Group Insurance Commission’s FY08 Rate
Increase Lowest in Nine Years
March 14, 2007

The Group Insurance Commission (GIC) approved premium rate increases for its health plans at the March 14, 2007 Commission meeting that are lower than rate increases seen in much of Massachusetts and the nation. Unlike many employers, the modest increase was accomplished without cost shifting to state employees and retirees. In fact, the GIC has not made substantial changes to the benefit offerings for the last four years.

The monthly premiums for the GIC’s HMO, Indemnity, and PPO plans will increase by an average of just 5.04% in the 2008 fiscal year (or by 3.7% if Medicare retirees are included) as compared to 7.4% for large employers in Massachusetts and an expected average of 6.4% for national employers (after changes have been made to benefits packages). Assuming no changes to benefits, rates are projected to rise by 11.3% in Massachusetts and 8.8% for national employers; government agencies across the country expect their rates to go up by 7.6% after changes (9.3% before changes).

“We’re very pleased with these rates” said Dolores L. Mitchell, Executive Director of the GIC.  “The increase is lower than last year’s and we’ve accomplished that without shifting more costs to our members.”  The rising cost of health care continues to outpace wage increases and general inflation, consuming the worries of private corporations and government agencies alike, the GIC continues to grapple with the challenges of cost containment with the strong belief that resorting to high-deductible plans or significantly shifting the burden of costs to its members is not an option. Over the years the GIC has worked with its health plans to implement a number of strategies to contain costs including disease management programs, health promotion efforts and tiered prescription drug formularies.   

“These results are another example of the excellent performance of the GIC’s management and staff in providing comprehensive benefits at competitive costs,” said Thomas A. Shields, Commission Chair.  “These results exemplify the GIC’s commitment to both its members and the taxpayers of the Commonwealth.”

The agency is entering its fourth year of an innovative program, called the Clinical Performance Improvement Initiative, which seeks to improve health care quality and contain costs by advancing transparency in the health care system and creating incentives for patients to seek the most effective care for their condition. To accomplish this task, the GIC works with a number of constituents to identify differences in resource utilization and quality, and provides this information to the health plans to develop tiered benefit designs.  GIC enrollees are given modest co-pay incentives when they use better performing providers. Although it is too early to say the extent to which this groundbreaking initiative is driving improvements in the system and containing costs for the Commonwealth, the GIC and its staff believes that taking evidence from a growing body of literature and research and putting it into practice will further benefit its members and the financial stability of the state.

Boston Municipal Research Bureau Report Concludes
Soaring Health Insurance Costs Threaten Boston's Competitive Edge
November 30, 2006

The Boston Municipal Research Bureau released a report today which describes how Boston and other cities and towns are facing a crisis of unsustainable cost increases for employee health insurance. The Research Bureau recommends, as a first step, that cities and towns be able to join the Group Insurance Commission to provide more control over plan design and costs.

Both the Boston Globe and The Boston Herald endorsed this position in today's editorial pages. The Boston Globe states in part that, "The cost of healthcare is the tapeworm of municipal finance, and it needs immediate attention. Luckily, the best fix is also the most obvious. By placing municipal employees under the same Group Insurance Commission that manages employee and retiree health benefits for state workers, good healthcare could be offered for substantially less cost." The editorial notes the GIC's work to improve health care cost and quality through the Clinical Performance Improvement Initiative, which charges lower co-payments to state employees and retirees who choose doctors that provide cost-effective care. For the complete text of this editorial, contact The Boston Globe.

The Boston Herald stated in its editorial that the Boston Municipal Research Bureau report provides evidence that the state, through its Group Insurance Commission (GIC), is doing something right. For the complete text of this article, contact The Boston Herald.

Change Agent Dolores Mitchell Pushes Envelope Again and Again
By Helen Graves Women's Business Boston
Saturday, July 1, 2006
Permission to reprint July 2006 from Women's Business Boston
Download Article "Change Agent Dolores Mitchell"

A couple minutes into a conversation with Dolores Mitchell, executive director of Massachusetts’ Group Insurance Commission, and you know these things:

    1. She doesn’t waste time, mince words or take any guff;

    2. She does, however, champion causes and willingly take the heat;

    3. She has a great sense of humor;

    4. She is truly a charismatic mover and shaker;

    5. She is your new role model.

    These days, Mitchell is in the midst of leading a revolution in health insurance with just-rolled-out tiered co-pays for doctor choices. Her tack is to couple quality care and cost containment for the state’s 266,000 employees, retirees and their dependents.   While the health insurance industry’s cost-efficiency efforts have targeted patients with “choice” and “high deductible” plans, the GIC’s Clinical Performance Improvement Initiative, Mitchell believes, will get to the broader impact of motivating medical providers to change the system.

