A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Connector Reports on Progress, and Challenges (6/11/15 Board Meeting Report)

Connector Reports on Progress, and Challenges (6/11/15 Board Meeting Report)

June 12, 2015

Yesterday, the Connector Board met to:

  • Discuss the Connector’s progress in improving customer service, operations, and IT systems;
  • Approve Administration & Finance subcommittee members;
  • Discuss planning underway for the next open enrollment period;
  • Approve contracts with vendors for operations and media/messaging work;
  • Share updates on the 2015-2016 Student Health Insurance Plan procurement; and
  • Approve final repeal of Commonwealth Care regulations.

Materials from the meeting are posted here https://www.mahealthconnector.org/about/leadership/board-meetings. For the first time in a long while, the board meeting was covered in the Globe, WBUR and other outlets. But for the full story, our detailed report is just a click away:

Executive Director’s Report

Louis Gutierrez, Executive Director of the Health Connector, kicked off the meeting with some updates on the Connector’s progress. He said that their focus since February has been on improving customer service and operations. With Patricia Wada and Health Connector COO Vicki Coates at the helm, they completed a six week operational assessment that uncovered deeper issues than expected, including customer service and payment problems. The Connector has been working to resolve individual cases while addressing root causes, and is stepping back from new functionality to focus on stabilizing the current system. As such, they have made big improvements but much consumer frustration remains.

Regardless, there have been consistent month-to-month increases in enrollment. As of June 1st, 158,000 people were enrolled in health insurance through the Connector, including 112,000 in ConnectorCare, up from 146,000 in May. Over 41,000 people are enrolled in dental plans through the Health Connector.

Last, Gutierrez announced that risk adjustments settlement figures will be available at the end of June.  Risk adjustment is a process set up through the Affordable Care Act (ACA) to reinforce market rules that prohibit insurers from only covering healthy individuals by transferring funds from plans with lower-risk enrollees to plans with higher-risk enrollees. According to Gutierrez, Massachusetts plan payment transfers will more moderate than originally forecasted.

Vicki Coates, the Health Connector’s Chief Operating Officer, provided an overview of the Health Connector’s operations work to improve the call center, resolve cases, and make systems changes.

  • Call Center: call center performance has improved due to increase in staff, decrease in absenteeism, decrease in after call handle time and decrease in overall call volume.
  • Urgent Cases: The backlog of urgent cases has continued to decline; the Connector helped over 1500 members to date and another 300 have been contacted, with resolutions expected by the end of June. At various points, many cases were unable to be resolved due to lack of systems functionality.
  • Account Changes: In May, systems functionality was put in place to enable customer service representatives to make changes to members’ accounts. At the peak there were 10,000 changes in a backlog, and as of yesterday, this number was down to 600.
  • Premium Billing: As of June 19th, the Health Connector will have issued checks to all members who requested refunds (about 900). An additional 810 members whose premiums were misdirected to the wrong account (i.e. dental instead of medical, old account instead of new account) have had premiums re-directed to the appropriate account. The Connector has put in strict controls to redirect payments to the appropriate account.
  • Verifications: The Health Connector began processing eligibility verifications, reducing the backlog from 44,000 to 16,000, with the remainder targeted to be processed no later than August 30th.

Connector Board member Michael Chernew, a health economist from Harvard Medical School, suggested that the Connector dive deeper and release more data about the types of issues being heard by customer service representatives and how they relate to IT system functionality. Louis Gutierrez responded that the Connector has multiple dashboards tracking several aspects of their IT and operations work – he will share this information with the board and aim to get board members’ perspectives of additional data to collect.

EOHHS Secretary and Connector Board Chair Marylou Sudders suggested that it would be helpful to have a public dashboard to help ensure public confidence. She also commented that she has seen a change in the number of consumer complaints since January, as she has heard from several consumers directly. Coates responded that they will aim to have an “executive dashboard” available at the end of the month.

Administration & Finance Subcommittee

The Board voted to approve Secretary Sudders and Executive Office of Administration and Finance Secretary Kristen Lepore as members of the Connector Board’s Administration and Finance subcommittee. Board member Celia Wcislo will also remain on the committee.

Open Enrollment 2016 Update

Renewals plan

The Health Connector has begun preparations for the next open enrollment period, which runs from November 1, 2015-January 31, 2016. Major work areas include:

  • Plan management: Seal of Approval (SoA) process for Qualified Health Plans (QHPs), including ConnectorCare, and Qualified Dental Plans (QDPs).  Health Connector will vote on conditional Seal of Approval at the July meeting. Once rates are available later in the summer, the Connector will be able to test plan details and readiness on their website.
  • Renewals & redeterminations:  Unlike the 2015 open enrollment period, when all those seeking coverage needed to complete a new application, the 2016 open enrollment period will offer a more passive and streamlined enrollment experience. All current Health Connector enrollees who remain eligible do not need to take action unless they choose to switch plans.
  • Release management: The Health Connector, MassHealth and MassIT teams, led by Patricia Wada, will continue to implement new functionality in the IT system. Key releases will happen throughout the summer and early fall.

