19 September Join the conversation on Twitter:

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1 19 September 2014 Join the conversation on Twitter:

2 Maryland Health Connection Update Get Engaged Health Care Reform Party September 19, 2014 Jon Kromm Deputy Executive Director A service of Maryland Health Benefit Exchange

3 Scope of Presentation Update on 2014 Enrollment Upgrade of Website Plans for 2 nd Open Enrollment (OEP) Certification of 2015 Plans and State s Benchmark Plan Re-enrollment for current MHBE consumers Consumer Assistance Call Center Connector Entities Insurance Producers Certified Application Counselors Marketing and Outreach SHOP Partnership with community and faith-based organizations 3

4 Update on 2014 Enrollment QHP enrollment as of 8/23/14: 78,666* Medicaid enrollment as of 8/27/14: 355,281 Includes 95,889 PAC enrollees enrolled into full Medicaid 1/1/14 Net change in Medicaid enrollment since 12/31/13 is +262,737 Ongoing 2014 enrollment Special Enrollment Periods for consumers with life changes (e.g. baby, marriage, loss of job, etc.) Medicaid eligibility determinations and enrollment year-round *QHP enrollment is unduplicated enrollment minus cancellations of existing policies. Consumers with special enrollment periods (SEPs) because of changes in circumstances can lead to redetermination of eligibility and cancellation of QHP coverage. 4

5 MHC QHP Enrollment by County As of 5/31/14 5

6 Medicaid Enrollment Growth by County December 2013 April 2014 Individuals whose coverage was converted from the Primary Adult Care Program into full Medicaid on January 1, 2014, are counted as April 2014 enrollments, but not December 2013 enrollments. Source: Medicaid Management Information System (MMIS), Department of Health and Mental Hygiene, December 2013 and April

7 Upgrade of Website Adoption of Connecticut Software Proven Success: CT s marketplace and website one of most successful in the country; same contractor transferring new system for Maryland. No Wrong Door: enables MD to continue integrated approach in which consumers use MHC to determine eligibility for either qualified health plans with financial assistance or Medicaid. Retain Autonomy of State-based Marketplace: Allows Maryland to continue its own robust consumer assistance programs and community-based outreach, certification and development of standards for qualified health plans, etc. Disciplined and Phased Software Development: Adaptation of CT s software only where necessary, with further enhancements post-november 15; close coordination with MHBE operations, carriers, and other stakeholders. Focus on Improving Consumer Experience: Relative simplicity of application, ability to upload verification documents, anonymous browsing, and other features will enhance consumer usability. Rigorous Testing: Extensive system and user acceptance testing underway to ensure best possible performance of system. 7

8 Upgrade of Website: Consumer Portal Consumer messages Consumer can change password and update household information Click Start New Application 8

9 Upgrade of Website: Consumer Portal Verifications Needed by Consumers 9

10 Upgrade of Website: Consumer Portal Navigation Panel: Green checks indicate completed sections 10

11 Upgrade of Website: Consumer Portal Each Program is listed and indicates whether the family member eligible or ineligible 11

12 2015 Plan Shopping Kick-off Nov. 9 Anonymous browsing and launch of new front-end consumer information website in English and Spanish; Nov The first HealthConnectNow! sign-up event will be held; Nov The call center opens to take phone applications at (TTY ); Nov All authorized insurance brokers (producers) and navigators are able to complete enrollments through the website and also provide in-person consumer assistance; Nov. 18 All caseworkers at local health departments and departments of social services begin enrolling consumers through the website. Medicaid applications (currently completed through SAIL) will be directed through MarylandHealthConnection.gov; Nov Self-service enrollment through the website becomes available for the first time to the general public and all other stakeholders. 12

13 2 nd Open Enrollment Certification of 2015 Plans MIA approval of forms and rates: 8/22/14; Among lowest rates in the country. MHBE QHP certification: completed by end of month Policy changes for 2015: Pediatric dental must be embedded in all qualified health plans; Drugs covered in medical plan must be identified in plan s filings; Drug formulary Internet link must connect directly to list of covered drugs without requiring further navigation, and must include tiering and cost-sharing; Tobacco rating prohibited QHP information for consumer assistance workers: under development with expected completion by end of month 13

