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:

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Environmental Pressures

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Sluggish Economy Financial Implications to Higher Education Continuing Concerns over Campus Safety Promise or Threat of Health Care Reform Potential for Global Public Health Concerns Increasing Internal and External Expectations

Current Funding Options

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• Institutional Funding– Tuition or General Fund– Allocation of Student Activity Fees– Designated Health Fee

• Fees-for-Service• Grants and Research Funds• Development or Donor Funding• Strategic Outsourcing • Funding in Combinations

Funding Sources and Systems

MajorFunding Sources

Common Funding Systems X = Significant O = Nominal N/A = Not Applicable

Traditional Pre-Paid

Traditional Pre-Paid

with Limited FFS

Pre-Paid with

20% to 59% FFS

Nominal Pre-Paid with

> 60% FFS

SHIBP Capitatio

nSecondary Payor

Institutional Allocations

X X X 0 0 0

Designated Health Fees

X X X 0 0 X

SHIPBs 0 X X X X X

Fee-for-Service Charges w/o Insurance Participation

N/A 0 X N/A 0 0

FFS with Participation with Private Insurance

N/A N/A X X 0 X

Employee Health Services

0 0 0 X 0 0

ACHA Survey - 2010

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• 57% had Designated Health Fee – 75% of publics – 29% of privates

• Billed Revenue– 50% received less than 10% from FFS

– 34% of publics – 72% of privates– 16% received more than 50% from FFS

– 20% of publics – 8% of privates

• Billing Source – 78% students (83% of publics – 69% of privates)– 41% campus SHIP (48% of publics – 31% of privates)– 24% other third-party payers (33% of publics – 11% of

privates)– Combination of sources

ACHA Survey – 2010 (Cont’d)

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• Health Insurance (HI) Requirement *– 65% of private schools– 35% of public schools (20% over 2006 survey)

• Most Common Funding Arrangements– Publics: a health fee but no HI requirement– Privates: no health fee and HI requirement

• Overall SHIP Enrollment = 10%– 8% without HI requirement– 31% with HI requirement

* Q13: As a condition of enrollment, does your institution require ALL full-time students to have some form of health insurance coverage? Answer NO if you have requirements for some, but not all, full-time students.

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Variables for Choice of Funding Models

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• Public vs Private Status• Enrollment Size and Eligibility for SHC Services• Involvement of Students • Scope of Services, Staffing, Hours of Service• Insurance Status of Eligible Population• Existence of SHIP and the Enrollment Mechanism• Perceived Institutional Value of Campus Services• Compatibility with Institutional Mission• Institutional and Academic Financial Pressures• Institutional Support for Financial Exploration• Other environmental drivers?

Lingering Questions for College Health

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What are the key features of HCR and how might they impact College Health?

What are the financial implications? What could we be doing now to position

ourselves in this dynamic environment?

The Challenges

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Impact of Federal Health Care Reform Changes in Employer-based Health Benefit

Plans Rising Costs of Higher Education Rising Costs to Operate College Health

Programs

Federal Health Care Reform

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Almost Everyone Covered by Some Form of Insurance

First Dollar Coverage for Preventive Services Improved Quality of Student Health

Insurance/Benefit Programs (SHIBPs)

Changes in Employer-based Plans

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Cost Shifting to Employees (including increasing use of high deductible plans)

Some Employers Will Shift Employees/Dependents to Exchanges

Employer-based Clinics

Rising Cost of Higher Education

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Most Cost Centers Will Be Critically Reviewed Activities Will Need to Justify Themselves on

Basis of Importance to the Educational Mission Non-essential Services Will Be Eliminated Outsource Where Possible

Rising Costs of College Health Programs

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Personnel Technology Aging Facilities

Opportunities

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Fee-for-Service is Dead—Back to Capitation Expand to Provide Services to

Faculty/Staff+Dependents Community Partnerships Experiment with New Organizational

Structures/Technology Elimination of Current Silos

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“The pessimist sees difficulty in every opportunity. The optimist sees the opportunity in every difficulty.”

--Winston Churchill

Questions and Discussion

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