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Please note: without the accompanying discussions, these minutes are incomplete.
I. Call to Order
• The meeting was called to order at 9:30AM
II. Present:
• Mary Henderson, Dana Conners, Charlene Rydell, Dr.
Robert McAfee, Trish Riley, Carl Leinonen, Robert Murray,
Tom Dunne, Linda Pistner, Karen Gagnon, representatives from
the public (Rebecca Wyke joined later)
III. Announcements from the Chair
• Chairman McAfee welcomed all to the meeting. Stating
that this was a very special occasion and group of people
and he has hopes of this work to be both exciting and successful.
• He notes that he expects that everyone on the board
can be punctual and if for some reason they are unable to
make a meeting or will be tardy to please call and let them
know so that they may start the meeting and then go back.
• He also would like to request they members go through
the chair when speaking and keep proper decorum.
IV. Introductions
• Chairman McAfee then asked the committee to formally
introduce themselves.
- Mary Henderson- Executive Director, Maine Equal Justice
- Dana Conners- President, Maine State Chamber of Commerce
- Charlene Rydell-10yrs in Maine House of Rep
- Dr. Robert McAfee- Former President of American Medical
Association
- Trish Riley- Executive Director of the Governor’s
Office of Health Policy and Finance
- Carl Leinonen- Executive Director of Maine State Employees
Association
- Robert Murray- Commissioner of the Department of Professional
and Financial Regulation
- Tom Dunne- Staff, Governor’s Office of Health Policy
and Finance
- Linda Pistner- Chief Deputy Attorney General
V. Update on Recent Progress
• Ms. Riley mentions that Ms. Ellen Schneiter, Deputy
Director of the Governor’s Office on Health Policy and
Finance regrets that she is unable to be here today.
• Ms. Riley discusses the relevance of the ex-officio
members of the board to include herself, Robert Murray and
Rebecca Wyke. Given the broad responsibilities of the Dirigo
Health Reform Act as a whole, of which this Board is a critical
part, liaison to broader efforts will be key. In addition
the Board will be well served by liaisons with Departments
with jurisdiction over insurance, licensing, state budget
and personnel matters
• Ms. Riley then goes on to explain the packet which
includes a work plan/timetable and fast facts.
• Ms Riley then updated members on progress to date,
noting the GOHPF has secured or will secure funding to help
support Dirigo Health implementation including,
- Proposals to the Robert Wood Johnson Foundation, HRSA, the
Commonwealth Fund
- Contract with Nancy Kane of Harvard University to assist
in hospital study and establishing SOP baseline data.
- Maine Health Access Fund funding will be sought for research
or aiding development in areas such as:
- Public purchasers
- Seminar’s (for hospitals)
- Business Plan
- The Revolving Loan Fund- the concept is under development
by Gino Nalli of The Muskie School of Public Service
• Chairman McAfee then asks the committee if there any
questions for Ms. Riley
• Chairman McAfee ask Ms. Riley to explain the boundaries/opportunities
of Dirigo versus GOHPF
• Ms. Riley responds stating that Dirigo Health is a
separate state agency charged with the development and administration
of the health benefit and establishing the Maine Quality Forum
as a part of the broader Dirigo Health Reform Act. GOHPF is
charged with oversight for the entire act, liaison to the
Board and implementing the cost containment and health planning
requirements of the Act.
VI. Governance of Dirigo Health Board
• Chairman McAfee asks Ms. Pistner to go over rules
for the governing of this body.
• Ms. Pistner discussed the role which the Attorney
General’s office will play for the committee, as being
a resource and available at every meeting.
• Ms. Pistner then went over some key laws that could
affect the board in the future, these included:
- Executive Session- Only certain things are “ok”
to discuss (e.g. Personnel issues) the public has a right
to know of all other business.
- Some records of Dirigo Health and Board will be private
(these need to be specifically laid out)
- Freedom of Access Act
- Any meeting of 3 or more members of the board discussing
Dirigo is considered a meeting (which must then be publicly
noted through the right channels)
- Administrative Procedure Act (rulemaking, fact finding)
- Conflict of Interest- (Title 5, §18)
- Legislation/Rulemaking- confidential at certain stages
- The Department of Administrative and Financial Services
has a handbook for reference
• Chairperson McAfee asked if there were any questions-
• Mr. Murray asked if the rule on 3 or more meeting
was applied to ex-officio members
• Ms. Pistner stated that it could be if there are discussions
of Dirigo Health She then discussed that the work of a public
agency, including work drafts, are public and can be requested
with 5 day notice.
• Ms. Wyke arrives at 10:15AM
VII. Business Plan overview
• Chairman McAfee asked for Mr. Dunne to give a brief
background on himself and then to discuss the Business plan
that he is drafting.
• Mr. Dunne discusses his background, including consulting
work in a variety of fields relevant to Dirigo. He then goes
on to give a little background on the business plan:
- The intent (what and why): Business plans are aimed towards
the internal executives (workers) not the general public;
they are to be key targets (customers, etc.), as well as some
basic “foundations” of an operation, for example,
its values.
• Mr. Dunne then asked for input from the Board on the
Business Plan
• Chairman McAfee states that he likes the intent of
having a business plan for Dirigo Health
• Ms. Henderson states that the business plan makes
sense although she has some concerns about the confidentiality
issues associated with the RFP process and Freedom of Access
issues.
• Mr. Conners says that having not seen the document
he struggles with how to respond- there are some immediate
challenging responsibilities and he is concerned with the
more precise actions needed now. He states that they will
know if they fail.
• Mr. Dunne responds and states that the business plan
is different that the timeline and suggests a switch in the
later agenda items.
• It is agreed to switch items: GOHPF/Dirigo Implementation
Chronology and Key Strategic Options- Status
• Ms. Rydell notes that she has concerns with the happenings
of the State Employee Health Plan health care purchase and
the chance that they may re-occur here
• Mr. Leinonen agrees, stating that it is hard to get
a reasonable bid when they know your budget.
• Mr. Dunne mentions that he is researching the competitive
bid process to understand for example how the Executive Director
can discuss options and tactics with the board.
VIII. GOHPF/Dirigo Implementation Chronology
• Mr. Dunne then went over Dirigo Health Key Milestones
for July 2004
- November to December 2003: there needs to be contacts with
prospective business suppliers; preparation of the a draft
product; focus groups held; filling the Executive Director
and other key positions; and the launch the Maine Quality
Forum.
- January to March 2004: determine the a savings offset payment
mechanism for TPA’s; issue a request for proposal of
products and services; confirm product compliance with Medicaid
funding regulations.
- April to June 2004: decisions on business suppliers; preparation
of Sales and Marketing campaign; general preparation for operational
start up.
• Chairman McAfee then stated that the board would go
into a recess for fifteen minutes. Meeting at break at 10:50AM.
• Meeting is reconvened at 11:07AM.
IX. Key Strategic Options- Status
• Mr. Dunne started the discussion stating that there
were three key options to profile. First is the Product, both
the benefit components and the overall financing/subsidization
element. The plan is to have a better draft of the product
by the end of December, and to use it with the input of the
RFP
• Ms. Henderson asks if there have been thoughts of
having multiple RFP’s for a range of services.
