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Citizens’ Health Care Working Group Public Meeting

Tuesday, August 16, 2005

Boston, Massachusetts






Randy Johnson, Chair
Catherine McLaughlin, Vice Chair
Frank Baumeister
Dotty Bazos
Montye Conlan
Richard Frank
Joseph Hansen
Therese Hughes
Patricia Maryland
Rosario Perez
Aaron Shirley
Deborah Stehr
Christine Wright

Representing the Secretary, HHS

Michael O’Grady


George Grob, Executive Director
Andy Rock
Caroline Taplin
Jessica Federer
Connie Smith
Rachel Tyree

Meeting Summary

Randy Johnson, Chairperson, called the meeting to order at 1 p.m.; the members shown above were present; members of the public were also present. Highlights of the discussion for the day are presented below.

Community Meetings Committee Discussion

George Grob, Executive Director, presented a summary of staff and Community Meetings Committee recommendations regarding upcoming community meetings; The Community Meetings would include: 2 large Signature Meetings; 10 Standardized Meetings; 30 Staff-Assisted Meetings; and meetings that could be initiated by others, unrelated to the Working Group, using materials developed by the Working Group. This strategy would combine both scientifically structured groups of representative audiences as well as random self-selected volunteer participants. In addition, meetings targeted at hard-to-reach groups could be held.

Supplementing the analytic side of this effort, there would be a randomized survey (during the spring of 2006) that would provide evaluative rigor against which the results of the other activities could be further gauged. Major firms being sought for assisting in conducting the community meetings were AmericaSpeaks and the Public Forum Institute. George Grob closed with a request for advice concerning a process for arriving at decisions about where in the country the Signature and Standardized community meetings should be held. George Grob indicated that the length of each community meeting would be anywhere from an hour for very short exchanges, to, typically a half-day, or to as long as day-long events.

Susan Goold, spokesperson for the CHAT application indicated that CHAT could be used for both a web-based as well as an in-person process. She explained that CHAT would work best for smaller groups, for both the systematic data collection effort as well as at the smaller, self-initiated meetings. It would be possible to leverage the Working Group’s activities working with other groups who are interested in using the program, to expand the possibilities for the use of CHAT. The major expense related to using CHAT has been recruiting and assembling the groups of participants, rather than the software itself. There are cheaper ways of running the program, such as through public libraries. Data collection can add to the costs and can be “trickier” since paper may have to be collected if the program is done manually (it’s a wash whether to rent laptops or pay someone to enter data). The cost of the program really depends on how it would be used. (See Goold slides as PowerPoint file)

Joe Hansen expressed concern about the cost, time, and resource implications of using CHAT. Michael O’Grady indicated he could possibly see a productive role for CHAT as a web-based program and possibly for select groups but not for everyone; he thought some participants might be upset if they were invited to community meetings, only to find out that their time would be spent on the CHAT activity rather than being able to express their thoughts and opinions regarding the questions in the statute. Michael O’Grady cautioned the Working Group members that, while CHAT is a great tool in the right context, that using it for community meetings might not be well received by some community groups who thought they were being invited to the meeting in order to be able to express their thoughts and opinions regarding health care issues. The Working Group engaged in further discussion and exchange of views about the utility and appropriateness of using this tool for Working Group purposes.

Catherine McLaughlin indicated that the law charged the Working Group with going out and talking to people and that the group needed to focus on this. She indicated that the members of the Working Group could all volunteer to participate in doing so (e.g., with nursing home residents, student groups, etc.). She felt that having the structure of a program like CHAT could be useful as a way to get the discussion started; however, she also indicated that one could also end the game at any time and continue with a productive dialogue.

Randy Johnson asked whether it would be reasonable for some, but not all Working Group members to be able to use the CHAT program; also, could it be used for varying amounts of time between one and two hours. Susan Goold indicated that the program could potentially be conducted in one hour although two was better. The program could be used as a jumping off point for further discussion.