14 Carrier Participation in

15 2 nd Open Enrollment MHC 2015 Benchmark Plan Definition and function of benchmark plan: State s 2 nd lowest silver plan within specific rating area; Benchmark plan s rates used to determine amount of consumer s advanced premium tax credit; Maryland s 2015 benchmark plans: MHC will offer 18 different silver plans from 5 carriers; Three will serve as benchmark plans for 2015: Evergreen Health HMO Silver HAS/HRA 1700 plan for Rating Areas 1 and 2 (BA City, BC, Harford, Howard, AA; St. Mary s, Charles, Calvert, Cecil, Kent, QA s, Talbot, Caroline, Dorchester, Wicomico, Somerset, Worcester) CareFirst BlueChoice HAS Silver $1,300 plan for Rating Area 3 (Montgomery and Prince George s) Kaiser Permanente MD Silver 1750/25%/HAS/Dental/Ped Dental Plan for Rating Area 4 (Garrett, Allegany, Washington, Frederick) 15

16 2 nd Open Enrollment Re-enrollment for Current MHC QHP Consumers: It s How to Get the Best Deal Outreach and Tracking Program: o Beginning mid-september, outreach to make sure everyone has a plan and assistance with reenrollment this fall. o Brokers and navigators will then work with consumers after open enrollment has begun. Key Message: o If you do not re-enroll, no financial assistance available in

17 2 nd Open Enrollment Consumer Support Center (call center) Facility expansion and new phone system installation Better customer service expected; Two locations (Baltimore and Woodlawn) with new CISCO platform for improved call management; Extended hours during open enrollment. Consumer Assistance Representatives (CSR) preparedness Staffing level ( CSRs) and improved process flows; Training new materials and scripts. New 3-Tier Help Desk planned Streamlined organizational structure with improved triaging; Enhanced Level 2 support for navigators, assisters, caseworkers.; Password resets facilitated more easily at Level 1. MHBE constituent services 17

18 2 nd Open Enrollment Connector Entities Year 2 Same structure with 6 umbrella organizations and community-based partners in 6 regions of State; FY 15 contracts executed.; 132 navigators; 100 in-person assisters. Navigators and Assisters preparedness Mapping navigators and assisters to new HBX roles; Credentialing, and system provisioning for certified staff on track; Statewide training to begin 10/6/14. Enrollment fairs Increased number to be held during 2 nd OEP; Scheduling, planning, and playbook underway. 18

19 2 nd Open Enrollment Insurance Producers: Enhanced Broker Engagement New Resources New system has well-functioning broker portal, with consumers able to request broker assistance and authorize broker to assist with application on their behalf; MHBE call center recently launched producer hotline, i.e. dedicated line for producers to obtain assistance; Additional training support planned for OE2 and new system. Expanded Producer Referral Program Pivotal role in re-enrollment outreach and assistance; Producer engagement meeting 9/23/14. Application Counselor Program Application Counselor Sponsoring Entities Six new entities; 60 new application counselors. 19

20 2 nd Open Enrollment Marketing and Outreach 2 nd OEP marketing and communications plan based on surveys and focus groups; Will communicate value of insurance; Kick-off week to begin November 9 with anonymous browsing; New, front-end consumer information website in English and Spanish. Social media campaign Kick-off 9/16 to promote re-enrollment, enrollment, and value of coverage; Videos and tutorials of testimonials of current and new enrollees underway. Non-digital materials Revision of collaterals and education materials to reflect new system and 2 nd OEP on target. MHBE internal partner communications First of regular installments developed and distributed. 20

21 SHOP SHOP Direct Enrollment 185 applications as of 9/2/14; 1,065 covered lives as of 8/30/14. 3-Phase Third-Party Administrator approach Phase One: TPAs adapt existing infrastructure to offer SHOP plans and provide broker-assisted employee choice; Phase Two: TPAs develop employer/employee portals; Phase Three: TPA-administered, fully automated SHOP; Milestone payments to TPAs; Significant reduction in cost of developing and operating SHOP. SHOP Implementation Three TPAs approved by MHBE Board at 8/19/14 meeting: Kelly Services, Group Benefit Services, and Benefit Mall; Planning among TPAs, carriers, and MHBE on track; SHOP plans to be certified after MIA approval of forms and rates. 21

