J_HCE_2016A 08/02/2016 09:01:00 AM Committee Summary

09:01 AM -- Enrollment Enhancement and Expansion Presentation



Representative Primavera called the meeting to order. The meeting agenda was distributed to the committee (Attachment A).



160802 AttachA.pdf



09:03 AM



Dick Cauchi, National Conference of State Legislatures (NCSL), presented to the committee on other states enrollment efforts. He provided the committee with an informational packet (Attachments B and C). Mr. Cauchi discussed the states that use social media to engage exchange clients, including Connecticut, Idaho, and Washington. He referenced the bus tour that California's exchange conducted. Mr. Cauchi further discussed the efforts to engage clients in Massachusetts, including various advertising strategies. He discussed how Hawaii partnered with nonprofit organizations to reach potential exchange clients.



160802 AttachB.pdf160802 AttachC.pdf











09:11 AM



Mr. Cauchi discussed the confusion that the open enrollment period communications can create on certain state websites. He discussed the importance of personal connections through navigators, assisters, community partners, agents, and brokers. He referenced The Commonweath Fund report (Attachment D) and highlighted issues related to affordability as key concerns when people choose whether or not to enroll in health insurance plans. He discussed the additional information that NCSL has available about state-based exchanges.



160802 AttachD.pdf



09:16 AM



Mr. Cauchi answered questions about life changing events that qualify persons to enroll in an insurance plan outside of the open enrollment period, which efforts are most effective in expanding enrollment, and whether people in other states select plans but then do not make premium payments. Committee members continued to dialogue with Mr. Cauchi about exchange usage in other states. He referenced a document from the Washington Health Benefit Exchange concerning enrollment (Attachment E). Mr. Cauchi responded to questions about whether other states have establish policies that drive business to the exchange.



160802 AttachE.pdf



09:29 AM



Kevin Patterson, Connect for Health Colorado, discussed the information presented by NCSL. A handout was distributed to the committee (Attachment F). He discussed how the states are trying to learn best practices from one another regarding enrollment. He explained the marketing and outreach strategies of Connect for Health Colorado (the exchange) and the efforts to make these strategies more cost-effective and targeted. Mr. Patterson said that the outreach efforts in the next open enrollment will be targeted to certain geographic areas that have high eligible-but-not-enrolled populations. Mr. Patterson discussed the communication between Connect for Health Colorado and the Department of Health Care Policy and Financing (HCPF) to reach clients that have been denied Medicaid, but who could qualify for other financial assistance for health insurance through the exchange.



160802 AttachF.pdf



09:33 AM



Mr. Patterson responded to committee members comments about Medicaid fraud, the various outreach efforts that the exchange could avail themselves of to improve enrollment, and efforts to reach younger populations. Mr. Patterson answered questions about the communication between Connect for Health Colorado and HCPF regarding potential enrollees and whether the issue regarding HCPF reimbursing the exchange for enrolling Medicaid clients had been resolved. Committee discussion about enrollment efforts ensued.















09:46 AM



Mr. Patterson discussed the social media efforts of the exchange. He answered questions about broker engagement by the exchange and efforts to communicate information related to tax penalties for not having health insurance. Mr. Patterson answered questions about the implementation of House Bill 16-1148, concerning the oversight authority of the committee with regard to policies that affect consumers proposed by the exchange. Taylor Roddy, Connect for Health Colorado, joined Mr. Patterson to answer questions about the exchange's branding strategies.



9:57 AM -- All Payer Claims Database Presentation



Ana English, Center for Improving Value in Health Care (CIVHC), presented to the committee about CIVHC and the All Payer Claims Database. She provided a powerpoint handout to the committee (Attachments G). Ms. English discussed the data that CIVHC collects, which goes back to 2009. In response to a questions, she said that CIVHC's budget is $5 million.



160802 AttachG.pdf



10:04 AM



Tracey Campbell, CIVHC, discussed the non-public release of information by CIVHC. She said that CIVHC does not receive direct state funding, but charges a fee for data. She outlined the various guidelines for non-public releases of data and the entities that access the data. Ms. Campbell discussed the CO Medical Price Compare Data Showcase and the Comprehensive Care Joint Replacement Program. She discussed the new web portal for report delivery that will be launched later this year.



10:15 AM



Ms. Campbell outlined the public releases of data that CIVHC provides. She highlighted the breast cancer screening rates for Medicaid clients. Ms. Campbell answered questions about how the data can be used by communities to address certain issues. Ms. Campbell and Ms. English answered questions about the funding and budget for CIVHC.



10:24 AM



Ms. Campbell discussed the CIVHC's reports related to the Colorado Commission on Affordable Health Care (Attachment H) and the Cost Driver Spot Analysis reports prepared by CIVHC (Attachments I, J, and K).



160802 AttachH.pdf160802 AttachI.pdf160802 AttachJ.pdf160802 AttachK.pdf





10:29 AM



Taylor Roddy, Connect for Health Colorado, discussed the partnerships between Connect for Health Colorado and CIVHC. A powerpoint handout was provided to the committee (Attachment L). She explained the tool that is being developed to allow exchange clients to evaluate monthly premiums, yearly out-of-pocket costs, and insurance plan information.



