Year 2007 Results and Fiscal Year 2008 Goals

2 Outline of Contents I.6 Month Objectives (Fiscal Year 2007) II.Results (Fiscal Year 2007) III.Critical Projects & Results (Fiscal Year 2007) IV.Fiscal Year 2008 Goals

3 I. 6 Month Objectives (Fiscal Year 2007) A.Commonwealth Care: Achieve stability and begin attracting members B.Commonwealth Choice: Launch fully on May 1 st C.Health Care Reform: Help communicate new responsibilities by July 1 st D.Operations and Finance: Establish infrastructure to allow Connector to function independently and stabilize operations

4 A. Commonwealth Care Overall Goal: Achieve stability and begin attracting members Progress: 92,046 members enrolled as of 7/1/07: 63,507 Type 1 18% above goal of 54,000 28,539 Types 2/3/4 68% above goal of 17,000 II. Results (Fiscal Year 2007)

5 A. Commonwealth Care Objective 1: Cover all qualified uninsured people whose incomes are below 300% FPL Progress: 92,046 members enrolled as of 7/1/07: *63,507 Plan Type 1 *28,539 Plan Types 2/3/4 Objective 2: Facilitate informed choice of health plans by delivering quality, consistent, and measurable customer service to members Progress: * 53% of members selected their own plan * Call center audits show 95%+ accuracy * Web visits continue to climb Objective 3: Develop Commonwealth Care into a financially-viable, self-sustaining program Progress: * Member self service options are increasing: web portal up in Jan 2007; Virtual Gateway pilot launching in July 2007 * Maximus contract is under-budget II. Results (Fiscal Year 2007)

6 B. Commonwealth Choice Overall Goal: Launch fully on May 1 st Progress: Individual shopping and enrollment capability launched May 1st Web functionality for individuals launched May 4 th Web functionality for voluntary employers launched May 29 th Functionality for contributing employers to launch by Jan 1 st, 2008 II. Results (Fiscal Year 2007)

7 B. Commonwealth Choice Objective 1: Cover a large share of uninsured people whose incomes are above 300% FPL Progress: Working toward target enrollments: * 18,000 members by 1/1/08 * 35,000 members by 7/1/08 Objective 2: Stimulate the development of affordable, quality health plans, including select networks Progress: * Six carriers offering total of 42 plans as of 5/1/07 * Four carriers offer select networks Objective 3: Facilitate informed choice of health plans Progress: * New web site launched May 2007 * Total visits per week have quadrupled since launch * Outreach and public info campaign launched May 2007 * Strategic partnerships formed II. Results (Fiscal Year 2007)

8 B. Commonwealth Choice (Objectives Continued) Objective 4: Minimize unintended disruption to the existing small-group insurance market Progress: * Over 600 brokers trained * 85% of July growth was in existing distribution channels Objective 5: Achieve financial stability & low administrative costs for commercial functions Progress: In early stage of implementation. II. Results (Fiscal Year 2007)

9 C. Health Care Reform Overall Goal: Help communicate new responsibilities by July 1 st Progress: Public info unit formed Jan 2007 Outreach and public info campaign launched May 2007 II. Results (Fiscal Year 2007)

10 C. Health Care Reform Objective 1: Inform employers about their responsibilities under Chapter 58, especially Section 125 plans and fair-share Progress: * PIU is handling up to 1200 calls and s per week * Over 100 business sessions conducted by Connector staff reaching over 10,000 people Objective 2: Inform individuals about their responsibilities under Chapter 58, especially the individual mandate Progress: * Partnering with community- based outreach organizations to conduct info sessions across the state * TV, radio and print ads statewide * 7 corporate partnerships; over $200,000 of donated publicity II. Results (Fiscal Year 2007)

11 D. Operations and Finance Overall Goal: Establish infrastructure to allow Connector to function independently and stabilize operations Progress: Commonwealth Care and Choice up and running with dedicated staff, infrastructure and reporting processes in place II. Results (Fiscal Year 2007)

12 D. Operations and Finance Objective 1: Develop customer support and problem resolution process Progress: * Public information unit launched in Jan 2007 * Maximus and SBSB work to resolve problems from customers Objective 2: Develop Connector’s standard operating procedures to ensure consistency Progress: * Operated with guidance of Operations Plan for Dec 06 - Jun 07 * Operations Plan for fiscal year 2008 under development Objective 3: Meet current staffing target (40 FTEs) by April 30, 2007 Progress: * 35 FTEs hired by 5/07 * Will hire more as needed II. Results (Fiscal Year 2007)