22 Importance of Community and Faith-Based Partners 2 nd and Beyond Enrollment Challenges Current 400,000 MHC and Medicaid enrollees more motivated to obtain coverage and/or easier to reach ( low-hanging fruit) target groups have more barriers to enrollment, despite potential benefits; Limited English proficiency; Need for cultural competency in outreach; Need to communicate value of insurance (e.g. young invincibles ); Affordability hurdles; lack of knowledge about financial assistance. Need for and Effectiveness of Community and Faith-Based Outreach: Consumers persuaded most effectively by those they trust; Ability of community and faith-based organizations to conduct education campaigns and calls to action is unmatched. Benefits of Partnership: MHBE greatly appreciates the partnership, support, and engagement in working towards our mutual goals of providing quality, affordable coverage to all Marylanders. 22

23 More Information MarylandHealthConnection.gov Sign Up for Updates Sign Up for Text Updates: Text Connected to Get information on insurance resources available to help now Link to details on meetings and reports MarylandHBE.com Meeting Information RFP Announcements Job Information 23

24 QUESTIONS? 24

25 19 September 2014 Join the conversation on Twitter:

26 Maryland Health Benefit Exchange: Standing Advisory Committee Adrienne Ellis, co-chair

27 Getting Started Amendment added to the 2013 MHBE Legislation Broad Representation- including consumers Reports to the MHBE Board of Directors Public comment accepted

28 Hot Topics Network Adequacy and Essential Community Providers Producer/Broker engagement Outreach and Enrollment Activities Navigator and Assister Training?????

29 Resources Meeting dates and locations found on the Maryland Health Benefit Exchange Website g-advisory-committee/ Questions or suggestions can be ed to Adrienne

30 19 September 2014 Join the conversation on Twitter:

31 Maryland Health Services Cost Review Commission New All-Payer Model for Maryland Population-Based and Patient-Centered Payment Systems September

32 Outline of Presentation Introductions Overview of New Maryland All-Payer Model and Global Budgets Opportunities for Success Public Engagement 32

33 Overview of New All-Payer Model and Global Budgets 33

34 Approved New All-Payer Model Maryland is implementing a new All-Payer Model for hospital payment Updated application submitted to Center for Medicare and Medicaid Innovation in October 2013 Approved effective January 1, 2014 Focus on new approaches to rate regulation Moves Maryland From Medicare, inpatient, per admission test To an all payer, total hospital payment per capita test Shifts focus to population health and delivery system redesign 34

35 New All-Payer Model for Maryland Focus shifts to the patient and improvement of care Align payment with new ways of organizing and providing care Contain growth in total cost of hospital care in line with requirements Evolve value payments around efficiency, health and outcomes Better care Better health Lower cost 35

36 Approved Model Timeline Phase 1-5 Year Hospital Model Maryland all-payer hospital model Developing in alignment with the broader health care system Phase 2 Total Cost of Care Model Phase 1 efforts will come together in a Phase 2 proposal To be submitted in Phase 1, End of Year 3 Implementation beyond Year 5 will further advance the three-part aim 36

37 Approved Model at a Glance All-Payer total hospital per capita revenue growth ceiling for Maryland residents tied to long term state economic growth (GSP) per capita 3.58% annual growth rate Medicare payment savings for Maryland beneficiaries compared to dynamic national trend. Minimum of $330 million in savings Patient and population centered-measures and targets to promote population health improvement Medicare readmission reductions to national average 30% reduction in preventable conditions under Maryland s Hospital Acquired Condition program (MHAC) over a 5 year period Quality revenue at risk to equal or exceed national Medicare programs 37

38 Focus Shifts from Rates to Revenues Old Model Volume Driven Units/Cases Rate Per Unit or Case Hospital Revenue Unknown at the beginning of year. More units/more revenue New Model Population and Value Driven Revenue Base Year Updates for Trend, Population, Value Allowed Revenue Target Year Known at the beginning of year. More units does not create more revenue 38

39 Revenues under global models > 90% Global Budget Revenues (GBR, TPR) Inflation Adjustment Demographic Driven Volume and Efficiency Non-global Revenues Inflation Adjustment Volume Governor 50% variable cost factor Quality-based adjustments Other statewide policy adjustments 39

40 Global Budget Agreement Consumer Friendly Provisions Quality monitoring and payment provisions Adjustments for potentially avoidable utilization Efficiency adjustments Quality adjustments Corridors to examine volume changes Market share adjustment 40

41 Challenge for Integration of Efforts Medical Homes Accountable Care Organizations Health Enterprise Zones (HEZ) Enrollment Expansion -Medicaid -Private Health Information Exchange-- CRISP State Health Improvement Process-Public Health 41