The Working Group members were interested in learning more about how the program might be used. George Grob indicated that he was interested in guidance regarding how to focus and best use staff time to investigate. Randy Johnson and Aaron Shirley agreed that the Community Meeting Committee could consider and provide further advice about how it would like this subject pursued. Susan Goold, in response to a question from Montye Conlan, indicated that other facilitators could be trained in running CHAT. Richard Frank pointed out that the program was really good at focusing on costs and benefits within the context of an individual’s insurance coverage and trade offs; what the Working Group would need to do was to figure out is how this fitted into the work that it needed to do.

The Working Group discussed how best to organize community meetings. George Grob indicated that it should be possible to accommodate individual preferences of the Working Group members. Michael O’Grady advised the Working Group to distinguish itself from, and not be seen as endorsing, sessions or community meetings that were self-initiated by groups independent of the Working Group.

George Grob reiterated the need for a decision process regarding the 2 Signature and 10 Standardized meetings. Michael O’Grady recommended and Randy Johnson reiterated the recommendation that the staff prepare a list in rank order of more than the minimum number needed and send it to the Working Group members for their consideration and decision—a sort of options paper with recommendations. The Working Group concluded that staff should prepare advice to the Community Meetings Committee which would then provide a list for consideration for the Working Group.

Oregon Meeting

Frank Baumeister indicated that there would be three days available for the Portland meeting, September 21, 22, and 23 and that he was busy putting together panels consisting of the original people who worked on the Oregon Health Plan who could provide valuable insight regarding the difficulties they dealt with. He believed the meetings would be important in helping the Working Group advance its thinking about its own work. A “listening event” in Portland would take place on the 23rd. Randy Johnson indicated that the meetings would begin early on the afternoon of the 21st so that some people could travel in on that day. Catherine McLaughlin recalled that, on the conference call regarding the Oregon meeting, participants had discussed having the Working Group meeting on Wednesday afternoon, September 21, when Randy Johnson could be present.

Schedule Discussion

Randy Johnson recommended some changes in the Working Group schedule. George Grob indicated he would send out some alternative dates for Working Group future in-person meetings for consideration. In addition, George Grob suggested there be a meeting of the Working Group on October 18-19 and proposed the first community meeting take place in November.

The Working Group engaged in an extended exchange regarding the report “roll out” and work on upcoming community meetings. In response to a question, Michael O’Grady said that the report roll out could be important; press like such events since there would be a tangible document, the report. It was important that it be done well; and it would be hard to predict the value of the event in advance. Most members of the Working Group indicated that they wanted to be present for the event.

Discussion of Draft Report

Catherine McLaughlin presented and discussed a revised draft of The Health Report to the American People. The Working Group discussed how to handle edits from the members. It was agreed that members would be sent both WORD and PDF versions to allow them the option of doing “track changes” on a WORD version.

Catherine McLaughlin reviewed the five major issues about style and content about which the Committee sought consensus from the Working Group as a whole. Michael O’Grady commented that—to establish and maintain the Working Group’s credibility—it was important that the tone of the report be factually accurate and not skewed to either a “the sky is falling” or an “everything is great” emphasis. Randy Johnson stated that most of the members were on the Working Group because they thought the system was broken. Michael O’Grady observed that the draft report struck a nice balance. There was further discussion regarding the level of detail and how anecdotal the report should be. Richard Frank observed that to assure that the Working Group’s reports and recommendations were well received, the written materials needed to stick with numbers that have been widely vetted and commonly accepted. There was a further discussion about the level of crisis to portray in the report.

George Grob said that he wanted to aim to have a finished version of the report by August 29 that would be mounted on the web to meet the statutory requirement. Working Group members would have until the morning of August 22nd to look at the draft. Staff would get the Working Group a revised version by August 24th and members would need to provide final concurrence by the 29th. Michael O’Grady indicated that, because of his particular position, the staff and the Working Group should not wait for his concurrence.

Randy asked to know any objections to accepting the draft budget as presented. Acceptance of the budget was moved, seconded and approved.

Randy Johnson adjourned the meeting at 4:23 p.m