Florida Group Health Insurance Plans - Download as DOC

Document Sample
Florida Group Health Insurance Plans - Download as DOC Powered By Docstoc
					                                     Meeting of the
              State Consumer Health Information and Policy Advisory Council
                    Health Plan Consumer Report Technical Workgroup

                                         DRAFT MINUTES

Date:                  July 19, 2006

Beginning Time:        10:00 a.m.

Venue:                 Face-to-face and by teleconference, AHCA, Tallahassee, FL

Members Present:       Bob Wychulis, Chair, Florida Association of Health Plans; James Bracher, J.
                       Bracher & Associates; Diane Kazmierski, BayCare Health System; Jerome Todd,
                       proxy for Lisa Rawlins, AHCA; Harry Spring, Humana, Inc.; Kim Streit, Florida
                       Hospital Association; and Tom Warring, AHCA.

Members Present        Denise Mineo, proxy for Victoria Bloodworth, Blue Cross Blue Shield of
by Teleconference:     Florida; Paul Jennings, St. Vincent’s Health System; Tamara Meyerson,
                       Preferred Medical Plan, Inc.; Angela Lockwood, proxy for Belynda Shadoan,
                       Office of Insurance Regulation; and Kristine Thurston Toppe, National
                       Committee for Quality Assurance.

Members Absent:        Mary Keister, Capital Health Plan, Inc.; and Art Weinblatt, Managed Care of
                       HCA, East Florida Division.

AHCA Staff present: Cheryl Barfield, Penny Walker Bos; Arlesia Brock, Ph.D.; Cruz Conrad, William
                    Dahlem, Ph.D.; and Ken Walker, AHCA IT.

Other Participants:    R.H. Hahn, Vista Health Plan; Darcy Gartner, Vista Health Plan; and Leslie
                       Dughi, Greenberg, Traurig.

Other Participants     Bruce Platt, Akerman Senterfitt; and Sharon Hatch, South Florida Community
by Teleconference:     Care Network.

Materials Provided: May 17, 2006 Minutes; Addendum to May 17, 2006 Minutes; AHCA-FCHIPA
Organizational Chart; Policies & Procedures; Roles, Affiliations and Purpose; Table of Motions; Table of
Tasks; Legislative Update; Update-FHIN Grant Awards; Recommended Specifications for the Health
Plan Consumer Website; Recommended Health Insurance Web Links; Small Employer Health Insurance
Rate Data Collection System (Premiums); Financial Data – Average Number of Days Taken to Pay
Claims and Other Data; Alternative Displays of Financial Information on the AHCA Health Plan
Website; Claims Payment Data Available from HEDIS and CAHPS Surveys; NCQA Standards and
Formulas for Ratios on Members-to-Providers in a Network; Post Meeting Critique; Proposed 2006
Meeting Calendar.

Meeting Handouts:      Summary of HB 1629

Welcome, Introductions and Roll Call: Bob Wychulis, Chair, called the meeting to order and
welcomed the members, audience participants, staff, and those attending by conference call. He then
called the roll and verified a quorum.
                      Draft Minutes of the Health Plan Workgroup Meeting, July 19, 2006

Review and Approval of Minutes: Bob Wychulis, Chair, then called for a review of the minutes of the
May 17, 2006, meeting and the supplemental addendum to the minutes.

MOTION #1: Jerome Todd made a motion to accept the minutes. Kim Streit seconded the motion to
accept the minutes, and addendum, with the note that the addendum should reflect Paul Jennings rather
than Paul Duncan. The motion was passed and the minutes were approved with the correction.

Agency Information: Penny Walker Bos reviewed the standard agency documents, noting that the
Organizational Chart and other documents had been updated to reflect the change in the name of the
Advisory Council and the Florida Center.

Legislative Update: Penny Walker Bos noted changes brought by HB 7073, including the name change
of the Advisory Council and the Florida Center. She updated the members on the latest Florida Health
Information Network (FHIN) Grant Awards.

Design of Health Plan Consumer Report Website: Dr. Bill Dahlem reviewed the proposed
specifications for the website, going over the outline of the potential layout of the website. A discussion
was held regarding where to obtain the data, and how that data would be displayed. He then reviewed
suggested ideas for the pages to display on the website. The members discussed how the consumer will
find specific health plans, and whether the search would start with the type of plan or the location of the
consumer. Ken Walker, AHCA IT, stated that he can adjust the portal as necessary, based on the decision
of the workgroup. There were several recommendations that the website portal start with the consumer
choosing the location, then selecting the type of plan they are looking for, e.g., private vs. public, etc.

