SustiNet Board of Directors Recap of Board Decisions Summary of Survey Reponses on “Additional Questions” December 15, 2010

Recap of December 2 Meeting 12/15/2010 2

Key agreements from 12/2 (1 of 3) Structure and governance Independent authority, governed by board For a time-limited period, use existing agency staff Maximize administrative resources outside the General Fund (e.g., federal Medicaid dollars) Enrollee populations Medicaid/HUSKY, state employees and retirees As soon as feasible, offer to municipalities, small firms, non-profits  Can start with municipalities (building on MEHIP experience) By 1/2014, offer to all firms and individuals, inside and outside exchange  Before that date, take such steps as developing business plan demonstrating feasibility  To prevent adverse selection, can experience-rate employers large enough to self-insure 12/15/2010 3

Key agreements from 12/2 (2 of 3) Delivery system and payment reforms Specific reforms  PCMH – strongly encourage, provide incentives and technical assistance  HIT – implement, in coordination with broader efforts, using leverage and federal dollars (not General Fund resources)  Incentives for evidence-based care that leave room for individual clinical judgment  Payment reforms - refocus incentives on promoting better health outcomes Structure  Flexibility to modify reforms, based on evolving evidence  Important for SustiNet to retain savings  Support multi-payer initiatives  May need to modify licensure laws to increase permitted scope of practice for advance practice nurse practitioners, etc.  Focus on reducing disparities Multi-year campaigns to achieve measurable objectives related to disparities, chronic disease, and other strategic issues 12/15/2010 4

Key agreements from 12/2 (3 of 3) Coverage/access policies beginning before 1/1/2014 State agencies and legislature work together to find resources Through HUSKY, cover childless adults up to 185% FPL  Starting 7/1/2012, provided funding source can be identified Re-align and restructure Medicaid and HUSKY payment levels  Re-align to Medicare payment levels, where appropriate. Exceptions:  With some services, Medicaid payment does not need to increase  With some populations and services, a benchmark other than Medicare is needed (e.g., pregnant women and children)  Begin on 7/1/2012, gradually phase-in over time. Full implementation requires identifying funding sources. Coverage/access policies beginning on 1/1/2014 HUSKY up to 133% FPL, implementing Medicaid expansion in federal law HUSKY from % FPL, implementing Basic Health Program (BH) option  Increase payment rates to reflect excess of federal BH funding over general HUSKY capitated rates 12/15/2010 5

Board Survey Results 12/15/2010 6

Areas of agreement: more than 2/3 support (1 of 3) Who should be added to the Board?  Individuals with specific expertise  Consumer representatives Advisory committees should include topics recommended by advisory committees and task forces Board should have authority and flexibility to merge committees and to establish new committees as circumstances change. Suggestions include:  Outcomes, including quality, safety, disparities  Delivery, including medical home and prevention  Prevention, including obesity, tobacco  Payment 12/15/2010 7

Areas of agreement (2 of 3) Board should have the authority to appoint an Executive Director Board should have the responsibility and authority to establish and monitor key metrics and to update these over time. Suggested topics include:  Access, provider participation  Cost, efficiency  Quality, safety, health outcomes; disparities reduction  Enrollee and provider satisfaction, patient experience Board should have authority to implement benefit design changes and delivery system reforms within broad framework established by legislature; legislature should weigh in on substantive changes to that framework 12/15/2010 8

Areas of agreement (3 of 3) Malpractice safe-harbor for those who follow practice guidelines State should spend $ on disparities reduction, overall wellness and prevention, workforce enhancements Offer SustiNet to new employer groups as soon as is feasible before 2014 (e.g. to municipalities, small businesses, not-for-profits)  Determine cost, funding, pricing  Resolve operational and logistical issues, licensure, underwriting, etc.  In analyzing feasibility before 2014, basis for determining whether state should offer a “competitive product”: provides value, underwriting losses don’t increase deficit Value of employer role 12/15/2010 9

Areas of some disagreement (1 of 2) Interest groups or elected officials on board? e.g.  Community Health Center Association of CT (CHCACT)  Primary Care Coalition of CT Who should appoint board members?  Governor and legislative leaders appoint specific members, similar to appointments of current Board, or  Current Board with nominating committee appoint new members Consumer representation on Board?  Consumers sit on Advisory Board only  Consumer Advisory Board elects a member to sit on the governing Board  Consumer representative selected by: Board, consumer organizations, CHCs, labor leaders, small business leaders, elected official(s)  Include consumer representative from each county 12/15/

Areas of some disagreement (2 of 2) Whether committees should be established in legislation Whether state should spend $ on obesity, tobacco cessation or other public health initiatives  Board members expressed concerns about funding  Several Board members felt they had insufficient information to set priorities Whether, when the Board is preparing to offer a “competitive product” to firms and individuals:  It may incur start-up costs that could affect the state’s budget deficit, or  It must identify alternative funding to cover start-up costs 12/15/