Exchange Implementation Advisory Committee May 31, :00pm-5:00pm UMBC Tech Center 1450 S. Rolling Road Baltimore, MD 21227

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Exchange Implementation Advisory Committee May 31, 2012 2:00pm-5:00pm UMBC Tech Center 1450 S.

Jeffrey Warner (by phone) Sandy Walters Louisa Tavakoli Lesley Wallace (by phone) Mary Lou Fox (by phone) Douglas Templeton Ken Hunter (by phone) Lee Diemer Heather Grzych (by phone) John Fleig

1 Exchange Implementation Advisory Committee May 31, :00pm-5:00pm UMBC Tech Center 1450 S. Rolling Road Baltimore, MD Members Present Tequila Terry (Co-Chair) Kevin Yang (Co-Chair) Vincent Ancona Linda Dietsch (by phone) Stephanie Scharpf (by phone) Julia Huggins Kathy Simmons Jeffrey Warner (by phone) Sandy Walters Louisa Tavakoli Lesley Wallace (by phone) Mary Lou Fox (by phone) Douglas Templeton Ken Hunter (by phone) Lee Diemer Heather Grzych (by phone) John Fleig Members Absent Paul Kniskern Peter Beilenson Kevin Gavin Welcome and Introductions Tequila Terry, Director of Plan & Partner Management at Maryland Health Benefit Exchange introduced and welcomed the Exchange Implementation Advisory Committee (EIAC) members and guests to the meeting. Committee members introduced themselves to those assembled. Quality Process Ms. Terry introduced guests Sharmaine Robinson, Chief of Health Benefit Plan Quality and Performance at the Maryland Health Care Commission (MHCC), and Bruce Kozlowski, Director of the Center for Health Care Financing and Health Policy at MHCC. Ms. Robinson and Mr. Kozlowski presented to the committee an overview of the quality measurement process.

2 Ms. Robinson began by presenting background information on evaluation and public reporting. She focused on the state of Maryland s report card for Managed Care Organizations (MCOs), who can use the report card data, as well as the scope of the data. Ms. Robinson explained three quality tools (otherwise known as health sampling tools) such as CAHPS, HEDIS, and evalue8, and the three phases within them. Ms. Robinson, in conjunction with Mr. Kozlowski, gave details on the sampling method, determining factors, data collection methods, process, and timeline for each of the three health sampling tools presented. CAHPS- The Agency for Healthcare Research and Quality s (AHRQ) Consumer Assessment of Health Providers and Systems (CAHPS). This survey measures consumer experience and is intended for consumer, provider organization, and regulator use. Additional information: o Eligible Population: > 18 years o Sample Size: 1,000-1,320 o Additional Questions: Up to 20 HEDIS- The National Committee for Quality Assurance s Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS uses clinical data, and is a quality and performance measurement tool to inform consumers, health plans, and providers. Additional information: o Eligible Population: Varies by measure o Sample Size: A: Total pop. H: % o Additional Questions: MHCC Behavioral Health evalue8- Evidence-based health benefit plan Request-for-Information survey. Additional information: o Measurement of performance percentage o Measurement of performance points o Maryland-specific, Race, Ethnicity, Language, Cultural Competence (RELCC) data will be used to gather health disparity information Ms. Robinson and Mr. Kozlowski offered information on the Supplemental CAHPS dental 2013 survey, currently under development, which is intended for consumers and publicly reports results. The Modified CAHPS vision 2013 section of the survey was introduced by AHRQ; however, it is not currently developed. The CAHPS vision survey will be primarily adapted from the dental survey. It is also intended for consumers and will publicly report results. Ms. Robinson shared portions of MHCC s 2011 Health Benefit Plan Performance Report and the 2011 Comprehensive Performance Report for Commercial Health Maintenance Organization, Point of Service, and Preferred Provider Organization health benefit plans in Maryland. Ms. Robinson continued by going over the Projected Exchange Timeline which stated three important dates. January 1, 2013: the Exchange must be certified for operation. October 1, 2013: individuals and groups will begin enrolling in the Exchange.