MOTION #2: A motion was proposed by Harry Spring stating that the user should enter the website first
by the user’s location then by the plan type. Discussion ensued as to whether the location should come
first, or the plan type. The motion was then amended as follows: When a user enters the AHCA Health
Plan website, the site should begin with either the user's location or the plan type. The motion was
seconded by Jim Bracher. The amended motion was then voted on and passed.

Discussion followed regarding the types of plans that would be made available on the website. Bob
Wychulis, Chair, pointed out that they needed to consider all plan information, and that a plan cannot be
eliminated from display even if there is no data available. Kim Streit stated that the consumer may or
may not have any knowledge regarding the difference in plans, and that AHCA should allow the
consumer to choose a health plan based on quality measures, as well as plan costs. It was suggested that
the website should also provide links to supplemental insurance plans, in future updates of the Health
Plan website.

Workgroup members suggested that AHCA should educate consumers on the various plan types
available, starting with the statutorily-created markets, small group and individual plans, then broken
down by various plan types. It was suggested that Preferred Provider Organizations should voluntarily
categorize themselves as to whether they market plans statewide or just in select counties. Jim Bracher
wondered if this would bring up the possibility of fair trade issues.

Jim Bracher also suggested that staff should look to the Office of Insurance Regulation (OIR) website to
see what’s already out there for educational materials. It was recommended that Dr. Dahlem should meet
with OIR to determine what information it has on Health Maintenance Organization (HMO) and non-
HMO plans, and what coordination can be achieved between AHCA and OIR.

                                                                                            Page 2 of 5
                      Draft Minutes of the Health Plan Workgroup Meeting, July 19, 2006

AHCA TASK: Harry Spring felt an opinion from AHCA Legal counsel on the question of PPO coverage
should be sought before proceeding.

Bob Wychulis, Chair, suggested that the workgroup reach out to OIR and to anyone else that may be
interested in forming a small sub-workgroup to work on information and definitions of health insurance
terms for consumers. Kim Streit reminded members of the Sunshine law as it applies to the workgroup,
and suggested that staff reach out to members individually.

AHCA TASK: Coordinate with workgroup members to pull together health insurance information and
definitions for the consumer as related to different plan types and products available. Members are to
submit information via email, then staff can prepare a document for review by the workgroup at the next
meeting. Harry Spring suggested that each workgroup member should review glossaries, including those
available from America’s Health Insurance Plans (AHIP) and Employee Benefit Research Institute

AHCA TASK: Lesli Dughi suggested that the "Insurance 101" document created by the House could be
helpful as well. Penny Walker Bos will research and provide a copy to the members for the next meeting.

Update on Office of Insurance Regulation Projects: Bob Wychulis, Chair, introduced Angela
Lockwood from OIR who provided a review of the overall OIR website and the Small Employer Health
Insurance Rate Data Collection System in particular, along with other financial data. She pointed out that
the OIR website for the Rate Data Collection System is not populated with data at this time, but expects
OIR will have the site fully populated by July of 2007. She explained that as health plans begin to make
their rate filings with OIR, the data will be added to the site. Bob Wychulis, Chair, stated that it was the
workgroup’s intention to link to the OIR site for small group premium rate information. There was some
discussion regarding the lack of information on the site and whether the linking should be postponed until
all of the data had been populated.

MOTION #3: Harry Spring made the following motion: The Agency should notify all small group
health plan carriers in Florida that, by law, AHCA must publish premium rates by plan, via a link to the
OIR website, beginning October 1, 2006. The Agency is to tell the carriers to file the rate data with OIR
before the startup date of the AHCA health plan website (October 1, 2006) or by August 1, 2006. The
motion was seconded by Jim Bracher.

Bob Wychulis, Chair, explained to the members that this is the first time this information has been made
available by OIR and asked OIR staff to determine how the information is updated and corrected. He
feels this is an OIR responsibility and they should be given a chance to respond. He felt the motion was
premature and should be dealt with in the future, once OIR has had an opportunity to respond. Harry
Spring expressed his concern that if they don’t act now, they may lose impact before the October 1
deadline for the health plan website. Jerome Todd expressed his concern with the statement “must
submit” and suggested they change to “request” or “encourage” the carriers to submit rate data.