    But pushing “the quality agenda,” Mitchell admits, is an uphill challenge. “It’s controversial. The doctors don’t like it,” she says. “We’re in the middle of a real sea change but in the meantime, the waves are chopping over my head.”     Mitchell laughs over her wording but she’s serious about doing what she believes is best for the public good. The GIC, with a day-to-day staff of 50, handles the state’s billion-dollar budget for health, life, disability, vision and dental insurances and related services.

    “We design what the benefits should be, procure them through a rigorous bidding process, select the vendors, contract with them, and then we monitor the hell out of them and push them to do more.” she says.    Leading the quasi-independent state agency since 1987 through the Dukakis, Weld, Cellucci, Swift and Romney administrations, Mitchell has been through plenty of change.   At her start was the beginning of escalating health care costs, followed by a slight cost reduction thanks to managed care, followed by the ensuing fight over reining in health insurers in order to provide better access and broader service.   Next came the furor over national health insurance, which died out in the Clinton years, and now, the issue of quality shortcomings.
   

 Throughout her tenure, Mitchell has kept a lid on the cost of the state’s insurance premiums compared to national and municipal costs, an achievement that no doubt has put her in good stead administration to administration.    Mitchell, however, chalks up her longevity to an appointing commission willing to let her push the envelope. As well, she’s made each administration a candid offer: to give it a go and if things aren’t working out, she’ll leave without a fuss.

    In this latest push of the envelope, Mitchell is spearheading what she sees as change from within the medical community. Going after the patient side of the equation doesn’t provide much impetus for actual improvement, she believes.     “Choice gives you very limited ability to push for quality because you don’t have much leverage when everybody is in the tent,” she says. “My goal has been to try to help people understand that not all providers are equally competent or caring, and there are differences and that we know a lot about these matters.”

    Mitchell began the Initiative by using the power of contracting and requesting health insurers’ books of business to analyze the data on two fronts: quality and cost-effectiveness.   In the new tiered plan, patients generally choose between $15 and $25 co-pays, the lesser co-pay attached to the doctors who rate well on both counts. The same type of co-pay rating system is already in place for hospitals in three of the GIC’s plans.   “We’re not saying that the doctor who doesn’t measure up on the cost-effectiveness side is a bad doctor, but that the better doctor is the one who is able to get the same results for the same medical condition using expensive resources more prudently,” Mitchell says.

    Plan subscribers didn’t jump ship over the co-pays in the recent open enrollment, Mitchell notes, although she expects phone calls later this summer as people get into using the new tiered system. And doctors will come around. “This approach is being adopted by other purchasers around the country and so it’s inevitable,” she says.
    This year, plans were allowed to introduce the new co-pays incrementally; next year, all doctors, groups and specialists will be included. “My theory is, you improve methodology by putting it on the road,” she says.

    Mitchell began wielding her contracting power at the get-go of her tenure. “I discovered that one or two of our plans did not cover reconstructive breast surgery,” she says. “That changed in about two-and-a-half minutes.”
    Leadership, Mitchell says, involves working hard and long, taking the heat, treating people well, rolling up sleeves to do anything and that includes stuffing envelopes, and making sure your staff knows you’re in control vs. in charge, especially in the face of adversity.

    Mitchell began her career in the state’s Office of Economic Opportunity in 1974 in the Sargent administration while also volunteering in what she calls “mid-century progressive activities,” Americans for Democratic Action and the Model Cities program.     She had met legislator Mike Dukakis, and when he won the primary for governor in 1974, she offered to work on his campaign full time. When he was elected, Mitchell worked in the governor’s office. Shortly before Dukakis lost the next election, she spent a stint as secretary of human services.

    After the ’78 campaign and “back out on the market,” Mitchell consulted at Abt Associates for a year. “I discovered that consulting was not my thing. I’m much too bossy for that.” Through a friend of a friend — “the women’s network at work” — she found out about and applied for an opening for the Boston director at Katherine Gibbs School.   Mitchell loved the job and seeing students emerge poised, self-confident and able to earn their own living, but after seven years she went to see Dukakis, who was governor again, to say she’d like to do another round of government.     “I remember the conversation well,” Mitchell says. “I said, ‘Besides, I’m over 40 so I’d better make a change now before age discrimination sets in.’ ”

    Mitchell was called upon when the GIC executive director’s role opened up. “I knew as much about insurance as I had known about business education,” she says. “I don’t mean to say that subject matter doesn’t count but what I do mean to say is that management and, more important, leadership skills are the most important. Given a certain level of intelligence and a certain willingness to learn the subject matter, the rest follows.”