3 January 1, 2014: the Maryland Health Benefit Exchange will be operational. In addition to this consolidated timeline, data collection from Qualified Health Plans (QHPs), Qualified Dental Plans (QDPs), and Qualified Vision Plans (QVPs) is expected to begin in Presented next was a Take-Up Study conducted by The Hilltop Institute measuring the estimated increased enrollment in the Exchange by Marylanders in years to follow. Additionally, a suggestion was made that the Exchange use the health benefit plan data reported in MHCC s public report(s) since the carriers and the networks on the Exchange will likely be the same. In the discussion that followed the presentation, the committee members raised several points that bear remembering: In the years when the Exchange will use commercial data to judge plan quality, it should consider limiting the sample to the Exchange population. Commercial quality standards are unlikely to apply well to Medicaid Managed Care Organizations (MCOs), due to factors unique to that market. The Exchange will conduct conversations aimed at developing standards for MCOs entering the commercial market. The Exchange is open to the possibility of providing consumers with an explanation of the possible difference in apparent quality due to the switch from commercial data to Exchange data. Summary of Benefits and Coverage Kevin Yang led a discussion on the presentment of a Summary of Benefits and Coverage (SBCs), a document that the Affordable Care Act requires health insurance carriers must issue for each health plan they offer. Specifically, Mr. Yang asked committee members to provide their thoughts on what data is needed for the SBCs, and value of using SBCs for plan comparison. The Exchange s initial stance was to create its own SBC for each qualified health plan offered on the Exchange. As discussion ensued, however, it became clear that committee members who are carrier representatives did not agree with this position. Specifically, several members raised concern that the Exchange would just be re-creating the work since the carriers already need to create a SBC for each health plan, regardless of whether it s offered on or off of the Exchange. One member explained that since carriers will issue SBCs in Adobe s Portable Document Format (PDF), the SBCs could be readily posted on the Exchange website. Mr. Yang asked whether a PDF would be enough for plan comparison, to which several members responded that the PDF would be flexible enough that addition or deletion of data could be easily inputted. Members also encouraged the Exchange to look at the synergies between the data required in SBCs by the Department of Health and Human Services (HHS) and the Exchange. Broker Compensation Tequila Terry led the broker compensation discussion, but first asking member what the broker compensation landscape looked like today. Several members offered input, explaining that brokers are primarily compensated in one of two ways: either through a fixed fee per enrollee; or by receiving a percentage of the enrollee s health plan premium. In the case of a broker working with a Third Party

4 Administrator (TPA) in the small business market, the carrier pays the broker, which generally pays the broker through the fixed fee method. Ms. Terry then steered the discussion toward broker identifiers. Specifically, she asked how carriers currently identify brokers. Members responded that most brokers have tax identification numbers, and that these numbers are generally the way carriers identify brokers. Members suggested that the same numbers, or perhaps even social security numbers, be used to identify producers for Exchange authorization purposes. Next, Ms. Terry asked about the process by which a producer becomes affiliated, or receives an appointment, by a carrier. Members explained that receiving an appointment by a carrier essentially requires confirming that a producer is licensed, and then executing a contract between the producer and the carrier that allows the producer to sell insurance plans issued by the carrier. Members further mentioned that this process generally takes one month to complete. In the case of TPAs, the TPA staff plays a role in the broker appointment and management function. Advisory Committee member Kathy Simmons, President and CEO of Group Benefits Services (GBS), explained that GBS executes a broker contract, which outlines the duties of the broker. The contract also completes the appointment with GBS for each carrier the broker has an appointment with. Members encouraged the Exchange to leverage several aspects of the broker compensation models in place today as the Exchange develops its Producer Authorization and Navigators programs. Exchange Branding Update Danielle Davis, Director of Communications and Outreach at the Exchange, and Kevin O Keefe, President of Weber Shandwick, gave an update on the branding effort. They presented a review of the objectives, process, and deliverables around the Exchange s brand, and detailed their research efforts and lessons learned. The names under consideration are: Health Plans Maryland Maryland Health Marketplace Insure Me Maryland Maryland Health Connection Get Covered Maryland The Exchange Board is expected to select a name at its June 12, 2012 meeting. Once a name is selected, the Exchange will launch a microsite at that address. Committee member Mary Lou Fox shared some thoughts regarding the Exchange branding effort: She encouraged the Exchange to select a name that will be likely to compete well in a more active marketplace in future years, rather than one that focuses on introducing Marylanders to the concept of a health insurance exchange.

5 She pointed out that consumers are the largest stakeholders in the Exchange, and asked that the identity of the consumer portal not be separated from the identity of the governing body, namely the Maryland Health Benefit Exchange. Public Comments A member of the public asked Ms. Davis and Mr. O Keefe whether the market research included testing of names with regard to dental and vision coverage as well as health coverage. Mr. O Keefe replied that the testing had been inclusive of vision and dental. General Updates Tequila Terry asked that any committee member that has not been in touch with Maryland Insurance Administration regarding SHOP rating rules contact her after the meeting. Ms. Terry reminded the members that the plan certification survey is due to her on June 4, She also reminded those present that new advisory committees will begin meeting in June and July 2012.

Members Present. Kevin Yang (Co-Chair) Tequila Terry (Co-Chair) Ken Erdelt Sandy Walters Liddy Garcia-Bunuel Kathy Simmons.

Members Present. Kevin Yang (Co-Chair) Tequila Terry (Co-Chair) Ken Erdelt Sandy Walters Liddy Garcia-Bunuel Kathy Simmons. Maryland Health Benefit Exchange Implementation Advisory Committee April 18, 2013 2:00 PM - 5:00 PM UMBC Tech Center 1450 S. Rolling Road Baltimore, MD 21227 Members Present Kevin Yang (Co-Chair) Tequila