 Welcome to the Green Mountain Care Board Meeting. My name is Kevin Mullen, Chair of the Board, and I'm calling this meeting to order. First of all, if I want to announce that Board Member Pelham is attending to Family Matter and will not be with us today and sends his regrets. With that, I'm going to call on the Executive Director for the Executive Director's Report, Susan Barrett. Thank you, Chair Mullen. Good afternoon. I want to announce that last night we received from CMMI, CMMI, a written response to Vermont's request for a one-year extension to the all-payer model. That response in that letter is posted on our website under What's New. It's also posted the same letter under Federal Communications. The gist of the response, just a couple of bullets to give you an idea of what they said, and please refer to that letter, is that CMMI is working to offer a one-year extension to the state of Vermont for its current all-payer model. So that would be for calendar year 23 plus a transition year for 2024, which would be to prepare for a subsequent model. The letter also clarifies the process for finalizing the official extension offer, and that includes the federal clearance process, which, according to the letter, is likely not to happen until later this year or fall of 2022. And after that happens, Vermont will pursue its internal clearance process, and then the board, our board, will vote on the agreement amendment. So I would refer to that letter for the general public, and I just will open it up to the board if there are any questions. Kevin, I have a quick question. Is that okay? Yes, it is. So Susan, I'm just wondering if it would be possible thinking about this letter and also, you know, where we're going with the extension, the next agreement, to invite the Director of Healthcare Reform to come in and talk about some of the strategic directions that they're considering. Sure. Chair Mullen, I can reach out to the Director of Healthcare Reform and see when she's available. That would be great. Thank you. And then last, you're welcome. And lastly, just the standing ongoing public comment that we've had for quite some time is that the board is currently taking public comment on a potential next model. We're sharing those comments with our partners at AHS and the Governor's Office so that they can be informed of the comments as they are taking the lead on the negotiations of that next model. And I will turn it back to you, Chair Mullen. Thank you, Susan. The next item on the agenda are the minutes of Wednesday, April 6th, and Friday, April 8th. Is there a motion? So moved. Second. It's been moved and seconded to approve the minutes of 4-6 and 4-8 without any additions, deletions, or corrections. Is there any discussion? Hearing none. All those in favor of the motion, please signify by saying aye. Aye. Any opposed? Please signify by saying nay. But the record show that the motion carried unanimously. So the purpose of this afternoon's meeting is a discussion on MVP nonstandard QHP plan design. And I understand that Christine Smith and Laura McAllenan are here to present. So whoever is leading that, if you could take it away. Hi, thank you. This is Christine Smith, and I just wanted to thank the board for giving us this opportunity to present this to you. It's something that MVP's been working on for quite some time, and we're excited to share with you. So I do have a PowerPoint presentation that I will share my screen if that's okay. That would be great. Can you guys see that? We do. Excellent. Okay. So we do have a proposal for one of our nonstandard plans for 2023, and I'm going to take you through a little bit about what drove that decision. So we will go through our QHP products and the proposed plan design, and then if there's any questions, I'd be happy to entertain them. So first, we have our, this is our portfolio today as it stands of our nonstandard plans with the March 22 membership in it. And the plan that we're looking at highlighting in this presentation is our bronze five plan. So as it stands today, we are offering all of the standard plans, as you know, plus the catastrophic plan. In addition, two nonstandard high deductible plans and the one high deductible reflective plan, three nonstandard, non-high deductible plans, and one reflective plan, which only have very small routine changes, and we did not bring them to the board today. And then our one revised nonstandard plan, which is almost identical to the current plan design with the exception of an increase in the deductible and out-of-pocket max. So what triggered this Green Mountain review is that deductible and out-of-pocket max that we're proposing has what's considered a significant change of plus or minus two percentage points to both the deductible and out-of-pocket max. Based on the Green Mountain Care Board's evaluation criteria for nonstandard plans, MVP feels that this really hits bullet number five, which is adding value to the Vermont market. Our proposed change to the deductible and out-of-pocket max for the bronze five would decrease the premium of this plan by approximately 4.07 percent, and that's based on the 2022 plan design. Actuarial is not 100 percent sure right yet what our market change is going to be for our premiums for 2023, so it was hard for us to put an exact number on that. Some of the research that we did regarding our bronze members is that in 2021 and 2020, our deductibles for the bronze plans were 7250 and 7850. We're proposing to move that deductible up to 9100, and we found that the percentage of members hitting their deductibles in those two years were 5.54 percent and 6.94 percent. What we have found through some extensive research and reading some verbatim that we've gotten back from