HUSKY Transition: Overview & Update

1. Connecticut Department of Social Services HUSKY Transition: Brief Overview/Update January 9, 2009

2. Voluntary transition began 9/08 • Voluntary transition of HUSKY member households began Sept. 1, 2008, from departing Anthem BlueCare Family Plan and Traditional Medicaid. • State’s 3 contracted health plans receiving members: Aetna Better Health; AmeriChoice by United Healthcare; Community Health Network of CT.

3. Over 106,000 members have switched • To date, households representing nearly 86,000 HUSKY A members have voluntarily left Anthem BCFP • Households representing more than 20,300 HUSKY A members have voluntarily left Traditional Medicaid. • 93,000 enrollees who were already in Community Health Network in September 2008 were not affected by the transition.

4. Key points: Migration fromAnthem, Medicaid • Most households voluntarily switching so far have chosen incumbent health plan Community Health Network of CT, which has long-time provider network in place. Enrollment in CNHCT has grown from about 93,000 to about 158,000. • Provider networks in new health plans Aetna Better Health & AmeriChoice by United Healthcare have made significant gains and continue to develop.

5. Next Steps: Transition nears completion • State of Connecticut and federal government have approved the process to move forward. • U.S. Centers for Medicare & Medicaid Services has approved Connecticut’s managed care contracts with Aetna Better Health, AmeriChoice by United Healthcare & Community Health Network of CT. • CMS has authorized mandatory enrollment. This will take effect Feb. 1, 2009, for households in Anthem BCFP & Traditional Medicaid that have not chosen new plan by Jan. 30.

6. Next Steps: Member notice process • Approximately 56,900 HUSKY A member households were mailed notices at the end of December. These were the households in Anthem BCFP and Traditional Medicaid that had not chosen a new plan by that time. [HUSKY B note: 4,475 households of HUSKY B member children in Anthem BCFP were also sent notices. By 1/6/07, the number of HUSKY B Anthem households had dropped to 3,170.] • Since the notices were mailed, several thousand members have changed plans. The number of individuals self-selecting one of the 3 managed care plans is increasing daily. • DSS is scheduling a second notice that will remind remaining Anthem BCFP and Traditional Medicaid members about changing plans by January 30.

7. Migration from Anthem BlueCare Family Plan & Traditional Medicaid by the numbers

8. Summary: Transition almost complete • Of the total HUSKY A population of about 153,000 households, the number still in Anthem and Traditional Medicaid at the end of December 2008 was about 56,900.  • This number drops incrementally each day as families pick new plans. Consequently, the number of families subject to having DSS pick a new plan for them because they have not done so by the end of January will be considerably lower than the 56,900 receiving notices at the end of December. • Customer service support is in place to mitigate any problems for families changing plans.  This includes the long-time 2-1-1/HUSKY Infoline service, which also will make outbound calls to families over the month. Customer service points at health plan membership services and ACS (HUSKY enrollment center) also assisting.

9. Capacity • Formulas are based on pre managed care ratios of providers to members • And utilization of services by members of various categories of PCPs • The three PCP groupings used for capacity are: • Adult • Children • Women

10. Capacity Adult providers include: • Family practitioners, general practitioners, internists, and NPs and PAs working in those areas Child providers include: • Family practitioners, general practitioners, internists, pediatricians, and NPs and PAs working in those areas Women providers include: • OB-GYN, Nurse Midwife, and NPs and PAs working in those areas

11. Capacity General practitioners, family practitioners, internists, and NPs and PAs who work in these areas are split between adult and children’s capacity i.e. One family practitioner = .67 providers for adult capacity and .33 providers for children

12. Capacity Ratio of PCP to total members enrolled: • Adult providers 1 to 387 • Children providers 1 to 301 • Women providers 1 to 835

13. HUSKY Enrollment & Capacity

14. Charter Oak Enrollment & Capacity

15. Specialists by Plan HUSKY *Includes Dermatology, Gastroenterology, Geriatrics, Infectious Disease, Neurosurgery, Podiatry, Pulmonary Disease, Rheumatology, Thoracic Surgery, Urology, Vascular Surgery, Other

16. Specialists by Plan Charter Oak *Includes Dermatology, Gastroenterology, Geriatrics, Infectious Disease, Neurosurgery, Podiatry, Pulmonary Disease, Rheumatology, Thoracic Surgery, Urology, Vascular Surgery, Other

17. Plan Assignments • Members who do not choose a plan by 1/30 will be assigned into one of the two new plans. • This is done to develop sufficient critical mass in the two new MCOs more quickly to ensure viability, and • So as to not overwhelm CHN administratively. • Automatic plan assignment will occur up to 85% of a new plan’s capacity. If that should occur, CHN will then begin receiving default enrollments again. • Arizona, Delaware, Illinois, and New Mexico also did this for their new plans when they re-procured their contracts

18. Transition Care Coordination • MCO Medical Directors’ input was solicited as to what data should be sought from the prior plan for transitioning members • Bimonthly data exchanges include information for members who: • Are in case management, including pregnancy • Are in disease management • Are inpatient • Have existing prior authorizations • Members transitioning from TM to a plan receive data for members who: • Pregnant • Receiving home health care • Have a recent inpatient stay

19. Transition Care Coordination, continued • In addition, all plans will routinely be receiving dental, behavioral health and pharmacy activity data of their members. • Protocols for referrals between the plans, and the Behavioral Health Partnership and Benecare are in place. • The Behavioral Health Partnership and the plans refer members requiring co-management (medical and behavioral health services) to each other.

20. Coordination for HUSKY members with prescheduled ongoing trips (e.g. dialysis, therapy) • Members switching from Anthem to Aetna or AmeriChoice: • will continue to receive NEMT from LogistiCare • Anthem members switching to CHNCT       • Logisticare is passing prescheduled trip information to CTS, CHNCT’s NEMT vendor • TM clients switching to the MCOs • Logisticare will continue to provider services for those in their service area that switch to Aetna or AmeriChoice • Arrangements are being made with FirstTransit to transfer info to LogisitCare or CTS   

21. PCCM Pilot Areas • Waterbury: 4 practices, including: • 16 Pediatricians • 8 Internal Medicine physicians • 6 Internal Medicine / Pediatric physicians • 7 Nurse Practitioners (family, children, and obstetrics) • 1 Certified Nurse Midwife • 4 Physician Assistants included in these practices • Mansfield/Windham: 3 practices, including: • 5 Pediatricians • 2 Family Medicine physicians • 4 Nurse Practitioners (for adults and families)

22. PCCM Member Mailings • Member mailings are being sent to households of existing patients of participating PCPs • Waterbury area: 6,153 households • Mansfield/Windham area: 2,229 households • Mailing to include January 30, 2009 date of deadline for BCFP and TM member switch • No deadline for PCCM enrollment for targeted households • Remind members of available customer service • Remind members of ongoing ability to change between plans or PCCM (No Lock-in)

23. PCCM Provider Advisory Group • First meeting was Tuesday, January 6 • Included providers from the pilot areas and applicants from other areas • Regular meetings to occur • Subcommittees include: • Care coordination • Disease management • Program evaluation