State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage
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Vondie Woodbury, M.P.A. Director Muskegon Community Health Project State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage
description
State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage. Vondie Woodbury, M.P.A. Director Muskegon Community Health Project. Eligible Businesses. Located in Muskegon County No health benefits for 12 months Offered to full and part-time employees - PowerPoint PPT Presentation
Transcript of State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage
Vondie Woodbury, M.P.A.DirectorMuskegon Community Health Project
State and Local Efforts to Close the Gaps Between Public and Private
Insurance Coverage
Eligible Businesses
Located in Muskegon CountyNo health benefits for 12 monthsOffered to full and part-time employeesMedian wage of $10 per hour
Physician Services In-patient hospital
services Out-patient services Emergency Room
services Ambulance services
Prescription drugs (formulary)
Diagnostic lab and x-rays Home health Hospice Care Accept pre-existing
conditions
Access Health Benefits
EMPLOYER EMPLOYEE COMMUNITY TOTAL
30% 30% 40% 100%
ADULT $42 / mo. $42 / mo. $53.76 / mo. $137.76 / mo.
CHILD $25 / mo. $25 / mo. $32.00 / mo. $82.00 / mo.
Funding the Three-share Model
Disproportionate Share Hospital (DSH) payment
DSH is matched with local funds
DSH matches local dollars at 1.29 rate
Community Match
Profiling Coverage in Muskegon
Distinctive Populations With Distinctive Needs
Commercial Plans102,000
Working uninsured17,000
Medicare/caid45,000
SMP2,000
Privately funded coverage
Access Health targets
Government sources of coverage
“Muskegon Care” Safety Net Coverage
EPIC-MRA 1999 Survey of 200 Uninsured Businesses in Muskegon County with fewer than 20 employees
— 69% “cost of premiums” barrier
— 81% would offer affordable coverage
— 95% able to afford $35-$50
— 67% coverage would reduce turnover
Cost of Commercial Products as a Barrier
Survey of Working Uninsured
48% not offered coverage
64% believe coverage extremely important
30% forgo treatment of current illnesses
65% able to pay $35 to $50 pm/pm
Coverage & Co-Payments
$5 PCP office visits$20 Specialist office visit$20 Urgent care center visit$5 Generic formulary drugs50% Non-generic formulary drugs
(total drug cost paid by Access Health not to exceed $6,000 per calendar year per member)
$50 Emergency Room visit$50 Outpatient hospitalization$100 Inpatient hospitalization$5 Home Care visit$0 Hospice visit$20 Outpatient behavior health services
Exclusion — Care
Any care received outside of Muskegon County Certain highly specialized catastrophic care
— limb reattachment
— neo natal
— transplants
— severe burns
Five Year Goals
Reduce cost shift to commercial
65%
22%
1% Reduce care shift to safety net
Indigent
Medicare/caid
Commercial
Uninsured Access Health8% 4%
Access Health Accomplishments
Over 1,300 individual members to date300 businesses97% of all local physicians participate1 public dollar leverages 2 private dollarsActuarial data in the range of $130 pm/pm 725 kids identified for Medicaid or MIChild
Improves Delivery of Care
Reduces deferred care Reduces ER and urgent care use Reduces stress on “safety net” Promotes community collaboration
Adds revenue to health care system
Complements Commercial Coverage
Entry level coverageTransitional product Nudges commercial market New insurance marketsBrokerage partnership opportunities
Three Share Funding
Unlike entitlement plans — one public dollar leveragestwo private dollars for health
Public Funds
Employer Funds
Employee fundsUses existing dollars in Michigan — budget neutral
For more information about Access Health and our other projects, please visit our website.
http://www.mchp.org
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