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 County

No health benefits for 12 months

Offered to full and part-time employees

Median 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 coverage

Transitional product

Nudges commercial market

New insurance markets

Brokerage 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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