• Ms. Riley responds yes, having multiple service providers
is an option.
• Mr. Dunne then goes on to discuss the Determination
of Savings Offset Payment-The TPA – is due February
1, to the legislature. He states that in parallel Dirigo Health
should be defining a broader “scorecard” that
could be used to measure success.
• Finally, Mr. Dunne talks about Selection of processing
and risk partner(s) - he states that the plan is to go live
on July 1, 2004. The normal process for a RFI and RFP are
very long- with periods of at least 6 weeks of advertising,
2 more weeks to review bids. (Which places us at early April
for a decision) Whether there will be an RFI then and RFP
or just have an RFP will be determined over the next few weeks.
• Ms. Riley then reminded the committee that there is
a TPA report due back to the legislature on February 1, 2004
that must be given jointly by the GOHPF and Dirigo Health
• In discussion of near term activities Ms. Henderson
states that the focus group will needs to happen very quickly.
She expressed concern of whether the full product definition
will be available within the discussed time frame.
• Ms. Riley then asked the board if they would like
to have two focus groups - one that dealt with a more generic
plan and another with a specific benefit plan.
• Mr. Leinonen agreed and said that early on it made
sense to get some baseline figures and then to go back and
fine-tune.
• Ms. Rydell agreed as well noting that early on was
crucial input in a successful design process
• Ms. Riley noted that she was hoping to aim a group
at employers who have insurance (with questions focused on
who is not buying into insurance plans and how could they
get everyone in the plan) She thought perhaps that they could
do a group on employers without insurance and look into those
variables.
• Ms. Henderson suggested direct focus on the employees
on MaineCare.
• Ms. Riley agreed and stated that she was hoping to
get some more information from the revenue service data on
businesses that have low wages which in turn have employees
enrolled in MaineCare.
• There was discussion and consensus that the focus
groups should test both the target businesses as well as key
consumer groups, and that there may be two steps, the second
having a much more precise definition of the target product.
Trish Riley will take this up with Lake, Snell.
• Chairman McAfee asked the board if they had any questions-
• Ms. Rydell asks how they are to launch the MQF- since
they are directly in charge of this-
• Ms. Riley responds and says that they need to send
out a letter with a time/date and mentions that they (MQF)
will at that time need to select a chairperson.
• Ms. Rydell asks if they should be at this meeting
and if it has been scheduled yet.
• Ms. Henderson then asks how often this board should
meet.
• Mr. Dunne responds that he would like to discuss three
items at the next meeting to include (product, people and
RFP). And that in order to get some more facts and research
done it would take him approximately 2-3 weeks. He also states
that perhaps it would make sense to schedule the meetings
on the same day as the board and MQF. The committee nods in
agreement.
• Ms. Riley mentions the difficulty with scheduling
around Thanksgiving but perhaps December 1, 2003 would be
a good day to meet.
• The board agrees to schedule the MQF at 9:00AM and
for their meeting to commence at 9:30AM so that they may be
at the start of the MQF meeting.
• Chairman McAfee requests to meet with Mr. Dunne one
week prior in order to review agenda.
• Mr. Dunne agrees and notes this.
X. Other Items
• Mr. Dunne profiled recent communications on Dirigo
Health.
- Mr. Dunne states that there has been an effort by the GOHPF
to respond to inquiries - there have been responses to almost
approximately 30 e-mail contacts.
- He also noted that there has been some recent web design
taking place on a new Dirigo Health web site, and that the
staff was arranging for InforME to develop a “vanilla”
web site for Dirigo Health.
• Ms. Riley notes that her staff has received more than
300 individuals who are interested in signing up for the program
now- and interestingly enough the numbers have been rising
as time progresses.
XI. Public Comment
• No members of the public spoke for or against any
issues
XII. Executive Session
• Motion by Rydell, Second by Leinonen to go into Executive
Session to discuss personnel issues.
- Vote: Unanimous
- Began at 11:40AM
• Motion by Rydell, Second by Leinonen to come out of
Executive Session
- Vote: Unanimous
- Ended at 1:15PM
XIII. New Business
• Motion by Leinonen, Second by Rydell to select Tom
Dunne as the Interim Executive Director of Dirigo Health
- Vote: Unanimous
• Motion by Rydell, Second by Leinonen to formally start
Executive Director search for Dirigo Health
- Vote: Unanimous
• Mr. Dunne requests that board review the draft business
plan in next five business days return their comments.
XIV. Adjournment
• The meeting was adjourned at 1:25PM
The Board of Directors of the Dirigo Health Agency held a regularly scheduled meeting on December 1, 2003. Dr. Robert McAfee, Chairman, convened the meeting at approximately 11:15, in Legislative Council Chambers of the Maine State House. Board members present included: Dana Connors, Mary Henderson, Carl Leinonin, Charlene Rydell, Commissioner Rebecca Wyke, Commissioner Robert Murray and Director Trish Riley. Tom Dunne and Ellen Schneiter of the Governor’s Office of Health Policy and Finance were also present to staff the meeting.
At the outset of the meeting, the Board voted unanimously to retire to Executive Session for the express purpose of discussing personnel matters. At 11:50, the Members voted to close the Executive Session and return to public session.
The Board reviewed the draft minutes of the November 3, 2003 meeting; several corrections were suggested. A motion was made, seconded and voted unanimously to accept the minutes as amended.
Mr. Dunne provided the Board with a brief overview of the proceedings of the first meeting of the Maine Quality Forum, held immediately prior to this Board meeting, noting that the next meeting of that group will be the morning of December 9th, to coincide with a statewide conference entitled “Quality Counts”, which will be held at the Augusta Civic Center.
Ms. Riley gave the members an update of recent events surrounding the Dirigo Reform Initiative. She noted staffing changes within the Governor’s Office of Health Policy and Finance. She also reported that most of the committees formed as a result of PL 469 have been convened and are eager to get their work underway. A communications strategy has been formulated for the entire reform initiative; Ms. Riley stressed that it is imperative that in all communications the linkage between cost, quality and access be repeatedly stressed.
Ms. Riley informed the Board that the Governor’s Office has retained Lake, Snell & Perry, a national market research firm, to conduct a series of focus groups around Dirigo. These consultants will test message, price points, trade offs, etc. with groups of employers (both those who currently offer coverage and those who do not), as well as employees, during late December and early January. Some of the locations that will be used for the focus groups will allow for observation by Board members, who are invited to attend.
Ms. Riley concluded her presentation with a brief update on the status of the MaineCare budget. She noted that the Governor’s staff has formulated a proposal for filling the $113million deficit, recovering only $7.8million from the MaineCare program itself. This strategy protects the appropriation of $53million in federal fiscal relief monies to Dirigo Health for its original purpose.
Ms. Riley then introduced Gino Nalli of the Muskie School, University of Southern Maine, who would be presenting an overview of the current small group insurance marketplace in Maine. Ms. Riley reminded her fellow Board members that the Dirigo product has to be an innovative package of services, not just a health insurance card. Moreover, the product must meet the demands of the current market, which is shifting rapidly; the market today is different from that which existed during the most recent legislative session. Importantly, the product must also be designed to satisfy all relevant federal requirements, to ensure the successful integration of MaineCare into the program. She shared a chart from a recent article by Drew Altman and Larry Levitt (Health Affairs, Jan 23, 2002), that shows the annual change in private health spending per capita between the early 1960s and 2001. The plot shows an up and down cycling of such spending, with deep dips in spending immediately following periods in time when there was significant legislative discussion and/or action around health care spending. Ms. Riley suggested the take away message from the chart to be that downward swings in cost are transient; that is, while cost declines may be experienced from time to time following reform efforts, they have not been sustainable. In Maine, if Dirigo is to succeed, moderations in that trend must be realized.
Mr. Nalli then reviewed the current state of Maine’s insurance market, using a series of slides provided to all present in handout form. He noted several general trends in the state’s small group market: there is an overall decline in the number of covered lives among small groups, with a dramatic decline in HMO enrollment, which tends to be the most comprehensive type of coverage available. While prices for small group HMO coverage has remained at a relatively steady rate of growth over the past several years, the rate of increase in the price of PPO coverage has been declining. This is likely attributable to changes in benefit structure, the underwriting cycle and, perhaps in part, to a competitive response to the Dirigo Health Reform Initiative.
Mr. Nalli reviewed the characteristics of some new small group products that are entering the market. He ended his presentation with a proposed set of criteria or principles for evaluating the design of the Dirigo Health product. The members discussed the trade offs there would be between benefits and cost and how an approach to balancing the two might be fashioned. It was noted that enrollment in Dirigo Health will be voluntary. As such, the offering will be one of a variety of choices; it will be important to understand if insurers will be willing to partner with the state to offer the product and whether or not it will be saleable in today’s marketplace.
The Board then took up the issue of setting a regular meeting schedule. It was decided that the group would hold regular meetings on the afternoon of the first Monday of each month.
Next, Mr. Dunne raised the issue of retaining consultant services to assist with certain tasks, most especially the preparation of the Request for Proposals to be put out to potential insurance partners. The Board agreed that this was a reasonable course of action. Members expressed some concern about the Agency’s ability to keep pace with the work plan and milestones that must be realized to meet a July 1st launch date. Mr. Dunne reported that things are progressing, but it was important to hire on staff and additional consulting power in the very near future.
Mr. Dunne reported that he had been holding a series of conversations with potential insurance partners, to both inform them of Dirigo’s likely direction and to garner input and suggestions from them. He noted that each of the discussions he had with insurers had been helpful, but all were concerned about the tight timelines facing implementation of the program as well as the potential risk exposure to any partnering organization. The Board encouraged Mr. Dunne to maintain open channels of communication between him and potential partners.
There was a brief discussion regarding the use of Executive Session to discussion issues related to competitive aspects of the program. The Attorney General’s office is working on this question and will provide the Board with an opinion in the near future.
The Board also discussed the communications strategy, both as it pertains specifically to the Agency and as the Agency relates to the broader, reform initiative-wide campaign. The members considered the benefits and drawbacks of traveling around the state to hold their meetings and to meet the demands being made for their appearance at various other forums. While it may be desirable to have members out across the state discussing Dirigo, there was some sense of caution about such a tact, realizing that potentially the greatest value and best public relations they can provide as a Board is to attend to the great press of business before them.
The only item of other business that was raised pertained to a letter forwarded to the Board by the March of Dimes, urging the incorporation of comprehensive perinatal benefits into the Dirigo package.
The meeting concluded with a public comment period. Several people requested clarification regarding meeting times and dates. A suggestion was made that meeting notices be posted on the website.
At 1:30, a motion was made, seconded and passed for adjournment.
The Board of Directors of the Dirigo Health Agency held a regularly scheduled meeting on January 5, 2004. Dr. Robert McAfee, Chairman, convened the meeting at approximately 1:05 in Legislative Council Chambers of the Maine State House. Board members present included: Dana Connors, Mary Henderson, Carl Leinonen, Charlene Rydell, Commissioner Rebecca Wyke, Commissioner Robert Murray and Director Trish Riley. Tom Dunne of the Governor’s Office of Health Policy and Finance was also present.
At the onset of the meeting, the Board voted unanimously to retire to Executive Session for the purpose of discussing personnel matters. At approximately 1:20, the Members voted to close the Executive Session and return to the public session.
The Board reviewed the draft minutes of the December 1, 2003 meeting; two corrections to the minutes were made. A motion was made, seconded and voted unanimously to accept the minutes as amended.
A motion was made to name Tom Dunne Executive Director of Dirigo Health, seconded and voted unanimously.
Mr. Dunne then introduced Dr. Bob McArtor, Chairman of the
Maine Quality Forum Advisory Council. Dr. McArtor provided
the Board with an overview of the contents of the initial
two meetings the Advisory Council has had to date; and the
scope of the goals for the upcoming meetings. In summary,
Dr. McArtor reported that the Council is a committed group
of professionals with diverse experience/backgrounds and is
anxious to begin their work. The Council is focused on the
following goals: Cleary defining the legislative requirements
specific to the Advisory Council; Development of the HealthCare
Provider Group; Identification of current existing partners
in the market that the Council will collaborate with in an
effort to limit unnecessary duplication. Additionally, Dr.
McArtor shared with the group the Councils intent towards
identifying and selecting key performance indicators/measures
as well as the work the group will begin specific to technology
assessment. Dr. McArtor reinforced that the Council is in
the very early stage of its development and as such is looking
for the Board’s approval specific to the goals and direction
of the Council.
After Dr. McArtors presentation several Board Members provided
the following feedback. It was suggested that the Council
strongly consider electing a Vice Chair to assist the Chair
with the work load. The Board agreed with Dr. McArtor that
one of the key initiatives of the Council is to determine
the criteria specific to identifying what specific outcomes
will be measured. The Board suggested that the Council focus
on achievable goals. The Board requested that the minutes
from the Quality Council be circulated to the Board.
Mr. Dunne shared with the Board that within the next month an Executive Director for Quality would be named.
Ms. Riley provided the Board with an overview of recent events and other related initiatives:
Mr. Dunne then introduced Mr. Gino Nalli who took the lead on the product discussion. The key points of Mr. Nalli’s presentation were as follows:
1. The marketplace has changed dramatically in the last 18-24
months.
2. Lower premium cost products aimed at small businesses.
3. Higher consumer cost sharing provisions are beginning to
be offset by innovative funding programs.
4. Adverse selection against richer, more traditional health
plans is likely to become more problematic.
In summary Dirigo Health expects to offer:
1. A program consistent with original cost estimates so as
to be:
a. Price competitive for both small businesses, their employees
and individual consumers
b. Meet stated financial projections
2. A set of services that differentiates Dirigo in the market
by:
a. Promoting primary care
b. Protecting consumers
c. Providing an integrated portfolio of population based services
d. Subsidizing low income employees
Mr. Dunne shared with the Board that Mercer has been selected as the consultant that will assist Dirigo with the RFP process. Staff has already met with Mercer to begin the process. The goal is to release the RFP to the market mid February. In order to meet this deadline a significant number of decisions need to be made over the next few weeks. As an example of issues that need resolution Mr. Dunne shared with the Board his recommendation regarding SOP. Mr. Dunne would like to assemble a group to include Mr. Dana Connors and any other Board member that may be interested along with a retired chief actuary of a large insurance company to meet and discuss methodology. This group would then bring the proposed methodology to the Board for their approval. The Board agreed with Mr. Dunne’s recommendation on general process.
Mr. Dunne asked the Board for some guidance on the Dirigo
Health budget. The Board confirmed that they felt comfortable
with the figures provided. The Board requested Mr. Dunne provide
a regular financial overview, and set-up a process whereby
planned material expenditures are appropriately reviewed by
the board or a board member. Mr. Dunne agreed.
The floor was open to the public for questions/comments. A
question was asked about the status of the release of the
RFP. Mr. Dunne responded the goal was to release the RFP mid
February.
Given the timing sensitivity specific to the RFP and certain decisions that the Board must make, the Board agreed to meet January 26th from 1:00-3:00pm. The February 3rd session is remains on the calendar, but whether to have the session will be determined on the 26th of January.
At approximately 3:00pm, a motion was made, seconded and passed for adjournment.
The Board of Directors of the Dirigo Health Agency held a meeting on January 26, 2004. Dr. Robert McAfee, Chairman, convened the meeting at approximately 1:00 in a conference room at the Department of Human Services. Board members present included: Dana Connors, Mary Henderson, Carl Leinonen, Charlene Rydell, Commissioner Rebecca Wyke, and Commissioner Robert Murray. Trish Riley was not present. Tom Dunne, Executive Director of Dirigo Health was also present.
The Board reviewed the draft minutes of the January 5, 2004 meeting; one correction was made to the minutes. A motion was made, seconded and voted unanimously to accept the minutes as amended.
On the Maine Quality Forum Advisory Council Mr. Dunne summarized three points:
On the overview of the situation for Dirigo Health Mr. Dunne covered three topics
Overall timeline: Some key tasks have not progressed per the baseline plan. A number of factors were cited. Mr. Dunne shared with the Board that the while the overall plan is for a July launch, making up lost time will be difficult. Planned major activities were profiled. The continued consideration of a phased start-up was also mentioned.
Overall Challenges - Three points were raised:
1. Human Resources- recruiting challenges exist.
2. Interest from the carriers continues to be mixed.
3. From multiple sources it clear that the market’s
expectations are high and will need to be managed.
The Savings Offset Payment: A series of conversations with representatives from ASO groups, MEWA’s etc. were held. The goal of the discussions was to reach consensus on a method to determine SOP. There are several ideas specific to the calculation methodology. Consensus was not reached. Key representatives, among their reasons, believe that agreeing to a funding calculation mechanism before understanding how the overall SOP will be determined is premature.
The Board requested Mr. Dunne to report at the next board meeting the outcome of the upcoming SOP discussions.
The discussion turned to Product. Mr. Dunne and Mr. Nalli made the following points:
1. Market has changed
2. Dirigo’s mission has not changed
3. Dirigo’s benefit plan must be attractive in terms
of monthly premiums to assure small business take up and consumer
access to necessary and appropriate health services.
4. The Dirigo plan may have a higher deductible and coinsurance
than originally planned.
5. The emerging new capabilities (HRA’s HAS) are at
this time likely to have less value to the Dirigo Health Plan.
6. A tiered benefit plan may be the best approach for Dirigo.
7. An illustration provided an overview of benefit, price
and subsidy strategy. The expectation is at the next board
meeting a detailed overview will be provided with targeted
benefits, approximate price and potential subsidies.
8. The commitment to preventive and wellness services was
affirmed.
9. The board discussed techniques for managing enrollment
and future subsidy levels to assure Dirigo can meet its financial
objectives.
10. The board considered whether contribution to premium for
individuals joining Dirigo be equal to employer and employee
contributions for the same income level. The issue was tabled
for the next meeting
11. The board briefly reviewed other product elements specific
to market parity i.e. regulatory requirements, mandated benefits,
demographic rating. The issue was tabled for the next meeting.
Mr. Dunne then asked the Board to approve his request that
the Legislative calendar be the source for all meeting times
and locations. The Board approved the request.
Dr. McAfee opened the meeting to public questions and comments. A comment was made from a representative of small business that not all small business purchased health care based solely on cost. That in fact there are many small businesses that will make decisions based on the value they are getting for the cost.
There were no further comments from the public.
The board agreed to reconvene Monday February 2, 2004 at
1:00pm, (later postponed to February 13, 2004).
The Board of Directors of the Dirigo Health Agency held a meeting on February 13, 2004. Dr. Robert McAfee, Chairman, convened the meeting at approximately 1:00 in a conference room at the Department of Human Services. Board members present included: Dana Connors, Mary Henderson, Carl Leinonen, Commissioner Rebecca Wyke, and Commissioner Robert Murray and Trish Riley. Charlene Rydell was absent. Tom Dunne, Executive Director of Dirigo Health was also present.
The Board reviewed the draft minutes of the January 26, 2004 meeting. A motion was made, seconded and voted unanimously to accept the minutes.
On the Maine Quality Forum Advisory Council, Mr. Dunne raised three major points:
Ms. Riley provided an overview of the recent events in other initiatives. A separate handout served as the basis for discussion. On the topic of MaineCare, Ms. Riley stated that a workgroup was refining the estimates for the MaineCare expansion and that the projected affect would be smaller than discussed last spring, and that the intention continues that Dirigo will be responsible for the financial impact of the MaineCare expansion.
On the overview of the situation for Dirigo Health Mr. Dunne covered three topics:
Savings Offset Payment for Third Party Administrators (and others). A recap of events since the last Board meeting was reported, as well as that a consensus on a method for determining the SOP for TPA’s was not reached. This was reported to the Legislature (Joint Standing Committee on Insurance and Financial Services) in early February. The suggested next steps include a meeting with interested parties by mid-March to discuss broader issues, and then reporting back to the appropriate Legislative committee. To the question raised by a Board member: “what is there is not consensus after this meeting?”, Ms. Riley stated that the legislation says the committee “may report out legislation…to implement the savings offset payments”.
On operations, Mr Dunne reported: 1) a letter of intent for
space in the downtown Augusta area has been signed; although
one of the bidders has said they may appeal, the advice received
is that a May partial move-in date is viable; 2) a strong
candidate for the Director of Operation position has been
interviewed; 3) while the legislation provides much of the
detail normally seen in bylaws, there may be gaps, and he
suggested that he work with one Board member to determine
what should be done next. The Board agreed that Mr. Dunne
should work with Ms. Rydell on this issue.
On the Dirigo Product, Mr. Dunne reported: 1) new input from
several sources has been received; common themes are about
benefit design and eligibility issues as well as pricing/value
considerations; 2) The team remains focused on the Dirigo
Health product as previously described: “tiered”,
providing financial discounts that adjust an individuals costs
(payments, deductibles and out-of-pockets) based upon personal
economic circumstances, and “focused” where many
of the elements of the product will consist of what is currently
available in the market, with targeted Dirigo special features;
3) Of late, the team has worked to refine the overall economic
picture, and had several work sessions with units of DHS to
clarify the processing requirements for MaineCare eligible
individuals; 4) In recent discussions with Carriers there
was a mixed sense of interest, with Carriers and others waiting
to see the RFP.
Dr. McAfee opened the meeting to public questions and comments. A comment was made on the Medical Liability situation and the need for accelerated progress
There were no further comments from the public.
The board agreed to next meet Monday March 1, 2004 at 1:00pm.
The Board moved into Executive Session, reconvening only
to adjourn.
The Board of Directors of the Dirigo Health Agency held a meeting on March 1, 2004. Dr. Robert McAfee, Chairman, convened the meeting at approximately 1:00 in a conference room at the Augusta Civic Center. Board members participating included: Dana Connors, Mary Henderson, Carl Leinonen, Charlene Rydell, Commissioner Rebecca Wyke, and Commissioner Robert Murray and Trish Riley. Tom Dunne, Executive Director of Dirigo Health was also present.
The Board reviewed the draft minutes of the February 13, 2004 meeting. A motion was made, seconded and voted unanimously to accept the minutes.
On the Maine Quality Forum Advisory Council, Mr. Dunne had
two major points:
1. After questioning whether MQFAC materials had recently
been delivered to Board members (they were not), Mr. Dunne
said he would remind staff to send along key materials from
recent MQFAC meetings.
2. The Executive Director interviews were almost completed,
and that an offer would likely be made within the next week.
Ms. Riley provided an overview of the recent events in other initiatives. A separate handout served as the basis for the discussion. On the topic of the Savings Offset Payment, Ms. Riley outline the expected next steps over the next few weeks including the involvement of outside experts (from Harvard and Mathematica) to further the process. In addition Ms. Riley informed the Board of the upcoming session with Dr. Ken Thorpe in which he will outline how other states/governments have done global budgeting.
Ms. Riley also profiled potential Dirigo brands and logos for the Board and the audience. A final decision is expected within a few weeks.
On the overview of the situation for Dirigo Health Mr. Dunne covered four topics:
Savings Offset Payment for Third Party Administrators (and others). Mr. Dunne confirmed with Ms. Riley that the expectation was still to have a mid-March meeting with the interested parties and the outside experts.
On operations, Mr. Dunne reported: 1) on space, the previously reported possibility of an appeal did not materialize, and that a May partial move-in date is still the plan; 2) the Director of Operations position has been filled; 3) financially, the spending to date continues within previously discussed budget levels; 4) on communications, Mr. Dunne has accepted Rep. Millet’s invitation to come to a Dirigo meeting in Oxford Hills (Mr. Connors confirmed he would also attend), and the marketing firm RFP response evaluation is underway with an expected decision in a few weeks; 5) the Dirigo website is going and it includes a link to meetings.
On product, Mr. Dunne stated that over the last two weeks the team has validated assumptions and made refinements consistent with the Board’s last discussion, and that the overall direction and key assumption remain generally consistent with previous discussions. He mentioned that he believes that the Board is close to agreement on the targeted product, and that now his immediate concern is the need to gain clarity on the operational processes and the overall contract between DHS and the carrier. A significant number of people are working on this issue.
Dirigo’s Plan. Mr. Dunne stated that as the team size
and complexity have increased the need for more formal rigor
in project management has also increased. At the next scheduled
board session he intends to layout the plan in more detail
with a focus on the expected key outcomes from each phase
of the going forward work. Several Board members spoke favorably
about increasing their understanding of the required accomplishments.
When asked if other Board member had questions or comments,
Mr. Connors spoke about the need to carefully balance what
is discussed in Executive Session vs. in the Public Meetings.
He acknowledged that there is a proper balance, but that sometimes
for example, having possible bidders listen to deliberations
of the Board can lead to a better outcome. He concluded that
this is an issue the Board should continuously consider.
Dr. McAfee opened the meeting to public questions and comments.
From the audience were:
- a question on the Oxford Hills session, confirming the location
(the High School) and date (March 25th),
- a comment from a Representative Curley thanking the Dirigo
Board for its efforts.
There were no further comments from the public.
The board confirmed that the next scheduled meeting was Monday April 5, 2004 at 1:00pm. It was also noted that there may be an interim Board meeting sometime in March. Mr. Dunne stated that he would use the standard communication channels (web site, interest parties list, and the legislative calendar) and that at least 7 calendar days notice would be given.
The Board moved into Executive Session, reconvening only
to adjourn.
The Board of Directors of the Dirigo Health Agency held a meeting on March 25, 2004. Dr. Robert McAfee, Chairman, convened the meeting at approximately 12:30 in the Welcome Center of the State House. Board members participating included: Dana Connors, Mary Henderson, Carl Leinonen, Charlene Rydell, Commissioner Rebecca Wyke, and Commissioner Robert Murray and Trish Riley. Tom Dunne, Executive Director of Dirigo Health was also present.
The Board motioned, seconded and voted unanimously to move into Executive Session to discuss commercially competitive aspects of the Dirigo Health Plan.
At 1PM the Board reconvened to Public Session. Dr. McAfee provided an overview of the work undertaken by the Board and staff to date, and stated that at this point there was confidence that the targeted product would meet the mission of Dirigo. A motion was made to approve the product definition as described to serve as the basis for the RFP. The motion was seconded, and unanimously approved.
Governor Baldacci announced the key features and benefits of the Dirigo Health CareWorks product, and stressed the importance the overall program for improving health care in Maine. He also thanked the Board and Staff their efforts.
Mr. Dunne provided an overview of the key steps undertaken to develop the product, including the use of outside experts to develop key financial measures such as a realistic price for the product, an expected level of newly eligible enrollees into MaineCare.
Karyn Lee Harrington profiled the Dirigo Health CareWorks product, citing prices and explaining the financial discount program, the extended wellness coverage, and the Healthy-me program.
Mr. Dunne then provided an overview of the next steps.
Details were available in a summary package, and can be accessed on the Dirigo web site. (www.dirigohealth.maine.gov)
The meeting was then opened to question from the press and
public. There were questions on:
- product specifics
- expected timelines
- carrier interest in bidding
The board confirmed that the next scheduled meeting was Monday April 5, 2004 at 1:00pm. The meeting was then adjourned at approximately 2pm.
The Board of Directors of the Dirigo Health Agency held a meeting on April 5, 2004. Dr. Robert McAfee, Chairman, convened the meeting at approximately 1:00 in a conference room at the Augusta Armory. Other Board members participating included: Carl Leinonen, Charlene Rydell, Commissioner Robert Murray and Trish Riley. Tom Dunne, Executive Director of Dirigo Health was also present.
The Board reviewed the draft minutes of the March 1st and March 25th, 2004 meetings. A motion was made, seconded and voted unanimously to accept the minutes.
On the Maine Quality Forum Advisory Council, Dr. Dennis Shubert discussed:
Ms. Riley provided an overview of the recent events in other initiatives. A separate handout served as the basis for the brief discussion. The majority of the remarks were about the ongoing legislative discussion on the overall budget. Ms. Riley acknowledged that the legislature was considering many options to meet the overall budget challenge, including proposals that would affect Dirigo, the Governor remained committed to keeping the investment in Dirigo at the previously authorized levels.
Mr. Dunne informed the Board of the need to develop a new
name for the product. The prior name being too close to a
product marketed elsewhere in the country.
Using a presentation provided to the Board and attendees,
five topics were covered on the situation for the Dirigo Health
Agency:
Plan overview: Mr. Dunne profiled a one page summary of the plan for launching the new product. In response to a prior request, identified were the key questions that should be answered before the program is ready to move to the next step. After a brief explanation the Board commented that it appeared to be a valuable tool.
Product: Ms. Harrington described recent feedback on the product since the last meeting. Overall comments have been positive with some remarks on the complexity of the product. Two issues were discussed and recommendations agreed up by the Board:
Financial Projections: Ms. Figueroa profiled recent work on the overall program’s financial situation, including assumptions on MaineCare, operating costs, etc. While there are many key assumptions it is the opinion of DHA leadership that the overall program is financially balanced. Areas for next investigation include the Savings Offset Payment, and the projected costs for developing the initial operations.
Operating Model: Ms. Tomsa described key elements of the target operating model, including key functions that will be performed by DHS and those by the carrier. She cautioned that while the RFP describes an approach, DHA may shift directions if carrier bids suggest better alternatives.
The Request for Proposal: Mr. Dunne gave an overview on status, confirming that the end of April was the target release date. Criteria for evaluation were confirmed. Major tasks remaining were described. Responding to a question, Mr. Dunne confirmed that both in and out-of-state carriers have expressed varying degrees of interest.
When asked if other Board member had questions or comments, Ms. Rydell expressed an interest in having access to the RFP document, and that the Board should be aware of the release date.
Dr. McAfee opened the meeting to public questions and comments.
From the audience were:
- a comment on the Maine Quality Forum.
- a comment on a published article on the upcoming move to
a new facility.
There were no further comments from the public.
The board confirmed that the next scheduled meeting will be Monday May 3rd, 2004 at 2:00pm.
The Board moved into Executive Session for the purpose of discussing Human Resource matters, reconvening only to adjourn.
May 3rd, 2004
The Board of Directors of the Dirigo Health Agency held a
meeting on May 3, 2004. Dr. Robert McAfee, Chairman, convened
the meeting at approximately 1:00 in a conference room at
the DHS Augusta office. Other Board members participating
included: Dana Connors, Carl Leinonen, Charlene Rydell, Mary
Henderson, Commissioner Robert Murray and Trish Riley. Tom
Dunne, Executive Director of Dirigo Health was also present.
The Board convened and voted to go into Executive Session for the purpose of discussing commercially competitive aspects of the program including matters that would prejudice the competitive position of the Agency, and Human Resource matters. The Board reconvened at 2:45 for the Public Meeting.
The Board reviewed the draft minutes of the April 5th, 2004 meetings. A motion was made, seconded and voted unanimously to accept the minutes.
On the Maine Quality Forum Advisory Council, Dr. Dennis Shubert
discussed:
1. The AHRQ proposal for a state wide medical information
interconnectivity system. After discussion it was concluded
that further investigation of the opportunity should be conducted
and reported upon at the next Board meeting.
2. The MQF will be issuing quality and performance data abstracted
from the discharge data base at MHDO for the years 2001-03
in late summer.
3. The paid claims data base for all Maine payers will not
be complete for its first year until October. The MQF is in
the initial phases of establishing data analysis techniques.
Ms. Riley provided an overview of the recent events in other initiatives. A separate handout served as the basis for the brief discussion. The majority of the remarks were on the status of the State Health Plan, including next steps.
Mr. Dunne described the overall status of the RFP, with target
issuance dates. The Board then reviewed key refinements to
the Dirigo target product. Among the topics were:
- Individuals and self employed of one, that the latter group
would be deemed eligible in the first quarter of Dirigo’s
operation
- Trade Adjustment Act Certification, that Dirigo intends
to make TAAC eligible individuals also eligible for Dirigo
- An Experience Modification Program in Year 2 will be offered
to bidding carriers
- The proposed term of the deal was described as a multi-year
deal with annual checkpoints
- There will be three types of “wrap” service
for Dirigo MaineCare eligibles (previously it was grouped
into two types)
- That specialty circumstances, such as handling Group A out-of-network
situations, were still under review; and confirmed from the
Board that when these low volume, complex circumstances arise
in the future, it is expected that a mutually agreed financial
solution would be worked out with the carrier.
- The evaluation team was discussed and it was agreed the
members would not be publicly announced until the evaluation
results were announced.
- Eligibility for the Financial Discount Program - options
were discussed, and the conclusion reached that before the
next meeting additional assessment should take place.
- Handling a potential over-subscription situation, the consensus
was that a “first come – first serve” approach
was preferable to a “lottery” and that staff should
investigate the implications and report back.
- The possibility of refining the employer incentive was discussed,
and while it was agreed it would be for employers who previously
have not offered health insurance benefits, the Board direction
was to investigate having the incentive linked more closely
to employer size.
Key next steps cited included:
- Gaining closure on remaining RFP open items, with the target
of issuing the RFP shortly.
- Providing support for the Bidder’s conference and
answering questions from possible bidders.
- Initiate rule making activities
- Beginning the design and development of target capabilities
On the name for the Dirigo product, multiple candidates exist
and outside counsel was investigating alternatives.
A one page summary of the plan for launching the new product was profiled. No new major tasks have been added since the last Board meeting.
On the Operation of the Dirigo Health Agency, Ms. Figueroa profiled recently contracted work, the financial situation of the Agency and the overall Program (no material new news to report), and the overall size of the DHA staff.
Dr. McAfee opened the meeting to public questions and comments.
From the audience were:
- a question on Mental Health Parity – after brief discussion
is was agreed a separate follow-up clarification would be
issued
- a question on Dirigo product implications with regard to
Provider and MaineCare. It was confirmed that a provider who
is part of the Carrier’s Dirigo Network would have to
handle Dirigo/MaineCare individuals, and that current practice
in terms of accepting new patients would remain.
- A question on the Experience Modification Program, which
was answered in the session.
There were no further comments from the public.
The board confirmed that the next scheduled meeting will be Monday June 7th, 2004.
The Board adjourned.
June 23, 2004
The Dirigo Health Agency Board of Directors held a meeting
on June 23, 2004. Dr. Robert McAfee, Chairman, convened the
meeting at approximately 2:30PM in conference room 209 at
the Augusta Armory. Other Board members in attendance:
Commissioner Rebecca Wyke, Trish Riley, Charlene Rydell, Dana
Connors, Mary
Henderson and Carl Leinonen participated via telephone conference.
The Board reviewed the draft minutes of the June 7th, 2004 meeting. A motion was made, seconded and voted unanimously to accept the minutes.
Mr. Dunne addressed the Request for Proposal bid received
June 11th. 2004 from
Anthem.
• The Bid in many ways matches the RFP.
• There are “trade-offs” within the bid,
and some open points. The evaluation team is currently clarifying
the proposal.
• Sharon Roberts is the point person representing Anthem.
Ms. Riley updated the Board on recent events.
• Meeting with CMS which was held at the regional office
in Boston.
• Appearance before Joint Committee on Appropriations
and Finance by Ms. Riley and Mr. Dunne
~Action item: Inform Dr. McAfee of next scheduled meeting.
• SOP methods workshop, intend to discuss next steps
at the next board.
• Bad debt & charity care ~ a recent Maine Hospital
Association studies show that 1/3 bad debt cases are people
with health insurance.
• State Health Plan will be released on Thursday, July
1, 2004. Final edits are being made now.
• Dirigo’s Income Eligibility approach - the next
step is rule making.
~ A question was addressed to the Board: Prior to any rule
making should the Board be approached with the detailed concepts
for review. The Board members agreed that the Board would
not address each issue but rather that the Agency should make
Board members aware of the timelines and provide information
directly to Board members at their request.
Ms. Kirsten Figueroa provided an overview of the agency including the status on the operating budget and the upcoming move.
The Board announced that the next Board meeting will be held
on Tuesday, July 6th, 2004
@ 2:00PM in the Board room of Dirigo Health Agency, 211 Water
Street Augusta.
The Board motioned, seconded and voted to move into Executive Session for the purpose of discussing the potential Bid negotiations at approximately 3:30PM.
After the Executive Session the Board reconvened and announced
that in addition to the July 6th meeting it would meet again
on July 1st, solely for the purpose of discussing the potential
Bid negotiations.
The Dirigo Health Agency Board of Directors held a meeting on September 7th, 2004. Dr. Robert McAfee, Chairman, convened the meeting at approximately 9:00am in Dirigo Health Agency conference room 211 Water Street Augusta. Board members in attendance were: Dana Connors, Mary Henderson, Carl Leinonen, Charlene Rydell, and Rebecca Wyke.
The Board reviewed the draft minutes of the July 6th, 2004 and August 23rd, 2004 meetings. A motion was made, seconded and voted unanimously to accept the minutes as presented.
Ms. Harrington updated the Board on the Anthem/DHA/DHHS implementation:
• Implementation teams have been established and are
committed to meeting the aggressive timelines. DHHS has Jeff
Green providing oversight to all its related activities. DHA’s
immediate challenges involve financial reconciliation and
reporting requirements.
• Training is under development and soon will commence
for key constituencies including: Anthem internal sales and
operations staff, Producers, and Provider Groups (mainly focused
on their administrative staff). Dr. McAfee provided guidance
on approaching the Provider groups, including in the future
leveraging forums such as the industry standard “Survival
Seminars” and annual meetings. He also reminded staff
of the importance of synchronized communications to the medical
community. (Leveraging the in-place vehicles.)
• The Bureau of Insurance has signed off on one of two
outstanding waiver requests (DHA as the Group policy holder).
If the BOI does not sign off on the second waiver (greater
than a 20% differential between in and out of network benefits),
there will be necessary product changes out of network, but
these would have minimal impact to the end consumers. A ruling
is expected by the end of this week.
• The Marketing campaign is showing positive results.
Phase One – Dirigo Reform Program Awareness - is underway.
A measure is the level of consumer requests for information
which has gone from less than 50/week before the campaign
to between 350 and 550 for the past 3 weeks. Phase Two –
DirigoChoice is scheduled to commence in October.
• An RFP for changes to DHHS eligibility systems is
slated to go out shortly with the objective of having responses
by the end of the month.
Mr. Dunne provided an overview of internal Agency financial
matters:
• A recommendation was made to increase the level of
support provided through Financial Discount Program (FDP).
In reflecting on the initial prices, current cost estimates
and assumptions on sales success, increasing the support to
employees and individuals was deemed appropriate. After discussion
of the trade-offs a motion was made, seconded and unanimously
approved to accept the adjusted FDP levels.
• The Annual Report is off to final printing. A letter
of transmittal from Dr. McAfee will be added.
• Agency Financials for FY04 were presented. The actual
expenses through the end of fiscal year were materially below
the levels projected last November, the levels roughly reflecting
the slower than anticipated start-up of the program. Figures
for the next fiscal years have been supplied to DAFS per state
standard process. Working sessions for later in September
are scheduled, and at this time it is expected that a version
will be ready for Board presentation. The Board asked that
going forward financials highlight the MQF financials separately
and that major interagency expense/transfers also be listed.
• Drafts of the Strategic plan exist for the Maine Quality
Forum and the Dirigo Health Agency. For the aforementioned
budget submission process, a brief summary is necessary. Over
the next few weeks the current versions will be set to Board
Members for comment.
Ms. Harrington confirmed the following:
• Consistent with market practice it was confirmed that
the 75% participation requirement will be held constant for
what ever level of workers and employee make eligible.
• It was confirmed that after exploring several options
the eligibility for individuals and self employed of 1 would
be based on a first come, first serve model. High level overview
of the process was provided as follows:
o All applications received in the mail room are date stamped
o Every application received on day 1 and thereafter has priority
o The day we hit the enrollment cap is the day we stop. Those
apps that come in on this day are given priority once enrollment
is opened again.
Dr. Shubert profiled the about to be launch MQF web site. He highlighted that 1) while the site is focused the end consumer; a key target is the provider community. That providing this level of information to the public should lead to change from within the medical community. He acknowledged that consumers and providers look at information on the website differently. The different perspectives create a tension that may leave each constituency not completely satisfied. Dr. McAfee recognized that prior private use of such information had achieved all that it could and now supported an open exposition and debate.
There were no other matters discussed, and there were no questions or comments from the public.
The Board agreed that the next Board Meetings will be as
follows:
- September 20th 12:30PM, location 211 Water Street
- October 4th 1PM, location 211 Water Street
The Board motioned, seconded and voted to adjourn.
The Dirigo Health Agency Board of Directors held a meeting on October 4th, 2004. Dr. Robert McAfee, Chairman, convened the meeting at approximately 1:00pm in a Dirigo Health Agency conference room at 211 Water Street, Augusta. Other Board members in attendance were: Dana Connors, Carl Leinonen, Charlene Rydell, Trish Riley, Rebecca Wyke, and Chris Bruenn. Also in attendance: Karynlee Harrington, Executive Director, Dirigo Health Agency.
The Board reviewed the draft minutes of the September 7th, 2004 meeting. A motion was made, seconded and voted unanimously to accept the minutes as presented.
Trish Riley updated on the Dirigo Health Reform initiatives.
• Tough Choices campaign is gearing up.
• Commission to Study Maine’s Hospitals:
o 25 meetings, 40 presentations
o Trish Riley confirmed that Bill Haggett’s document
is not the final report of the Commission
o Commission’s final report is due November 2004
Ms. Harrington updated the Board on the major milestone met today…DirigoChoice goes LIVE! A small business (2-50) or self-employed of 1 can call Anthem as of today for a quote. High call volumes (over 300 calls by noon) flooded Anthem’s lines, and overflowed to DHA as well as DHHS in Skowhegan. DHA will closely monitor: who is enrolling, what tier they choose, or if they were previously insured or uninsured. Further, DHA will work to create some follow-up, such as finding out why a person didn’t sign up after he/she received a quote. Ms. Harrington thanked the Board for their guidance, key staff for their efforts, as well as the Legislators and advocates for their support.