AMENDED MOTION #3: Jim Bracher then amended the motion to say that AHCA should “notify” the
plans that the information is going to be linked on the website and “urge” that plans comply in a timely
manner. Jerome Todd seconded the amended motion. After more discussion by the members, a vote was
called for by the Chair, and with the majority of members voting nay, the amended motion was denied.
The original motion #3 was then voted on and passed as stated.

Display of Financial Indicators: Dr. Dahlem introduced alternative views of financial information
(particularly, "Average number of days taken to pay claims") for display on the AHCA Health Plan
website. According to OIR, plans not reporting these data will be referred to OIR's Market Investigation

                                                                                             Page 3 of 5
                     Draft Minutes of the Health Plan Workgroup Meeting, July 19, 2006

Unit. There was discussion regarding the possibility that the average days to pay claims may be affected
by pharmacy claims and therefore not very helpful to consumers. Additionally, there is the problem that
the data includes both electronic and paper claims. Bob Wychulis, Chair, volunteered to provide the
AHIP prompt payment report for dissemination to the members. Discussion continued on what financial
information should be provided on the website, noting that there may be some gaps in the data. However,
some members expressed their concern that some financial data should be displayed. Discussion was also
oriented to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data on
claims payment, noting that this information could be displayed in addition to the OIR data.

MOTION #4: Kim Streit proposed the following motion: The Agency should display data on claims
payment from the CAHPS survey (two items), along with the range of data on the "average number of
days to pay claims" (Col G, OIR report) in the same area of the AHCA Health Plan website. The motion
was seconded by Harry Spring. Discussion ensued and there were concerns that the data should be
separated and not shown together. After further discussion, the motion was tabled for further discussion
at the next Workgroup meeting allowing staff to provide a display of the proposed information.

AHCA TASK: Present alternate mock-ups of proposed website pages at the next meeting.

Provider Network Information: Kristine Thurston Toppe, National Committee for Quality Assurance
(NCQA), reviewed the claims payment data available from Health Plan Employer Data and Information
Set (HEDIS) and CAHPS Surveys. She also discussed NCQA standards for ratios of providers-to-
members in a provider network, as a proxy for "network adequacy". After some discussion regarding
network adequacy, Bob Wychulis, Chair, led the group back to the discussion of provider networks and
how network information is displayed. Ms. Toppe was asked if the network data could be out of date and
how could they ensure that the information provided was current. Ms. Toppe said that new NCQA
standards for 2007 will require more timely and accurate information specific to a plan's display of
physician network information.

MEMBER TASK: Kristine Thurston Toppe will provide a copy of the NCQA standards for the next

The members then visited the National Association of Insurance Commissioners (NAIC) website and
reviewed the consumer financial information displayed. There was some discussion as to whether or not
the consumer would find the financial information helpful. It was then decided to table the topic of
financial performance indicators until a future meeting.

MOTION #5: Harry Spring made a motion that the Agency should write to each of the health plans that
did not provide data on claims payment to OIR requiring them to provide the information to OIR or
AHCA. Angela Lockwood requested that OIR be given a chance to refer noncompliant carriers to OIR's
Market Investigation Unit first, and allow those that did report to amend their data for corrections. The
motion was then amended as follows: The Agency should write to the health plans that did not submit
data to OIR on the "average number of days to pay claims" to date, requiring the plans to submit the data
to OIR or AHCA in time for the October 1 deadline. Plans should also have the ability to resubmit more
accurate data to OIR by (a specified) date. The amended motion was seconded by Jim Bracher, and upon
a vote, the motion was passed.

Meeting Summary: Bob Wychulis, Chair summarized the requests and tasks brought up during the
meeting, as well as the motions and future agenda items.

                                                                                          Page 4 of 5
                    Draft Minutes of the Health Plan Workgroup Meeting, July 19, 2006

Next Meeting: The next meeting was tentatively scheduled for August 23. 2006. Bob Wychulis, Chair,
asked AHCA staff to provide the members with available meeting dates for September by email. The
meeting was adjourned at 1:55 p.m.

AHCA TASK: Provide members with available meeting dates in September by email.

                                                                                        Page 5 of 5

Description: Florida Group Health Insurance Plans document sample