    Thanks to a “healthy constitution and chronic inability to say, ‘No,’ ” Mitchell hasn’t stopped at bringing all of the above to just the Group Insurance Commission.     She is also director of the Massachusetts Health Data Consortium, president of the Massachusetts Healthcare Purchaser Group, board president of the Greater Boston Big Sister Association, co-chair of the Business Advisory Group of the E-Health Initiative, director of the E-Health Collaborative and vice president of her local Democratic Town Committee. She was just appointed to the Board of the Connector, the board that directs the new Massachusetts Health Reform Act.

    Asked, “What’s next?” and Mitchell replies, “I’m a testimonial to the unplanned life. I don’t know what comes next."     What she does know is that she’ll continue to seek out improvement just as she has for the past 19 years at the GIC.


    “I’m not here just to get up every morning and go to work and do the same old, same old,” Mitchell says. “I want to push the envelope a little.”

Commonwealth Employees to Pay Lower Co-Pays for Higher Ranking Providers
February 16, 2006

The Commonwealth’s Group Insurance Commission today endorsed a plan to increase the transparency of health care providers’ cost and quality.  Commonwealth employees and their dependents who choose higher ranking physicians and physician groups will pay lower co-pays than those who choose lower ranking ones.  “The Commission voted today to advance a project we started three years ago to give our enrollees more information about their health care choices,” said Dolores L. Mitchell, GIC Executive Director.  “The program encourages enrollees, through modest co-pay differentials, to seek out good quality physicians who are aware of their choices of care and their cost implications to the health care system and their patients.”

Today’s action is part of a multi-year initiative that began three years ago to address the wide disparity in physician and hospital quality care as well as rising health care costs.  In addition to rising costs, the Commission has been concerned about the declining number of people covered by health insurance.  Many employers have moved to high deductible plans, where employees must pay the first $1000 to $2000 of their care.  Other employers have discontinued or drastically reduced coverage, particularly for retirees.  The GIC’s project, called the Clinical Performance Improvement (CPI) Initiative, gathers information about health providers and rewards enrollees for choosing quality, cost effective care.  The program has received national recognition within the health care industry.

During the first year of the program, the GIC required its health plans to submit all their claims to an outside vendor that analyzed this critical mass of data for cost efficiency and adherence to best health care practices.  These analyses were given back to the plans, so that they could identify quality, cost-effective hospitals, physicians and physician groups who use resources prudently for the benefit of their patients.  A few plans implemented hospital tiers during the first year of the project.  Today’s vote for phase II of the project gives enrollees information about physicians and physician groups, and gives them modest co-pay incentives to select quality and cost-effective providers.  Each plan put together its own benefit design consistent with the initiative.  Some plans tiered Primary Care Physicians, others tiered specialists.  Members retain access to all providers within a particular plan’s network. 

The GIC outline benefit changes, which go into effect July 1, 2006, at its annual Public Hearing on March 1.  The Commission will vote on premium rates at its March meeting.  The benefit changes do not affect any of the GIC’s Medicare plans, nor its Basic indemnity plan members.  “What we do not anticipate is wholesale shifts in our members’ choice of physicians,” said Dolores L. Mitchell.  “We believe that these benefit changes will prompt patients to take a more active role in their own health care, giving them more reason to discuss quality and cost implications of care choices with their doctors, ultimately improving quality and reducing the cost of care.”

State Workers' Insurance Adds War, Terror Benefits
December 16, 2005

The state's Group Insurance Commission broke new ground on life insurance benefits when it voted to adopt war and terror benefits for life and accidental death and dismemberment for the next fiscal year. "State employees serving our country in Afghanistan, Iraq and elsewhere in the world, as well as employees affected by terrorism, will now have some peace of mind that their loved ones will have coverage," said Dolores L. Mitchell, Executive Director of the Group Insurance Commission. "We felt there was an issue of fairness. Employees receive coverage for an auto accident when they drive off the road, but not for being on a subway where someone blows them up. We felt they should have coverage," she stated.

John Brouder, Partner of Boston Benefit Partners, which assisted GIC staff on the procurement, said, "The Commonwealth's request for this explicit coverage for war and terror deaths, and The Hartford's willingness to offer such coverage, is another example of the GIC's willingness to push the envelope on behalf of plan participants. To my knowledge no employers in the area are currently offering this coverage". The new contract with The Hartford Financial Services Group, Inc, which will include this coverage, will take effect July 1, 2006, the beginning of the state's FY07 fiscal year.