42 Opportunities for Success Under the New All-Payer Model 42

43 Model Opportunities Delivery System Objectives Opportunities for Success Global revenue budgets providing stable model for transition and reinvestment Lower use reduce avoidable utilization with effective care management and quality improvement Focus on reducing Medicare cost Integrate population health approaches Control total cost of care Rethink the business model/capacity and innovate Align with physicians and other providers Improved care and value for patients Sustainable delivery system for efficient and effective hospitals Alignment with physician delivery and payment model changes 43

44 Reduce Avoidable Utilization By Improving Care Examples: 30- Day Readmissions/Rehospitalizations Preventable Admissions (based on AHRQ Prevention Quality Indicators) Nursing home residents Reduce conditions leading to admissions and readmissions Maryland Hospital Acquired Conditions (potentially preventable complications) Improved care coordination: particular focus on high needs/frequent users, involvement of social services 44

45 Public Engagement 45

46 Focus Shifts to Patients Unprecedented effort to improve health, improve outcomes, and control costs for patients Gain control of the revenue budget and focus on providing the right services and reducing utilization that can be avoided with better care Maryland s All Payer Model Enhance Patient Experience Better Population Health Lower Total Cost of Care 46

47 Implications for Consumers Successful hospital under a modernized waiver High quality, efficient and effective care while strategically maintaining market share Partners with physicians and other practitioners, urgent care and post acute care to improve population health Improves care resulting in reducing avoidable utilization freeing up funds for investments in population health and new technology and clinical services High quality with reduced clinical utilization will be the most successful 47

48 HSCRC Public Engagement Short Term Process Phases Global Budget Implementation: Fall 2013: Advisory Council - recommendations on broad principles January July 2014: Workgroups Four workgroups convened Focused set of tasks needed for initial policy making of Commission Majority of recommendations needed by July 2014 Population Focus: July 2014 July

49 Discussion-- Initial Staff Thoughts on Possible Approaches for Next Phase of Work HSCRC Advisory Council Multi Agency and Stakeholder Groups Alignment Models Consumer Engagement/ Outreach and Education Care Coordination Initiatives and Infrastructure Payment Models Transfers GBR Rev/Budget Corridor Performance Improvement and Measurement Potential Ad Hoc Subgroups GBR Template GBR Infra. Investment Rpt. Market Share. Efficiency Monitoring Total Cost of Care Physician Alignment LTC/Post Acute. 49

50 19 September 2014 Join the conversation on Twitter:

51 + What Data Drives Health Planning and Assessment in Maryland? Health Care Reform Engagement Party Annapolis, MD September 19, 2014

52 + Reminder Determinants of Health Source: Steven A. Schroeder, New England Journal of Medicine, Sept 20, 2007

53 + Prior to Decision Makers Used Data Mostly about Health Care in their Own Setting Health Care Utilization Health Costs Efficiency Measures Quality Measures

54 For examplefocus at + state and hospital levels trends in Medicare admissions and readmissions

55 +ICPC Q Score Card: Acute Care Encounters per 1,000 Beneficiaries

56 +ICPC Score Card: Admissions per 1,000 Beneficiaries

57 +ICPC Score Card: Quarterly Readmissions per 1,000

58 + Top Trend Conditions Diabetes Mellitus Congestive Heart Failure (CHF) Chronic Obstructive Pulmonary Disorder (COPD) Chronic Renal Failure Pneumonia Acute Myocardial Infarction (AMI)

59 + Understanding Differences in Health Outcomes

60 + State Health Improvement Process (SHIP) Framework and resources to align local action to continuously improve population health and health equity 20 Local Health Improvement Coalitions Co-Chaired by Hospital and Public Health leaders and include cross-section of health and human services State and Local Accountability 41 measures: health outcomes and determinants State and county baselines and 2014 targets Racial/ethnic disparity information

61 + SHIP Measures

62 + SHIP 2013 Measures

63 + SHIP 2013 Measures

64 + SHIP 2013 Measures

65 + Medicare Waiver Measures Patient Satisfaction (hospital, home health, nursing home, ambulatory care) Enhance Care Transitions (hospital, NH, PC) Sustain high physician participation in public programs Increase ACOs, PCMHs, bundled payment Increase the quality of care processes Decrease hospital complications Reduce readmissions (hospital, home health, NH) Reduce the growth in health care costs