our members is that the bronze membership premium is very important to them, and the lower we can get the premium on a plan, the more advantageous it is for them. They're not concerned about hitting their deductible or out-of-pocket max. They're simply shopping for the cheapest plan they can find, and we believe that by moving the deductible up, we can achieve that goal of lowering the premium for our members and listening to what they have to say. Here is some of the verbatim pulled right out of our survey from our members, and you can see I've highlighted the words that show that they think the plans are expensive, that the premiums are high, there's an exorbitant amount of premium. We're listening to these members. Cost is the forefront of their dissatisfaction for our bronze members, and our bronze and PS score and our net promoter scores were the least favorable of all of our plan scores, and we believe that by making these changes to the bronze five, we can give members a more affordable option. So our proposed plan design, and I just have our bronze one plan in here so that you can see that this is our other offering to the bronze members, but what we're proposing for the bronze five is that we take the deductible and out-of-pocket max and move those matching benefits up to the max 9100, if and so that is what comes out to be the federal level for the plans for 2023. I also have down here the membership. These membership numbers were as of January. I since repulled the numbers and those numbers were back on the other slide, so our membership in this plan has gone down a very small percent. We don't recommend mapping these members to any different plans. We feel like the bronze five members should stay in the bronze five plan because like I said, we don't believe that this deductible out-of-pocket max is going to make a very great impact on them and that's all I have. So do I have any questions? Board members, do you have any questions? I have a couple of questions. Hi and welcome to the MVP team. We don't see you often so I just wanted to say hello and welcome. Could we go back to slide eight please if you wouldn't mind? Absolutely not. Let's slide eight. Okay. Okay, so I was wondering, so in looking at how many members hit there did the 72, 50 or the 78, 50 deductibles, it looks like it's a pretty low percentage of folks. Do you have and you did give us the average in the median? So it looks like for most folks this change would not have a dramatic impact. Do we have any sense of those who did hit the deductible if how many of those would continue to hit the new deductible or stay under that amount by any chance? Yes, thank you for asking that question. I did mean to point that out as well. So what we saw was that almost all would still hit the new deductible because it seemed like they were a lot of inpatient visits or exorbitant amounts that put them way above the current out of pocket max and deductible. So thank you for asking that. Well, thank you for the clarification. And then I had a question on slide 11 about the plan design. So I recall quite a long time ago now, the plan designs that had the matching medical deductible and out of pocket max were introduced because it was popular in the marketplace. And so there were a number of folks who were lobbying to get that type of plan design lobbying used loosely, not in the official sense. What I was curious because I can't remember the full plan design is whether for those services that the deductible is waived for, is there a copayment for those? Yes. So for the items that the deductible is waived for, obviously it's our preventive services which are covered in full. The first three PCP visits are without a deductible, but then there is a copay after deductible. And the generic scripts have a small copay, but again, not applicable to the deductible. Right. And do you happen to know what the PCP and the generic script deductibles are just for context? I could absolutely pull that up for you if you give me one second. Sure. If you don't want to share your screen while you're doing that, please, you know, no worries. Okay. Am I sharing my screen right now or are you still seeing the presentation? You are. We can see your screen. There we go. Yeah. Thank you. What little dog do you have? So I have two dogs. I have a wonderfully behaved Bernice Mountain dog who you do not hear. And I have a wonderfully misbehaved Peek-a-Poo who you do hear. Chair McMullen, I actually thought it was your dog because it sounds very similar. So there we go. Honestly, she has been quiet all day. And right now she is saying, why are you in the office in a meeting? I want some attention. There's got to be somebody else in there with you because she can hear you talking. Exactly. And I have the door open so she could come in. Okay. So in our non-standard plans for bronze five, the PCP co-pay, oh, I'm sorry, this bronze five plan is 100% zero percent coinsurance after deductible with the exception of those items. Okay. All right. So that means for those items that they're covered in fall until somebody hits the deductible. Correct. Okay. Got it. That was my recollection about how those plans worked but I couldn't quite recall. So in thinking about the types, in general, the types of folks who might buy the bronze five plans, it sounds like it might be assuming a savvy shopper, which we all know health insurance is confusing. So that's a big assumption. But assuming that for the moment, it might be someone who is fairly healthy, is looking for a low premium, might want, you know, wants to keep up with their preventive visits, maybe needs to see a PCP a couple times a year or has a generic prescription. But in general, it seems like this plan is really designed