Dimitry Petion, the Connector Board’s small business representative, asked why the provider search and payment processing functions were in the “to be determined” bucket, as they are key functionalities for a successful consumer experience. Gutierrez said that as they found they needed to repair some basic functionality, new functionality needed to fall under “TBD.” He said that there will be a provider search function and payment processing capabilities; what is TBD is whether these functionalities will be integrated into the HIX system or will operate outside the system. They are trying to repair the existing payment portal and include consumer protections from double payment and include the ability for consumers to see the correct invoice amount.

Chernew asked about whether there has been usability testing with consumers and plans, in addition to testing to make sure the system works. Wada responded that a number of user interface (“UI”) issues come from the call center, and the IT teams look at that to identify the root cause. Ops teams at MH and CCA do testing in multiple swim lanes: Quality assurance (QA) – make sure it works correctly and “user acceptance” – subject matter experts from MassHealth and the Connector do end-to-end tests using different scenarios, testing the most complicated cases.

Contract Approvals

The Connector Board approved several contracts and extensions:

  • Dell Marketing Services: Up to $4.8 million for IT systems modifications and testing in for the next open enrollment period; and up to $1.867 million to improve customer service.
  • Weber Shandwick: up to $2.5 million for outreach, media and messaging, targeting the remaining uninsured, returning members, and the general public, shifting from broad-based media platforms to local outlets, ethnic media, and other outlets, such as billboards, local stores and gas stations.
  • Lease Renewal: Renewing the lease of the Health Connector’s current office space.

With regards to the Weber Shandwick contract, board member and broker representative Mark Gaunya asked why $450,000 had been earmarked for the SHOP (former known as Business Express), when it has such low membership (about 5,000 people) and these funds could be used for other priorities. Connector Communications Director Jason Lefferts responded that unfortunately, the Connector lost about half of the SHOP membership in the ACA transition as sole proprietors moved into the non-group market. Gutierrez said the Connector staff will go back and consider rebalancing the SHOP funding.

Petion asked why the Connector has yet to develop appropriate messaging to reach the remaining uninsured. Lefferts said that the Connector is being thoughtful in their decision to move from broader media like TV to a more community-focused strategy. Connector Deputy Executive Director Ashley Hague added that for the first time the Connector is the one entrance for both MassHealth and Connector members, and there is a need to look at both populations. Petion said that the Connector needs to look at measurable results from the outreach efforts to effectively reach the uninsured. Secretary Sudders applauded the community-based outreach approach as it is a goal of the Commonwealth to reach the 4% of residents who are uninsured.

Student Health Insurance Update

For several years, the Health Connector has served as the facilitator of the health insurance procurement process for state universities, community colleges and most of the UMass campuses. By way of background, Massachusetts has required college students to enroll in health insurance – and colleges and universities to offer health insurance – since 1989. Students can waive this coverage if they are enrolled in comparable coverage, which now includes MassHealth and subsidized coverage through the Health Connector. Due to new rules under the ACA which allowed more students to become eligible for MassHealth and Connector coverage, enrollment in students health insurance plans (SHIPs) has been decreasing since 2014.

Heather Cloran, the Connector’s Associate Director of Program and Product Strategy shared results of the 2015-2016 academic year procurement. Participating schools included UMass Lowell, Dartmouth Boston and Worcester, each of which purchased insurance separately; all state universities (9 schools purchasing together); and all community colleges (16 schools purchasing together). Premiums decreased for five out of the six participating groups of schools (only the state universities saw an increase).

Gaunya commented that in materials the board received, it stated that the Blue Cross Blue Shield of Massachusetts (BCBSMA) SHIP plans had a medical loss ratio (i.e. percentage of premium spent on medical claims versus administrative, marketing and other uses) of 150% and questioned whether there is a threat of adverse selection (i.e. only sicker students signing up for the plan). Hague responded that it was a business decision for BCBSMA to do this and that due to the population, there is not much threat of adverse selection. Many students waive out of their school’s insurance by staying on their parent’s plan or accessing subsidized health coverage (if they are Massachusetts residents). Cloran added that yes, the BCBSMA rates are underfunded but they can handle it.

Repeal of Commonwealth Care Regulations

Commonwealth Care, the Connector’s subsidized health insurance program for residents below 300% of the federal poverty level, ended on January 31, 2015. In its place, the Connector created the ConnectorCare program, utilizing federal subsidies and state funds to keep coverage affordable for this population. At the last meeting in April, the board voted to approve releasing the repeal of the Commonwealth Care regulations for public comment. The Connector did not receive any oral or written testimony on the repeal. At yesterday’s meeting, the board approved the final repeal of the Commonwealth Care regulations.

The next Connector Board meeting is scheduled for Thursday, July 9th at 9:00am, 1 Ashburton Place, 21st floor.

     - Suzanne Curry