Meeting Minutes
Board Attendees: Nancy Wyman, Comptroller, Co-Chair; Kevin Lembo, Healthcare Advocate, Co-chair; Bruce Gould; Paul Grady; Bonita Grubbs; Norma Gyle; Estela Lopez; Joseph McDonagh; Jamie Mooney; Marie Smith; Marie Spivey; Paul Lombardo for Thomas Sullivan; Rob Zavoski for Michael Starkowski; Cristine Vogel
Office of the Healthcare Advocate: Africka Hinds-Ayala; Vicki Veltri
Office of the State Comptroller: David Krause; Tom Woodruff
SustiNet Consultants: Linda Green; Katharine London; Anya Rader Wallack; Stan Dorn
Absent: Ellen Andrews; Michael Critelli; Jeannette DeJesus; Margaret Flinter; Nancy Heaton; David Henderson; Alex Hutchinson; Jeffrey Kramer; Sal Luciano; Lucy Nolan; Rafael Perez-Escamilla; Andy Salner; Marlene Schwartz; Todd Staub; Tory Westbrook
Kevin Lembo opened the meeting by welcoming all attendees and asking Board members and co-chairs to introduce themselves. Minutes from the May 12, 2010 and June 1, 2010 meetings were approved with no changes.
Anya Rader Wallack summarized her assistance with SustiNet Committees and Task Forces in writing reports by the July 1, 2010 deadline. The summary of the presentations made at the June 1st Board of Directors meeting was sent to all Committee and Task Force co-chairs for feedback. Anya welcomed input from Board members, saying there will be some major policy issues left unaddressed that will need to be addressed by the Board. She pointed out that health disparities weren't fully addressed as part of Task Force and Committee recommendations, and will need to be revisited more thoroughly in the future.
Anya opened the discussion on the proposed Board of Directors work plan for the period June through December 2010. To view Anya’s PowerPoint presentation, click here. Kevin suggested that public input on the Board’s recommendations be solicited earlier than scheduled, perhaps in September or October. Marie Spivey agreed, and said that the Commission on Health Equity would be interested in working with the Board on public forums. Marie Smith asked where analytics would fall under this proposed work plan. Anya said she felt it was a crosscutting issue, saying that all the Committees mentioned the need for data in order to conduct evaluations. Marie Smith said she felt this was very important and shouldn't be left until the end to work out. Anya said perhaps she could pull together an early draft of what should be included and then it could be revised later. Bruce Gould added that evaluations should not place a further burden on providers. Marie Smith said that she and Alex Hutchinson would like each of the Committees to determine the metrics for their respective groups. Jamie Mooney suggested looking at meaningful use measures as a starting point. Stan Dorn said that the recommendations to the Legislature don't need to be specific regarding metrics, but rather should designate general areas that the metrics need to address. Additional metrics could be determined as the plan unfolds. Anya said that the Provider Advisory Committee identified general areas, and made a clear statement that they should not be burdensome and that they should be drawn from nationally vetted sources.
Nancy Wyman stated that the financial discussion mentioned in the work plan needs to occur before November. Nancy asked Stan if there was any estimate of what it would cost to implement what the federal government will require in the federal healthcare reform package. Stan said he has been working with Jon Gruber and hopes to provide numbers within the next month or two. Nancy asked about funds that are currently being used that can be diverted, and also requested an estimate for providers who will need to implement HIT. She asked about the financial impact on hospitals, insurance companies and premiums. Stan said he didn't have figures for HIT implementation costs for individual doctors, clinics or hospitals. He said it was expected that health care spending will decrease when care coordination and HIT are employed because of the elimination of unnecessary tests, and said he would include these factors in the estimates. He also said he's working on the assumption that overall, implementation of HIT will drive costs down and keep premiums down.
Anya began the detailed discussion of the work plan, describing the core questions, baseline proposals and additional considerations and options. Anya presented some questions to the Board, beginning with asking if the subject matter for each meeting is laid out and staged in a way that makes sense. She asked if there were any additional topics needed. She also asked if there were additional considerations that should be added for any of the meetings. She wanted to know if any additional information or analysis was needed from the consultants, state agencies or other experts to assist with making decisions. Finally, she asked what criteria might be used to help set priorities within any of the known topic areas.
Anya agreed to prepare a primer for the July meeting.
Anya discussed considerations and options for each upcoming meeting, beginning with July. Stan added that the 2009 SustiNet legislation requires the Board to make recommendations for individuals who are not offered insurance who are ineligible for entitlement programs to enroll in SustiNet as of July 1, 2012. The legislation further provides that the Board recommend how the individual market as a whole will eliminate discrimination based upon health status. There was discussion about the importance of educating SustiNet participants as to what will be covered and how to identify SustiNet providers.
Rob Zavoski pointed out that federal guidance and interpretation of the federal reform act (the Affordable Care Act) is still under development, particularly by the Centers for Medicaid and Medicare Services. Much of the guidance may not be available in July. Anya said there will be gaps due to changes at the federal level, and this is something that will need to be revisited continually. Bruce said that a major concern for SustiNet is whether there are enough primary care doctors, and suggested there could be something on the exchange to assist patients with choosing doctors. An unidentified speaker said that there will be data needs for SustiNet, and recommended looking at Medicaid's data system earlier rather than later. Marie Smith suggested that some time be spent in determining what the data system will be expected to do. She said that it would be helpful for each Task Force and Committee to decide what they want to achieve, determine if the technology exists, and then go forward from there.
Anya discussed considerations for the August meeting, and there were no comments from Board members. She mentioned that in September the evaluation component would be included for consideration. There were no additional comments from Board members for the September or October meetings. As a result of the earlier discussion, Anya agreed to come up with a proposal for an earlier, organized process for public input rather than waiting to address this in November. Anya welcomed feedback on any aspect of the work plan, saying that either calling or e-mailing her would work. She said that before the next meeting the work plan would be revised. She also said she would be preparing for the initial big policy discussion.
Cristine Vogel wanted to know how the Board could become informed and educated in order to be effective. Anya said the Board will need to do lots of work prior to each meeting. Kevin pointed out the value in having representatives from DSS, the Comptroller's office and other involved parties who can share their expertise. Paul Grady asked that any relevant information be sent to Board members as early as possible. Norma Gyle expressed the sentiment that this was a bit overwhelming, saying she would like to see a comparison with Massachusetts’ efforts for health care reform so as not to reinvent the wheel. Anya said that all three consultants have extensive knowledge of MA’s plan and can easily provide comparisons. Bonita Grubbs requested subject matter experts who could give presentations on the various topics. Paul described the Rand study, which is posted on the SustiNet website, as being an excellent evaluation of the MA plan. Anya said it is a useful report that addresses an array of potential cost containment mechanisms that could be implemented in MA and the potential savings. However, she said it isn't specific to the MA reform or the structure of their exchange or related matters.
Kevin said there may be a need for more than one meeting in a month. He agreed to send any relevant information to Board members a week before each meeting. Kevin asked for opinions regarding the role of Task Forces and Committees after July 1. Bonita and Marie Smith both said that their respective committees would still like to be advisers during the process. Bruce said that it would be helpful to be able to consult with Task Force and Committee members during the writing process. Kevin said it would be up to the Board liaisons and Committee/Task Force co-chairs to determine how their involvement will continue.
Meeting was adjourned.
Next meeting will be 7/14/10 at 9:00 am.