Boston Globe Editorial
Healthy Cooperation
July 25, 2005

The Boston Globe's editorial board recognized the GIC's efforts to provide quality health insurance and other benefits at a reasonable cost to more than 250,000 state workers, dependents and retirees. The GIC was cited as a model for municipal governments in its work to provide excellent, affordable health coverage.

The editorial stated, "Municipal managers and union leaders need look no further than state government, where workers enjoy excellent, affordable health coverage. The annual increase in the cost of providing health coverage to state workers is about half that for municipal workers…The Commission can be counted on to press private health plans for the best service for state workers. It takes measures, such as adjusting workers' co-payments, to protect taxpayers. The Commission could be a model for local communities."

For a complete copy of the editorial, see The Boston Globe's website.

Electronic Tools Helping to Improve Safety and Quality
(winter 2005)

If you were rushed to the Emergency Room, would you be able to list the names of all of your prescription medications? If you are young, healthy, and fully conscious, it might be an easy task. But, if you were badly injured or on multiple medications, doing so would be hit or miss at best. Mixing prescription drugs can be fatal in these instances.

The GIC is participating in two programs to assist with preventing medical errors and to improve quality of care. The MedsInfo-ED pilot project provides, with your permission, electronic prescription data electronically giving emergency room doctors and nurses a list of your prescribed medications. (Medicines used to treat psychiatric conditions, substance abuse or HIV/AIDS are excluded by law.) Any information that is received will be kept secure in your medical record at the hospital. The three hospitals participating in this pilot program are Emerson Hospital in Concord, Beth Israel Deaconess Medical Center in Boston, and Boston Medical Center.

Meanwhile, the American College of Physicians, with initial funding provided by Blue Cross Blue Shield of Massachusetts and under the guidance of a large coalition of health organizations, is working to develop standardized electronic medical records for every hospital and doctor's office in Massachusetts. Called the E-Health Collaborative, this massive project would enable physicians to access their patients' prescription information, lab data, preventative test data, X-ray information and more to assist with improving care for each individual patient. Both the GIC and the Executive Office of Health and Human Services are participating in this initiative. Governor Romney announced his support of these endeavors at a winter press conference.

The GIC's Clinical Performance Improvement (CPI) Initiative

The GIC Targets Provider Quality and Efficiencies to Rein In Health Care Costs

The GIC shook up the standard way of approaching health plan contracts at the March 10, 2004 Commission meeting. Faced with its fourth consecutive year of double digit rate requests from its plans, the GIC voted to implement new health plan contracts effective July 1, 2004, based on its Clinical Performance Improvement (CPI) Initiative. Through its plans the GIC seeks to gather quality and efficiency data for hospitals and physicians alike. The GIC will use this information to reward enrollees and providers through their health plans. Enrollees that select high-quality and cost-efficient providers will pay lower out-of-pocket costs. High quality, cost-efficient providers will receive higher reimbursements from the plans.

"The state continues to grapple with budget shortfalls and we have a responsibility to be part of the solution, " said Dolores L. Mitchell, Executive Director of the Group Insurance Commission. "On the other hand, we felt we had gone as far as we comfortably could in shifting costs to enrollees. We could not continue to do 'business as usual' and instead are looking to the health care system to extract savings."

While costs have risen, numerous studies have documented that health care quality varies greatly among providers: according to a June 2003 study published in the New England Journal of Medicine, only 54.9% of patients get the highest quality of care. This quality gap varies widely, depending on medical condition. During the first year of the GIC's new health plan contract, the health plans will be gathering quality of care data about area providers. The data will be analyzed by outside experts who will use it to identify high-quality, cost-efficient providers. GIC enrollees will be rewarded with lower out-of-pocket costs for choosing quality, efficient providers.

"This initiative is not without controversy," said Dolores Mitchell. "The provider community has expressed its discomfort with hospital and physician report cards. Additionally, some of our enrollees will need to select a new health plan, although we have limited both their provider disruption and additional costs."

Some of the incentives for enrollees to select quality, cost-effective providers will be implemented for the new fiscal year beginning July 1, 2004. One of the GIC's new plans provides members with network hospital information and members will pay lower co-payments for selecting a high quality/high efficiency hospital. Another new plan offers higher benefits for routine procedures at network hospitals and for designated high-risk procedures at additional hospitals more experienced with those procedures. In future fiscal years, when data is available, physician tiers tied to quality and cost-efficiency will be put in place.

"Our enrollees must be an active part of the solution in improving health care quality and keeping costs in check," said Mitchell. "Our CPI Initiative engages enrollees by giving them tools to make an informed decision about their health plan."