Joint Committee Committee on Joint Health and Human Services (03/01/2012)

Final
STAFF SUMMARY OF MEETING

COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES

Date:	03/01/2012	ATTENDANCE

Time:	01:36 PM to 03:47 PM	Acree	*
		Aguilar	X
Place:	LSB A	Bradford	*
		Brown	X
This Meeting was called to order by		Fields	X
	Senator Boyd	Foster	X
		Joshi	X
This Report was prepared by		Kefalas	X
	Elizabeth Burger	Kerr J.	X
		Lundberg	X
		Massey	X
		McCann	X
		Mitchell	X
		Newell	E
		Nicholson	X
		Peniston	X
		Roberts	X
		Schafer S.	X
		White	X
		Young	X
		Summers	*
		Boyd	X

		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Presentation on the CO Health Benefit Exchange Update on the All-Payer Claims Database		Witness Testimony and/or Committee Discussion Only Witness Testimony and/or Committee Discussion Only

01:37 PM -- Presentation on the Colorado Health Benefit Exchange

Gretchen Hammer, Chair of the Colorado Health Benefit Exchange Board of Directors (board), Richard Betts, Vice-chair of the Colorado Health Benefit Exchange Board of Directors, and Patty Fontneau, Executive Director of the Colorado Health Benefit Exchange (exchange), introduced themselves to the committee. Copies of their presentation and the 2011 progress report on the implementation of the exchange were distributed to the committee (Attachments A and B).

01:40 PM

Ms. Hammer discussed the activities of the board. She noted that Senate Bill 11-200 created the board and dictated the makeup of the membership of the board. She discussed the specific requirements for members who serve on the board, and noted that a list of the board members is included in Attachment A. She described the Legislative Implementation Review Committee and discussed the hiring of Ms. Fontneau as Executive Director of the exchange.

01:45 PM

Ms. Hammer discussed the stakeholder engagement process used by the board, and noted that all of the board meetings are open to the public. She noted that the exchange recently received an establishment grant and discussed the activities that will be carried out with the grant moneys. She provided an update on the technology services that will be part of the exchange. Ms. Hammer noted that the board is researching and discussing a number of policy decisions for successful implementation of the exchange by 2014.

01:48 PM

Ms. Fontneau thanked the board and the members of the Implementation Review Committee, and noted that there has been active stakeholder input in the activities of the exchange. Mr. Betts commented on the activities of the board. Ms. Fontneau responded to questions from Senator Mitchell regarding the implementation of the federal Affordable Care Act. Ms. Hammer and Ms. Fontneau responded to additional questions regarding exchanges in other states and the implementation of navigator services in the exchanges. Mr. Betts and Ms. Hammer responded to questions from Senator Nicholson regarding how the exchange will address the unique needs of rural Coloradoans. Ms. Fontneau responded to questions from Senator Lundberg regarding how the exchange will interact with the Colorado Benefits Management System, and Mr. Betts commented on how the exchange will determine eligibility for public health programs.

02:04 PM

Ms. Hammer responded to questions from Representative Kefalas regarding whether the exchange will combine the small group and individual insurance pools, and she explained that the board has decided to structure the exchange as one administrative entity with two separate lines of business for the individual and small group markets. She explained that the individual and small group risk pools will remain separate and noted that the board will study how managing the risk pools separately will affect the insurance marketplace. Representative Kefalas asked what role the board will have in determining the essential health benefits that will be offered by the plans in the exchange. Ms. Fontneau responded that the board and the exchange are working closely with the Division of Insurance (DOI) and interested parties in open meetings regarding the essential health benefits. Representative Kefalas asked what the current status of the exchange is in light of the case pending before the U.S. Supreme Court challenging the federal Affordable Care Act, and Ms. Hammer referenced Senate Bill 11-200's legislative declaration that finds that establishing the exchange is in the best interest of the state of Colorado.

02:10 PM

Ms. Hammer responded to questions from Representative Acree regarding the certification process that will be required for insurance plans sold through the exchange, and noted that the exchange may not duplicate the functions of the DOI. Representative Joshi asked about the requirement that the exchange be financially self-sustaining by 2015 and Ms. Hammer responded. She further responded to questions regarding the effect of the exchange on CoverColorado and Getting Us Covered, Colorado's high-risk insurance pools. She stated that, when the exchange is fully implemented, an estimated 460,000 individuals and 80,000 employees and dependents of employees of small employers will enroll in coverage through the exchange and will utilize premium assistance and tax credits to pay for the coverage. An additional 160,000 individuals and 260,000 employees and dependents of

employees of small employers will enroll in coverage through the exchange without financial assistance for the costs of the coverage. Ms. Hammer further responded to questions from Representative Kefalas regarding whether the exchange will include a navigator function.