Ms. Harrington also updated the Board on:
• Marketing efforts. Dirigo Health Reform commercials
now airing; DirigoChoice radio, print, and television ads
will be airing beginning November 8.
• ACES RFP. Bids are due November 8.
• The organizations represented at the 9/23 Dirigo Health
Now training event. This list includes:
o Consumers for Affordable Health Care
o Franklin County Health Access
o Franklin Community Health Network
o Getting Healthy HMP (Gardiner)
o Maine Association of Mental Health Services
o Maine Center for Economic Policy
o Maine Council of Senior Citizens
o Maine Equal Justice
o Maine General Health
o Maine Heart Association
o Maine Peoples Alliance
o Maine Primary Care Association
o Maine Small Business Alliance
o Maine Women’s Lobby
o Roman Catholic Diocese of Portland
Ms. Harrington handed out a packet of information that included:
• The DirigoChoice talking points document that was
recently sent to the Legislature.
• The “Who to Call” sheet with the DirigoChoice
phone numbers at Anthem.
• The GOHPF’s First-Year Progress Report on Maine’s
Dirigo Health Reform Act.
• Anthem’s Employer Brochure for DirigoChoice.
• The DirigoChoice Discount Estimator.
• The DirigoChoice Discount Application and the DirigoChoice
Discount Application instructions.
• A calendar of speaking engagements for Dirigo Reform,
DirigoChoice (Anthem and DHA).
Dr. Shubert updated the Board on the Maine Quality Forum. Specifically, the status of the website and the RFP for a paid claims database.
Kirsten Figueroa provided an overview of internal Agency
financial matters:
• Agency Financials for FY05 were presented. Actual
expenses through the end of September are materially below
the levels projected last November, the levels reflecting
the slower than anticipated start-up of the program. As requested
from the Board, the financials highlight the MQF dollars separately.
• A draft of the Strategic Plan for the Dirigo Health
Agency was distributed to the Board for their review.
Dr. McAfee addressed the need for a cap on enrollment for self-employed of 1 and the staggered enrollment/cap for individuals. DirigoChoice is the first program in the market to include individuals and self-employed of 1 in a small group product; the impact of this must be monitored.
There were no other matters discussed, and there were no questions from the public. One comment from the public is that enough copies be made of information passed out to Board. To that end, the minutes of the past meeting have been posted on the website.
The Board agreed that the next Board Meetings will be as
follows:
- November 1st 1:00PM, location 211 Water Street
The Board motioned, seconded and voted to adjourn.
The Dirigo Health Agency Board of Directors held a meeting on Monday, November 1, 2004. Dr. Robert McAfee, Chair, convened the meeting at approximately 1:00PM in the Dirigo Health Agency Board Room, located at 211 Water Street in Augusta. Other Board members in attendance: Dana Connors, Carl Leinonen, Trish Riley, Rebecca Wyke, Mary Henderson, Christine Bruenn, and Charlene Rydell. Also in attendance: Karynlee Harrington, Executive Director for Dirigo Health Agency.
Dr. McAfee presented and the Board reviewed the minutes of the October 4, 2004 meeting. A motion was made, seconded and voted unanimously to accept the minutes as presented.
Trish Riley, Director of the Governor’s Office of Health
Policy and Finance, updated the Board on the following:
• The Commission to Study Maine Hospitals:
o The next meeting will be November 22, 2004; Nancy Kane will
present her findings specific to the Financial Health of Maine’s
Hospitals.
o Commission will submit their report to Governor after public
hearing. Specific timeline yet to be determined.
o Dr. McAfee questioned the Commission’s future. Trish
Riley noted that it is up to the Legislature whether or not
to extend.
• Veterans Task Force continues to compile recommendations.
• Tough Choices: First “town meeting”-like
gathering is anticipated for February 2005 with 1,000 random
Maine citizens from all demographic groups.
• New Employees have joined the Governors Office of
Health Policy and Finance
Team: Marta Frank and Jude Walsh.
Dr. Dennis Shubert, Director of the Maine Quality Forum,
updated the Board on the following:
• MHINT (Maine Health Information Network Technology)
feasibility study: Using a diagram, Dr. Shubert explained
how the complexity of the project and the need to know more
about the probable software and hardware options made it impossible
to provide an actual business plan at the end of Phase I.
Dr. Shubert explained his concern about the solidity of provider
buy in before the actual projected costs were known. The Board
will review the Phase I report and the Phase II budget at
its January meeting.
• Strategic Communication Plan: Chris McCarthy provided
an overview and introduced specific activities associated
with Phase I of the plan. In summary, the plan recognizes
that MQF must reach many audiences, for many purposes, via
various methods. The Phase I activities included an awareness
campaign using print advertisement and Maine Public Radio
sponsorship (including graphic design work). Also included
was a brief description of a grass root approach to engaging
and activating all of Maine’s citizens.
Karynlee Harrington, Executive Director of Dirigo Health
Agency, provided the Board with an update on DirigoChoice
and the agency:
• As of October 29, 2004, 450 applications have been
received for a total of 771 members (94% sole proprietors
and 6% small businesses).
• From October 4 through October 22, 2004, Anthem had
issued 2,878 DirigoChoice quotes (65% to self employed individuals
and 35% to small groups).
• Marketing Update: The next phase of media campaign
begins November 8, 2004 consisting of TV, radio, and print.
The message is specific to DirigoChoice, geared to small businesses,
with a call to action to contact Anthem or an Anthem-appointed
producer.
• Ongoing:
o DHA/DHHS MOU drafted and being reviewed for comments/changes
o Financial reconciliation processes
o Eligibility/Enrollment RFP: proposal is due 11/8/04, anticipate
signing contract in December.
o DirigoChoice educational sessions are being held and presented
by Anthem, Dirigo Health Agency, and GOHPF.
• Actions items:
o In the first quarter of 2005, conduct a survey asking those
who were previously insured: did they have a high deductible
plans? And did they cover their independents?
o Revisit the discount estimator and refine/enhance the message.
Emphasize that there is a difference in premiums, deductibles
and out of pocket expenses and that those differences are
determined by household income. Putting the discount estimator
on the website for use by producers and individuals.
o Draft of Rules is finalized; notice of public hearing in
newspapers on 11/10/04. The Public Hearing will be held at
the Dirigo Health Agency, 211 Water Street, Augusta Board
Room on 12/1/04.
Kirsten Figueroa, Director of Budget and Fiscal Operations,
summarized the financial status:
• Agency financials for FY05 year-to-date were presented.
Actual expenses through the end of October are materially
below budgeted levels. As requested from the Board, the financials
highlight the MQF dollars separately.
• The FY06/07 Biennial Budget is nearing completion
and will be presented at the next Board meeting.
Karynlee Harrington will circulate a memo to all Board members regarding availability for next Board meeting.
There were no other matters discussed, and there were no
questions or comments from the public. Dr. McAfee motioned,
the Board seconded and voted to adjourn.
Health Policy & Finance