66 + SHIP MEASURE DATA SOURCE TIMELINE SHIP #17: Increase \life expectancy VSA, DHMH Annual/July Prevention Quality Indicator (PQI) Composite Measure of Preventable Hospitalization HSCRC Casemix Data Set Quarterly (6 month lag) SHIP #12: Reduce the % of adults who are current smokers BRFSS Annual/March SHIP #13: Reduce the % of youth using any kind of tobacco product Maryland Youth Tobacco Survey Biennial/June SHIP #40: Increase the % vaccinated annually for seasonal influenza CDC National Immunization Survey; BRFSS Annual/March SHIP #39: Increase % of children with recommended vaccinations CDC National Immunization Survey Annual/Sept. SHIP #15: Reduce new HIV infections among adults and adolescents MD HIV surveillance system; US Census Bureau; ACS 5 year Census Annual/March SHIP #33: Reduce diabetes-related emergency department visits HSCRC Casemix Data Set Annual/July SHIP #34: Reduce hypertension related emergency department visits HSCRC Casemix Data Set Annual/July SHIP #11: Reduce the % of children who are considered obese Maryland Youth Tobacco Survey Biennial/June SHIP #10: Increase the % of adults who are at a healthy weight BRFSS Annual/March SHIP #41: Reduce hospital ED visits from asthma HSCRC Casemix Data Set Annual/July SHIP #36 & #37: Reduce hospital ED visits related to behavioral health HSCRC Casemix Data Set Annual/July SHIP #22: Fall-related death rate VSA, DHMH Annual/July

67 + SIM Measures SHIP measures Primary Care measures (child and adult prevention, screening and chronic disease management measures) Examples BP control, appropriate prescription use among asthmatics Care Coordination Health Care Utilization (CRISP) -- Hotspots

68 + Incomplete reporting (immunizations) Missing information (demographic factors) Unreliable information (demographic factors, risk factors) YOU CAN HELP!

69 19 September 2014 Join the conversation on Twitter:

70 Data Drives Reform: What Consumers Need to Know September 19, 2014 Ben Steffen Executive Director MHCC 70

71 A data driven health system New Objectives Global Hospital Budget Model Patient-Centered Care New Reward Systems Gain-sharing Shared Savings Incentive-based Payment New Occupations Community Health Workers Data Scientists Population Health Directors 71

72 Health care reform will increase the need for timely, accurate, and detailed data (appropriately secured) Contains simulated data 72

73 New systems and better integration are needed Clinical Operations Decision support Electronic Health Record Patient registries & practice level analytics Medical Mgmt Population Health Analytics Provider Performance Measure. Health Information Exchange Claim data from payers Real-time clinical data Speed Data Governance Completeness 73

74 How claim data become useful: an illustration Carriers Admin. Systems Quality and Costs Systems Decision makers Claim Data Data Collection Claim Data Warehouse Data Marts Analytic Tools Derived Data Data Security Domain Patients & Consumers Data Governance Domain 74

75 MHCC and other state agencies already gather information to support policy responsibilities Control health system costs through effective and efficient planning Drive quality improvement through public reporting and oversight Further delivery system reform and diffuse information technology to improve quality and reduce costs Designates CRISP as Maryland s Health Information Exchange Promotes the adoption of HIT by providers Health reform activities demand that information be more timely and accessible to providers and consumers HIE and HIT efforts are complementary to this new goal MHCC is accelerating information collection 75

76 Health information exchange will link providers and other clinical decision makers CRISP is Maryland s state designated health information exchange (HIE) serving both Maryland and the District of Columbia. CRISP s principal charge is to connect healthcare providers across the region CRISP does not hold clinical data, it provides infrastructure to support exchange ONC meaningful use requirement was early driver of CRISP, but ONC abandoned exchange connection requirements in CRISP builds on multiple use cases CRISP Portal Encounter Notification System Prescription Drug Monitoring System Support for new hospital payment model (transmission of readmission info) Using CRISP to deliver clinical and care management information represents an economical approach for information exchange 76

77 The Data Infrastructure to Support New Health System Clinical and Business Decision Makers Source Systems ADT feeds Inpatient EHRs Outpatient EHRs CRISP Reporting Services Clinical Domain Care Management Domain Performance Domain Clinical Labs Results Radiology Results Care Management Performance and Population Health Measures Administrative Pharmacy Fills Payer Claim Systems Hospital & NH Administrative Data Trusted Entities (Govt) MHCC & Others Maryland Cost and Quality Reports Portal Consumers & Patients Patient Satisfaction 77