02:19 PM

Ms. Fontneau responded to questions from Senator Mitchell regarding whether tax credits for employers are available only through the exchange. She further responded to questions from Senator Mitchell regarding whether there are elements of Colorado's exchange that would not have been included if there were not federal requirements to do so. Ms. Hammer responded to questions from Representative McCann regarding how the essential health benefits offered in plans in the exchange will be determined and from Representative Kefalas regarding medical-loss ratios in health plans. Senator Nicholson asked if there was an available estimate of how many individuals will remain uninsured if the U.S. Supreme Court rules the individual mandate unconstitutional and Ms. Hammer responded that an estimate is not currently available.

02:26 PM

Senator Boyd thanked Ms. Hammer, Mr. Betts, and Ms. Fontneau for their presentation.

02:28 PM -- Update on the All-Payer Claims Database

Phil Kalin, Chief Executive Officer, Center for Improving Value in Health Care (CIVHC) introduced himself and Dr. Lalit Bajaj, Children's Hospital, and Paul Rulison, Treo Solutions, to the committee. A copy of their presentation was distributed to the committee (Attachment C). Mr. Kalin described the goal of the All-Payer Claims Database (APCD) which is to provide data on health care costs in an aggregated form to allow consumers and businesses to determine quality and cost-effectiveness in health care. He said the health care marketplace cannot function without data and the goal of the database is to determine where there is value in the health care system.

02:33 PM

Mr. Kalin discussed the reasons for the creation of APCD, stating that consumers were clamoring for actual information about how much health care services cost. He stated that businesses are in need of information about where to best spend their health care dollars, and that health policymakers are interested in knowing how new initiatives from Medicaid and other public health programs are affecting health outcomes and costs. He noted that an APCD is a tool for empowering informed decision making by consumers and business purchasers, a gateway to transparency that is necessary for bending the cost curve, and a tool for creating transparency of pricing and quality in the health care system. He stated that an APCD is not a centralized electronic medical record, a tool to see individual health records, or a means of controlling or denying care for individuals.

02:38 PM

Mr. Kalin described the history of CIVHC and the APCD. He described the 2011 milestones for the APCD including the completion of rulemaking to guide data submissions, the receipt of funding from the Colorado Health Foundation and the Colorado Trust, and the entry into a contract with database manager Treo Solutions after a competitive procurement process. He described the 2012 plan of work, which includes the creation of a database to accept test data in February of 2012; the submittal of test data by March 31, 2012; the submittal of historic data by June 30, 2012; the submittal of the first six months of 2012 claims data by August of 2012, and then monthly thereafter; and the generation of the first reports from the APCD by late 2012. He discussed the requirements for health payers to submit data to the APCD, stating that in 2012, Medicaid and commercially fully insured large

groups and individual insurers are required to submit data, and in 2013, Medicare, small group insurers, and large group self-insured payers must submit data. He noted that by 2014, CIVHC expects that the APCD will have collected claims data for 90 percent of Colorado's 4.2 million insured individuals.

02:44 PM

Mr. Kalin responded to questions from Representative Acree regarding how the APCD interacts with anti-trust laws and from Representative McCann regarding whether payers are required to participate in the APCD. Senator Roberts asked if the database will be able to parse out trends regarding individual patient acuity.

02:55 PM

Representative Kerr asked how data will be secured within the APCD and Mr. Kalin provided an overview of the encryption measures that will be used to protect the information in the database.

03:02 PM

Dr. Lalit Bajaj, Children's Hospital, described the samples of reports that may be generated by the APCD which are contained in Attachment C. He highlighted how the reports will provide consumers data relevant to the costs and quality of care they may need. He also noted how the data will provide information for employers on the cost and quality of health plans. He noted that the database will generate reports regarding the utilization of health care services and the outcomes of care.

03:07 PM

Dr. Bajaj responded to questions from Representative Young regarding the reports that will be generated by the APCD and the analysis of the data from the APCD. He further responded to questions from Senator Roberts regarding comparisons of data from the APCD to other states' data. Dr. Bajaj responded to questions from Representative Kefalas regarding how physicians will use the data in the APCD to improve the quality of care. Dr. Bajaj continued to respond to questions from the committee regarding potential applications of the data obtained from the APCD.

03:22 PM

Mr. Rulison described the privacy and security protections in the APCD. He described how data is transmitted to the APCD and stated that data can only be submitted from an Internet address that is unique to each payer using a unique encryption key. Once data is submitted, only a combo of keys held by the submitter and Treo can make the data intelligible. After submission, the data are moved to another server and re-encrypted using a different encryption key. He described the password protections for the data and stated that attempted connections from unauthorized systems will automatically be blocked and logged. Mr. Rulison described the security measures in place at the APCD's physical location and the APCD's electronic access controls.

03:40 PM

Mr. Kalin responded to questions from Representative Gerou regarding whether the APCD will contain data on individual patients. He further responded to questions from Representative Gerou regarding appropriate uses of the data within the APCD.

03:47 PM

Senator Boyd thanked the panel for the presentation. The joint committee adjourned.