Meeting of the
Comprehensive Health Information System (CHIS)
Health Plan Consumer Report Technical Workgroup
Minutes
Date: November 30, 2005
Beginning Time: 10:00 a.m.
Venue: Face-to-Face and Teleconference, Tallahassee
Members Present: Victoria Bloodworth, James Bracher, Diane Kazmierski,
Belynda Shadoan, Kim Streit, Tom Warring and Bob Wychulis, Chair.
Members Participating by Teleconference: Tamara Meyerson, Harry Spring,
Wanda Stinson (proxy for Mary Keister), and Kristine Thurston Toppe.
Members Absent: Paul Jennings, Sharon Nisbit, Lisa Portelli, Linna Van Nette,
Art Weinblatt.
AHCA Staff Present: Penny Bos, Bobbie Carpenter, Cruz Conrad, Bill Dahlem,
Beth Eastman, Beth Register, Judith Salpeter, Sarah Sheppard, Jerome Todd,
Carolyn Turner and Ken Walker.
Other Participants: Askar Chukmaitov representing the FSU College of
Medicine, Roger H. Hahn representing Vista Health Plan, Nir Menachemi
representing the FSU College of Medicine and Bruce Platt representing Akerman
Senterfitt.
Other Participants by Teleconference: Kevin Wrege, representing AHIP.
Materials provided: Agenda; Draft Minutes from the August 16, 2005 Meeting
of the Workgroup; Draft Proposed Health Plan Consumer Report Rule, dated
10/28/05; Guiding Principles for the Health Plan Website; OIR data collection
form: Report of Gross Annual Premiums and Enrollment Data; Memo from Tom
Warring: Issues before the Health Plan Workgroup (9/19/05); Listing of Top 10
Websites-Health Plan Information for Consumers.
I. Welcome and Introductions. Bob Wychulis, Chair, opened the meeting
at 10:00 AM. He thanked AHCA staff for their work to prepare for the
meeting.
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II. Review of Draft Meeting Minutes (8/16/05).
Bob Wychulis asked for comments on the meeting Minutes from the
previous Workgroup meeting as submitted. Belynda Shadoan requested
a modification to the statement that "OIR will have raw data, beginning in
April 2006 on the speed of payment."
AHCA TASK: Jim Bracher requested that staff provide a summary of
motions and assigned tasks from recent Workgroup meetings, so that the
progress on each may be assessed.
MOTION #1: Jim Bracher made a motion to approve the Minutes pending
the requested change. Tom Warring seconded and the motion passed
without objection.
Discussion of Display of Medical Loss Ratio.
Tom Warring asked if the financial indicator "medical loss ratio" had been
selected by the Workgroup for display on the website. Bob Wychulis
noted that the Workgroup had discussed this indicator before, but that no
final decision on its posting had been made. Discussion ensued regarding
the indicator's usefulness to consumers and it's relation, if any, to the
quality of a health plan.
Jim Bracher recommended that this issue be discussed at a later CHIS-
Advisory Council meeting, in the context of other financial indicator
information on all health care entities. The Workgroup concurred and
Belynda Shadoan recommended inviting appropriate staff from the Office
of Insurance regulation (OIR) to such a meeting.
III. Status of Health Plan Consumer Report Rule.
Carolyn Turner stated that changes were mandated to the rule after
review by the Legislature's Joint Administrative Procedures Committee.
The rule was filed for final adoption in early December (and was adopted
on December 25, 2005).
IV. Guiding Principles for Health Plan Website.
Penny Bos directed attention to the document, Guiding Principles for the
Health Plan Website, and requested comments. Kim Streit noted that the
Principles had already been adopted for all AHCA websites by the CHIS-
AC. After some discussion, modification of the Principles was postponed
until the website "wish list" could be compiled.
V. Review of On-line Florida HMO Report, 2005.
Bill Dahlem led the Workgroup through the various portions of AHCA's
website for the 2005 HMO Report. He noted that most other states simply
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display their hardcopy reports as a PDF file, but with Florida's report, the
user can select specific indicators to view and compare plans.
Some Workgroup members wondered why AHCA selected a rating of "10"
as the definition of "Best Health Plan". It was suggested that the decisions
on how to score certain survey items be examined by the Workgroup.
Harry Spring wondered how the NCQA recommends displaying data from
the CAHPS survey, and Kristine Thurston Toppe agreed to inform the
Workgroup on that matter at the next Workgroup meeting.
Discussion then centered on aggregating data by geographic location.
County-level data was recommended, since ZIP codes can be problematic
(frequent changes in definition and cases where a single ZIP straddles two
counties). Ken Walker (AHCA-IT) noted that isolating data at the county
level requires a more dynamic database, i.e., more work for the IT
designers.
Jim Bracher noted that information of plan coverage areas was often out
of date, and suggested the data should be updated as soon as possible
after it changes.