13 D. Operations and Finance (Objectives Continued) Objective 4: Develop and implement Connector financial reporting process and reviews Progress: * Budget updates and regular reviews of actuals occurring Objective 5: Complete office move by January 2007 with minimal disruption of basic operations Progress: * Move completed by mid-Jan 2007 with no downtime for staff II. Results (Fiscal Year 2007)

14 A.Commonwealth Care B.Commonwealth Choice C.Health Care Reform D.Operations and Finance 22 major projects initiated to support these areas 17 projects completed, 3 in progress, 2 deferred III. Critical Projects & Results (Fiscal Year 2007)

15 A. Commonwealth Care Status 1. Stabilize Phase I and launch Phase II  2. Implement appeals process  3. Implement sales and marketing plan, messages and outreach efforts  4. Specify rules for employer contribution subsidiesDeferred 5. Evaluate, refine and promote the Commonwealth Care program in the context of an individual mandate to have insurance Deferred III. Critical Projects & Results (Fiscal Year 2007)

16 B. Commonwealth Choice Status 1. Issue RFR and select Sub-Connector  2. Issue RFR, select and certify health plans  3. Issue minimum creditable coverage regulations  4. Develop Young Adult Plans  5. Develop Section 125 plan regulations and operations  6. Market “Commonwealth Choice”  7. Develop sales program and incentives, including brokers  III. Critical Projects & Results (Fiscal Year 2007)

17 C. Health Care Reform Status 1. Develop state-of-the-art web site  2. Set up public information and problem resolution unit  3. Secure funding to support Connector’s health care reform role  4. Develop Mandate waiver/appeals processIn progress 5. Launch public information campaign  6. Evaluate first yearIn progress III. Critical Projects & Results (Fiscal Year 2007)

18 D. Operations and Finance Status 1. Hire and orient staff, develop standard operating procedures In progress 2. Complete Connector move  3. Develop Connector budget and plan of operations  4. Establish financial controls and oversight for high volume of monthly transactions  III. Critical Projects & Results (Fiscal Year 2007)

19 Fiscal Year 2008 Goals (Draft) A.Commonwealth Care: Solidify program and continue enrolling members. B.Commonwealth Choice: Begin attracting members and fully launch employer services. C.Health Care Reform: Work towards short and long term success of health care reform through outreach, website enhancements, and program evaluation. D.Operations and Finance: Enhance infrastructure and reporting.

20 Overall Goal: Solidify program and continue enrolling members. Objectives: 1.Based on 2006 DHCFP survey data, cover virtually all qualified uninsured people whose incomes are below 300 percent of the federal poverty level (FPL) ▪Goal by 7/1/08 = 136,000 members 2.Control costs of contracting with MMCOs. 3.Refine program structure and operations to support continue growth and overall Connector objectives (e.g. S 125 rollout). A. Commonwealth Care IV. Fiscal Year 2008 Goals (Draft)

21 Overall Goal: Begin attracting members and fully launch employer services. Objectives: 1.Enroll nongroup members quickly ▪ Goal by 12/31/07 = 8,500 members ▪ Goal by 7/1/08 = 14,000 members 2.Establish fully automated Voluntary Employer services by 10/1/07 ▪ Goal by 12/31/07 = 7,000 members ▪ Goal by 7/1/08 = 14,000 members 3.Establish Contributing Employer services by 1/1/08 ▪ Goal by 7/1/08 = 7,000 m embers 4.Continue investing in website as a critical tool for businesses and consumers. 5.Develop coordinated management of key partnerships: ▪Health plans (Seal of Approval reprocurement); ▪SBSB and CSC. B. Commonwealth Choice IV. Fiscal Year 2008 Goals (Draft)

22 Overall Goal: Work towards short and long term success of health care reform through outreach, website enhancements, and program evaluation. C. Health Care Reform Objectives: 1.Enhance Connector’s role as an easy-to-use source of information on health reform (includes web site) and inform/train employers, brokers and affected parties. 2.Coordinate with other state agencies on health reform, including waiver renegotiation. 3.Define enforcement process for individual mandate. 4.Define key measures of how Connector’s health care reform will be evaluated and invite researchers to participate. 5.Begin to develop cost containment strategies to ensure health care reform’s longer term success. IV. Fiscal Year 2008 Goals (Draft)

23 Overall Goal: Enhance infrastructure and reporting. Objectives: 1.Achieve administrative breakeven budget by end of FY08. 2.Establish routine operational reporting for all Connector programs. 3.Ensure premium billing systems meet all programmatic needs. 4.Identify and implement operational efficiencies. D. Operations and Finance IV. Fiscal Year 2008 Goals (Draft)