160802 AttachL.pdf



10:32 AM



Ms. Campbell answered questions about release guidelines, if the data is deidentified, and who owns the data. She told the committee that the vast majority of the data is deidentified. She explained that there are limited circumstances when researchers could access identified data, but those researchers would need to meet guidelines and sign certain agreements. She stated that the data is owned by the state, but CIVHC is the administrator. Ms. English and Ms. Campbell further discussed the security of the data maintained by CIVHC.



10:41 AM



Ms. Roddy and Ms. English answered questions about the ability to identify those who are uninsured. Committee discussion about cyber security ensued. Ms. English and Ms. Roddy answered questions about the out-of-pocket cost data that the cost-analysis tool will provide to consumers. NCSL provided a handout concerning states that have all-payer claims databases (Attachment M).



160802 AttachM.pdf



10:50 AM -- Single Geographic Rating Study Presentation



Commissioner Marguerite Salazar, Division of Insurance, presented on the Single Geographic Rating Report. An informational packet was provided to the committee (Attachments N, O, P, and Q).



160802 AttachN.pdf160802 AttachO.pdf160802 AttachP.pdf160802 AttachQ.pdf



10:56 AM



Michael Brown, Lewis and Ellis, Inc., discussed the purpose of the report. He reviewed the current factors used in rating and the current regions in Colorado. Mr. Brown discussed common cost patters by region and the total cost of care. Mr. Brown answered questions about the total cost of care data. He reviewed the cost per service for outpatient visits for various regions. Mr. Brown answered questions about the data and geographic regions.













11:12 AM



Mr. Brown discussed the key impact scenarios for going to one rating region. He said that there are currently seven states that have a single rating region. He highlighted the impacts to consumers, carriers, and the insurance market if the state were to move to one rating region. Mr. Brown discussed the regulatory considerations for both continuing with nine rating regions and shifting to one rating region. He stated that his recommendation was to keep the current regions, but introducing a rating band, and that he does not recommend moving to one rating area.



11:26 AM



Mr. Brown answered questions about the report and recommendations, including establishing a rating band. Commissioner Salazar responded to comments from the committee about addressing why health care costs in certain areas are higher. She discussed the establishment of a stakeholder group to study ways to control the underlying health care service costs, which was done at the direction of the Governor. She said she hopes to have the recommendations from the stakeholder group available by December 1, 2016. Commissioner Salazar responded to questions about the use of imaging in certain areas and the possibility of communicating with providers about the reasons for the high use of imagining in certain areas of the state. Mr. Brown clarified that the costs are based on the patient's address and do not reflect people who live out of state who are injured in Colorado.



11:41 AM -- Discussion about Rural Health Insurance Rates



Cindy Sovine-Miller, Colorado Commission on Affordable Health Care, presented to the committee on rural health insurance rates. She provided a handout to the committee (Attachment R). She highlighted page 3 of the handout that provides information about trends in Colorado coverage. She discussed the increase in Medicaid clients and stated that there was not a proportional increase in Medicaid providers. Ms. Sovine-Miller reviewed information that was collected in statewide meetings about competition, technology, workforce, and workforce pipeline. She discussed the importance of preventative care. She stated that the commission will issue a report in November with recommendations and feedback from stakeholders.



160802 AttachR.pdf



11:53 AM



Michelle Mills, Colorado Rural Health Center, reviewed the challenges facing rural Colorado, including higher insurance premium rates, consumer demographics, and time and access to care. She provided two handouts to the committee (Attachments S and T). She stated that 13 counties do not have a hospital. Ms. Mills reviewed the opportunities to meet rural needs outlined in Attachment S. She stated that case managers could be effective in reducing the cost of care, but there is no payment method for case mangers. She discussed the importance of preventative care and rural citizens accessing care in the metro areas. Ms. Mills responded to questions about the difficulties to integrating care in rural areas. Ms. Mills continued to dialogue with the committee about rural health care costs.



160802 AttachS.pdf160802 AttachT.pdf













12:12 PM



Cindy Palmer, Colorado Choice Health Plans, discussed the efforts of her organization to serve underserved populations. She discussed the rural population and the provider community in rural areas. She stated that rural areas have a higher percent of Medicare, Medicaid, and uninsured populations. She referenced the impact of legalized marijuana on rural emergency rooms. Ms. Palmer discussed creating pathways of care for those from rural communities to allow information to be shared between providers. She discussed the use of imaging, continuity of care, the need to control the cost of pharmaceutical drugs, and evaluating the cost-per-unit of care, which is driven by the provider community.



12:25 PM -- Public Comment



Representative Primavera announced the upcoming committee meetings scheduled for August 24 and October 5. A Legislative Council Staff memorandum regarding insurance premium tax credits for contributions to the health exchange (Attachment U) was distributed to the committee.



160802 AttachU.pdf



12:26 PM -- Joel Ryan, Mountain Midwifery Center, testified before the committee. He stated that insurance companies do not want to contract with his business. He referenced a paper by the Federal Trade Commission concerning midwifery. He discussed the practice of midwifery, the lack of utilization of midwives by certain insurance carriers, and the need to regulate the health care market.



12:31 PM -- Jennifer Gaughan, Integrated Pediatric Healthcare, testified before the committee. She discussed nurse practitioners and that certain health insurance plans offered through the exchange do not contract with certain providers. Ms. Gaughan answered questions from the committee. Senator Aguilar stated that there is nothing that compels insurers to contract with providers.



12:37 PM



Senator Martinez Humenik asked that at the next meeting Connect for Health Colorado address issues related to special enrollment periods for pregnancy.



12:38 PM



The committee adjourned.