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Health Care Review Reform Committee Legislative meeting 8/22/2018

August 27, 2018

The first item discussed today is the draft review of a bill to look at a self-insurance plan in ND.  The Insurance Department individuals then spoke to the draft bill and they do overall support this bill. 

 

This bill will be looked at again at the next meeting and will look at acting on at that time.

 

The next presentation was by Ms. Cristal Thomas Gary, Principal of Leavitt Partners, speaking on, working with the group ND for the Advancement of Care Medicaid work group. She gave an update.  Leavitt was retained by the hospital systems to help work with this work group.

 

The Group:

  • July 19th, they kicked off, meeting weekly

  • 5 major hospitals working in this group

  • Provider driven

  • Looking at how to improve care delivery and improve outcomes and decrease cost.

  • Department of Human services has joined the work group. 

  • Working to develop a model for a Medicaid ACO model.

They have identified that they need to be collaborative, outline key definitions and principles and stakeholder process to design final program. 

 

Steering committee will have to define what would the ACO look like.

 

Key considerations:   What are the opportunities for savings, identify care model to leverage those opportunities, what are the financial and infrastructure to support those changes.

 

Concerns and risks:  complexity, timeline, stakeholder engagement, and provider readiness and department capacity. 

 

One of the biggest challenges there is:  no clear road map for change, 13 states have looked at ACOs and no one single model is the best. 

 

Over the next two months, this group will develop a framework, and bring to the committee later.

 

Questions from Representative Keiser and Representative Hogan: Representative Hogan asked if they are looking at all the long-term care and other facilities that house Medicaid patients.  Presenter stated they will continue work.

 

One of the presenters from DHS encouraged the group to look also at the Oregon plan and what they are currently doing.

 

Christopher Jones, Executive Director, Department of Human Services, reported.  Schools, higher Ed and training, safety and infrastructure, social networks, housing market, healthcare system, employment and economy are all areas in DHS.  Gave a good slide of what the agency DHS looks like.    All the slides from his presentation are on line at nd.gov. The growth in the cost of the department is mostly from long term care development disability programs. 13% of our population is on Medicaid. A couple of priorities:  MMIS certification should be certified by June 2019.  Looking at several other priorities the department is working on.

 

A presentation was given by Mr. Jon Godfread, Insurance Commissioner.   He spoke to:

1. Association Health Plans.  Will be June 2019.  These AHPs cannot discriminate based on a health factor, or keep certain individuals or employers out of the AHP plan due to health conditions.  Associations looking to form an AHP should ensure they are fully compliant with the nondiscrimination provisions in the regulations.

 

2. Short term limited duration plans.  STDL type of coverage primarily designed to fill gaps in coverage that may occur when an individual is transitioning from one plan or coverage to another plan or coverage.  Insurance department is assessing for fraud.  These plans are generally not comprehensive and serve a narrow purpose, provide coverage for 185 days or less, and allow one renewal initially.

 

3. State Innovation RFP update given.  Discussed claim on payout claims at a million. 

 

4. Managed Care Organizations.  The insurance department would prefer to give the insurers organization to work on this.

 

The organizations below introduced themselves and then at 1pm are doing a panel discussion. 

 

Aetna 

Russel Harper, Aetna is an international company out of Hartford Conn.  Aetna been in existence since 1853.  Has dramatically changed over the years. CEO moved the organization to join a person, to help them, move more from reactive to a proactive product.

 

Blue Cross Blue Shield ND

More than 2,5000 people employed.  In several locations in ND

Are committed to work with the state to create a successful managed care program that affords access to care and optimal benefit package to our ND members in rural and metro areas.  The programs are intended to evolve with the populations we serve. 

 

Medica: Nonprofit health plan in Twin Cities MN

Doing business since 1990’s in ND.  Mission is to be the trusted health care plan of choice.  First, they see themselves as collaborating, currently serve Medicaid in all aspects, focus on disabilities, etc. Believe programs to be designed for each group best delivers care.  Medica believes in relationships and supports that type of structure.  Believe also in education to individuals.  4 areas they have are experience, local focus, collaboration and support having tailored programs of different needs and populations

 

 

Meridian Health Plan

Primary a Medicaid organization and in Iowa and Michigan. They are a high-quality plan, providers rank these individuals as number one in the states.  This is an accredited NCQA accreditation status. The Pharmacy Managed Plan: PBM is fully integrated.  Transparent model, 100% web based applications, offers data integration and real-time access to live claim.  The PBM pass through model.  Are physician led, fully integrated pharmacy benefit manager, quality of care and provider focused, and are experienced in developing state-wide provider networks.

 

Sanford Health Plan

Lisa Carlson spoke on this plan: is nonprofit health plan, in business for 20 years. Integrated health system, 275 employees, 2nd largest carrier in ND and SD.  Are operating on the federal market place in ND and SK, projected annual premium revenue of about 1 billion. Have employer sponsored group and many other programs in ND and SD. Philosophy is high quality of health care is best provided close to home. And partner with engaged communities. 

 

WellCare Health Plan

Serving Medicaid 2.7 million members for Medicaid, serve Medicare and Medicaid only.  Contract and coordinate with different agencies. 

Work with 11 states in the US. 

 

All the above groups then were involved in a panel discussion answering different questions from the legislators talking about patient satisfaction with the group and how often the appeal process is used and if they each have an appeal process.  Talked about all different variables with the groups. 

They then discussed about enrollment into their group. Discussed the benefit of one versus two or more groups in ND. 

 

Each group talked about what is unique for each of them. And then discussed access to patients, what about long term care, Developmental disabled patients.  

 

Excellent day, I encourage all of you to go to nd.gov and read the minutes from today, Health Care Review Reform Committee meeting minutes when they are posted.

 

 

 

 

 

 

 

 

 

 

 

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