for that kind of population. Does that, is that really what you were going for with this? Yeah. We actually, we think of this plan. It's almost like the catastrophic plan without the age requirement. And in addition to that, I just wanted to point out that we do have the relationship with our virtual partners that members can use our telemedicine program to see a PCP or specialist if they choose to go virtually at no cost share. So that, you know, they do have that option as well included in this plan. Okay, great. All right. Thank you. Those are my questions. Thank you, Robin. Do other board members have questions or comments? Quite a quiet crew today. So with that, I'll move to public comment. Would any member of the public wish to comment on the proposal for the nonstandard plans under the QHP from MVP? Is there any member of the public who wishes to comment at this time? And I'm going to call on the health care advocates office first, Eric Schulteisen. Hi, Eric. Hi. So this, you know, this is not something an insurer can fix, but I think it's worth just noting that if you look at the comments from plan members, three of the four look at the combined costs of out of pocket and premium. So it is true that cost is at the forefront of their dissatisfaction, but it's not just costs with premiums. It's the whole system. So, you know, I, it's this again, this isn't something MVP can fix, but it's really dissatisfaction with our health care system and the narrative that if people are just insured, that's a good thing. I think it's questionable because we want people to be insured, but we also need people to be able to afford health care. Thank you. Thank you, Eric. And it's something that has troubled me over the years that we have so much under insurance and yet we're so proud of our 3% uninsurer. So thank you, Eric. Next, I'm going to turn to Walter Carpenter. Walter. Thanks, Kevin. And I hope I make sense. I've had COVID all week, so I'm just. Oh, no. Well, yeah. I got it at work where I was serving the public to make those Vermont tax dollars and I got it. To back up, Eric, and then to back up Robin, who pretty much took my, were thinking alike with my question, I just would be curious to meet some of these people that MVP took surveys from because every time I hear someone talk about deductibles, it's not in a favorable manner. Deductibles are insurance companies passing costs on to us to prevent us from using health care in order to ensure that their bottom line stays stable. The MVP CEO makes something like a million a year, probably more than that right now, and these deductibles are ensuring that that salary goes up along with their other higher CEOs. So to back up, Eric, and then to back up Robin, I'd be curious to meet some of these people again that you surveyed because no one that I ever talked to, and I work in the tourist business and I talk to people from all over the spectrum, likes deductibles. Basically, deductibles are you're paying for insurance for the privilege of not being able to use the insurance that you're paying for. So I don't see how these plans are going to do any good to anyone. Thank you, Alter. Is there other public comment? Is there other public comment? Okay, I'll move back to the board. Does any board member have any further comment or question? Might I ask the legal team when we're expected to make a decision on this? You may. This is Laura Belleville, staff attorney, and you may vote on this today if you're comfortable doing so. It was noticed for a potential vote. Thank you, Laura. Does any board member wish to make a motion at this time? I'll move approval of the plan design changes. And then I'd like to make a comment. Is there a second to the motion? Second. It's been moved and seconded. And Robin, go ahead with your comment. Yeah. So I think from my perspective, the under-insurance that we've all spoken about is one of the biggest challenges that Vermont consumers are facing as well as premium costs. But I also recognize that there's a role in the market which has a number of different plan designs for a plan that essentially operates as a catastrophic. And I do say that one appealing feature about this plan for fairly healthy folks could be that there is no cost sharing for generic meds, the three PCP, and the preventive care, which may be the types of care that they're most likely to seek. So while I'm not really a fan of plans with deductibles in this range, because it's hard to really see folks being able to come up with the premium plus that amount, I do see a place in the market. And I hope that we are doing our best to make sure that consumers are picking a plan that meets their most likely healthcare needs for any given year. Hey, is there other discussion from the board? Is there other discussion from the board? If not, all those in favor of the motion, please signify by saying aye. Aye. Aye. Any opposed, please signify by saying nay. Let the record show that the motion carries unanimously. And thank you, MVP. And as was noted, we don't get to see you very often. So thank you for coming in and presenting today. And we look forward to your extremely low or negative rate requests in the future. We look forward to that too. Thanks. So with that, I'll ask the board if there is any old business to come before the board. Is there any old business to come before the board? Is there any new business to come before the board? Is there any new business to come before the board? Hearing none, is there a motion to adjourn? So moved. Second. It's been moved and seconded to adjourn. All those in favor of the motion, please signify by saying aye. Aye. Aye. Any opposed, please signify by saying nay. Thank you, everyone, and have a great rest of the day. Bye.