AHCA TASK: SCHS staff should meet with OIR and AHCA Managed
Health Care staff to improve the process for publishing timely HMO
coverage areas.
VI. Display of Financial Information from Health Plans.
Belynda Shadoan directed attention to the OIR data collection form,
"Report of Gross Annual Premiums and Enrollment Data", which will
collect information on direct premiums earned and average number of
days taken to pay claims (Column G). She noted that Column G had not
yet been defined by OIR, but that an Information Memorandum would be
issued containing that definition. Presently, the information is not audited
and will initially be published in June 2006.
OIR TASK: OIR should provide a definition of Column G ("Average
number of days to pay claims.") on the Gross Annual Premiums report.
Regarding premium rates, Bob Wychulis noted that the information in
OIR's upcoming small group premium rate database will be consumer
friendly, and instructed staff to examine the websites of other states for
their presentation of health plan premium rates.
The Workgroup also expressed interest in the results of "prompt pay"
investigations at OIR's Market Investigation Unit. Belynda Shadoan noted
that, with the exception of published reports and Consent Orders, all of the
Market Investigation Unit's data are confidential. Kim Streit recommended
that AHCA place a link to the OIR Market Investigation Unit website in
order to view the published results from market conduct studies.
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AHCA TASK: SCHS staff should meet with OIR staff (Sam Binnun) to
discuss Prompt Pay data. Staff should also invite appropriate OIR staff
(Sam Binnun, Rich Robleto, etc) to appropriate meetings of the CHIS-
Advisory Council and the Health Plan Workgroup.
VII. Report on Health Plan Provider Networks.
Tom Warring informed the Workgroup on the data maintained by AHCA's
Bureau of Managed Health Care on health plan provider networks. He
noted that AHCA has adequate data on HMO networks, but no data on
PPO networks. He recommended that AHCA provide links to each health
plan's website so that consumers can access the latest information on
provider networks.
AHCA TASK: Staff should look at several HMO and PPO websites to
determine the presence of timely information on provider networks.
Kim Streit asked if AHCA had data to judge the adequacy of provider
networks. Mr. Warring replied that AHCA does judge networks for their
reasonableness in providing the services they offer. There are no set
formulas for performing this task.
VIII. Review of Top 10 Health Plan Websites.
Bill Dahlem led a review of the Top Ten Websites (as determined by
AHCA staff) for health plan quality information. The HMO site for in New
York State was highlighted as a model for the presentation of data. The
site also has useful information on premium rates and benefits. Ken
Walker noted that the California HMO website listed the languages spoken
by staff at each HMO, perhaps an idea for the AHCA website.
Jim Bracher asked if any website had quality information on members of
PPOs. Kristine Toppe replied that she was unaware of that information
being posted on any website. She offered to determine if other states are
using CAHPS or HEDIS data for non-HMO membership. She also offered
to describe the NCQA's efforts with measuring PPO performance.
Bob Wychulis noted that New York displays data on member complaints
and that Florida should again look into this matter. He mentioned the
importance of distinguishing between an information request and a true
complaint of service. Then, complaints should be aggregated into
categories for publication.
IX. Website Wish List / Development of Health Plan Website.
Bob Wychulis summarized the major items to be displayed on AHCA's
health plan website. These are: Member satisfaction (CAHPS); quality
indicators (HEDIS); premium rates and benefits; speed of payment of
claims; plan coverage areas; and (possibly) complaints.
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Other highlights of the discussion included:
All plans should be displayed in one report, aggregated by plan type.
The health plan website should mirror the look of
FloridaCompareCare.
Information on a plan's provider network should be accessed via a link
to the plan's own website.
Information on individual plan premium rates and benefits should be
accessed via a link to OIR's website.
Some information should be presented in a static fashion (e.g.,
CAHPS/HEDIS data), while other information should be presented
interactively (e.g., plan coverage areas).
The work on the website can be done in house by AHCA-IT There are
new positions allocated to this project and work can begin around April
2006.
Please see the document, Wish List for a Health Plan Consumer Website
for more details on this topic.
MOTION #2: Jim Bracher made the following motion:
AHCA staff should summarize the website Wish List, especially as it
pertains to health plans.
Based on the Wish List, modify and tailor the website Guiding
Principles for Health Plans.
The Health Plan Workgroup supports AHCA in the creation of the
health plan website in-house.
Bob Wychulis will meet with Kevin McCarty of DFS to discuss sharing
data and other information. The meeting should include
representatives of AHCA-IT (Ken Walker or proxy), DFS-IT and other
CHIS-AC members, as appropriate.
The Health Plan Workgroup should meet in January or February to
discuss these items.
Tom Warring seconded and the motion passed without objection.
Next Meeting. A date in late January or early February was mentioned as a
likely next meeting date.
Adjourn. The meeting adjourned at 1:30 p.m.
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