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Lessons from Massachusetts Health Reform: Organizing for Success

Explore the key elements of MA Health Care Reform, including the role of the Health Connector in implementing programs, defining coverage standards, and overseeing waivers and appeals. Learn how strategic outsourcing, stakeholder support, and a state-of-the-art website helped expand access to healthcare. Discover the lessons learned for successful implementation and growth in Commonwealth Care and Commonwealth Choice.

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Lessons from Massachusetts Health Reform: Organizing for Success

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  1. Organizing Health ReformEarly Lessons from Massachusetts Rosemarie Day Deputy Director and Chief Operating Officer Commonwealth Health Insurance Connector Authority State Coverage Initiatives National Meeting Nashville, Tennessee Thursday, February 7, 2008

  2. Key element of MA Health Care Reform Share the responsibility

  3. Government’s RoleMultiple State Agencies Involved

  4. Health ConnectorOrganization • Health Connector was established by the law as an independent public authority overseen by a board of ten directors. • Many key policy decisions left to Connector Board • Organization was free from some state agency constraints (e.g. hiring, procurement).

  5. Launch and administer Commonwealth Care program Launch and administer Commonwealth Choice program Define minimum creditable coverage Establish Affordability standards Promulgate regulations on S. 125 Plan requirement for Mass employers Administer waivers and appeals related to the individual mandate Health ConnectorKey Tasks

  6. Health ConnectorRapid Ramp-up • Law passed April 2006. • Executive Director was hired in June 2006. • First Board meeting was held on June 7, 2006. • Core staff was hired during the summer and fall of 2006. • CommCare implemented October 1, 2006. • CommChoice implemented May 1, 2007.

  7. Health ConnectorStrategic Outsourcing

  8. Young Adults Indiv.& Families Small Biz. Voluntary Plans Health ConnectorRole in insurance market

  9. Health ConnectorState-of-the-art Website

  10. ResultsBroadened Access (as of 1/1/08) • Net new commercial insurance 100,000 • (includes almost 16,000 with • coverage through Commonwealth Choice) • Commonwealth Care ~170,000 • Medicaid enrollment growth 70,000 • ________ • TOTAL > 300,000

  11. ResultsSteady Growth in Commonwealth Care As of 1/1: 168,924 members - 42,114 premium paying - 126,810 no premium

  12. ResultsSteady Growth in Commonwealth Choice

  13. Health ConnectorImplementation Lessons Overall, implementation has been helped by: • Tight deadlines • Continued stakeholder support • Flexibility in the law • Board of Directors • Partnerships with existing state agencies • Sufficient start-up funds

  14. Health ConnectorImplementation Lessons Specifically, Commonwealth Care implementation was facilitated by: • Existing MassHealth infrastructure • Uncompensated Care Pool “members” • Auto-assignment • Virtual Gateway infrastructure • Outreach grants

  15. Health ConnectorOverall Lessons • Be a “virtual organization” (buy, don’t build) • Take incremental steps (“walk before run”) • Over-prepare for every Board meeting • Be a “learning organization”

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