78 New Data and New Challenges New data is essential to the new care models, payment systems, and health care entities that have arisen from the ACA New hospital payment model adds another dimension and opportunity to reform in Maryland. The MHCC will continue to seek input on how best to balance the need for information with the rights of individuals to control their health care information. 78

79 19 September 2014 Join the conversation on Twitter:

80 How Do I Do It? 19 September 2014 #GetEngaged Leni Preston, Chair leni@mdchcr.org

81 Got Card? Get Care! New initiative to create health literate consumers. What does that mean? An informed selection process when purchasing health insurance Knowledge of how to use their card Ownership of one s care and health 2013 Maryland Women s Coalition For Health Care Reform 81

82 Low Health Literacy: The Impact Those with low health literacy are: Less likely to: Select the best insurance plan for their circumstances Know how to read health labels & take medications appropriately Take preventative actions More likely to have: Poorer overall health status & more hospitalizations & emergency care Later diagnosis for cancer & diabetes Higher mortality rates 2014 Maryland Women s Coalition For Health Care Reform 82

83 Low Health Literacy: What are the Numbers? Only 12% of adults have average health literacy. That means nearly 9 out of 10 lack the skills to manage their own health. 36% Americans have basic or below basic health literacy. Those with below basic health literacy = 41% Hispanic Americans 24% African Americans 2014 Maryland Women s Coalition For Health Care Reform 83

84 What is Health Literacy? A Three-Legged Stool Leg #1: Health Insurance Literacy Ability to understand the complex terms, concepts, and financial implications when purchasing health insurance in order to pick the right plan 2014 Maryland Women s Coalition For Health Care Reform 84

85 Health Literacy: Leg #2 Health insurance literacy + health care literacy = Getting the full benefits from an insurance plan: What is a primary care provider and the value of prevention? What is the difference between in-network and outof-network providers why does it matter? Why go to a doctor and not an emergency room? What is an annual check up and what questions should one ask? What will be financial responsibility for patient? 2014 Maryland Women s Coalition For Health Care Reform 85

86 Health Literacy: Leg #3 Owning Your Own Health: What are the Steps? Health Care Literacy + Consumers make wise and informed decisions Healthy eating & Exercise Regular check-ups Shared decision-making with their provider Providers work with individuals to empower them to share treatment decisions Consumers are proactive as the managers of their own health Highest level = advocating for the health of their communities Patient Engagement: A Framework for Improving Health & Lowering Costs Maryland Women s Coalition For Health Care Reform 86

87 Got Card? Get Care! Goal of the Campaign is to provide consumers with the tools they need to become health care literate with: Culturally and linguistically appropriate materials, such as: Video vignettes; Fact sheets, handouts or other tools; Website banner-ads and social media posts; and Other resources 2014 Maryland Women s Coalition For Health Care Reform 87

88 How Do You Get Engaged? Navigators and others can commit to actively working with consumers to help them become care aware All of us can create partnerships with community-based organizations, churches, etc. Please partner with the Coalition and let us know what: Programs or resources you currently have Individuals in your communities specifically need Resources would help you partner with others in your community Now, your ideas! 2014 Maryland Women s Coalition For Health Care Reform 88

89 Maryland Rocks on Reform Maryland s multiple reform initiatives mean that there is a role for all of us: Stay informed Become active in your organization or community Educate others in your family and community Participate on a committee, work group or task force Share your ideas and expertise 2014 Maryland Women s Coalition For Health Care Reform 89

90 Put Your Ear to the Ground Nothing is more powerful than personal stories! Gather Them Share Them 2014 Maryland Women s Coalition For Health Care Reform 90

91 Get Engaged! Take the Pledge & Commit To: Provide expertise in a policy area Participate in the Got Card? Get Care! Campaign Organize in your community Participate in a secret shopper project Collect and share stories 2014 Maryland Women s Coalition For Health Care Reform 91

92 This Isn t Just a Party It is Serious Business Share Your Ideas. Join the Coalition & encourage others to do the same. Go to our website for resources & let us know what you need Maryland Women s Coalition For Health Care Reform 92

93 Leni Preston, Chair, Website: