a consumer operated and oriented plan “co-op”
DESCRIPTION
A Consumer Operated and Oriented Plan “CO-OP”. Why the Health Reform Debate?. CMS forecasts growth for Private Plan Medicare and Medicaid spending to grow from: $2.6 trillion and 17.5% of GDP in 2010 to $4.5 trillion and 19.6% of GDP by 2019. Why the Health Reform Debate?. - PowerPoint PPT PresentationTRANSCRIPT
A Consumer Operated A Consumer Operated and Oriented Planand Oriented Plan
“CO-OP”“CO-OP”
Why the Health Why the Health Reform Debate?Reform Debate?
• CMS forecasts growth for Private Plan Medicare and Medicaid spending to grow from:
• $2.6 trillion and 17.5% of GDP in 2010 to $4.5 trillion and 19.6% of GDP by 2019
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Why the HealthWhy the HealthReform Debate?Reform Debate?
• CMS forecasts project consumer out-of-pocket spending to grow from $284 billion in 2009 to $466 billion in 2019
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Post Reform Business Post Reform Business ModelModel
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CO-OP-MissionCO-OP-Mission
• Foster creation of “consumer” governed nonprofit health plans offering plan accountability, high quality, low cost, and coordinated care
• Enhance competition by providing additional choices for consumers and small businesses
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GovernanceGovernance
• Initial Board candidates who bring health insurance and health care expertise
• Within 2 years Board consists of at least 51% consumer members
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National Association of National Association of State Health CO-OPs State Health CO-OPs
(NASHCO)(NASHCO)• Arizona, Colorado, Connecticut,
Illinois, Iowa/Nebraska, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Montana, Nevada, New Jersey, New Mexico, New York, Ohio, Oregon, South Carolina, Tennessee, Utah, Vermont, Wisconsin
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CO-OP Profit StandardsCO-OP Profit StandardsSurplus Revenue used to:1.Lower premiums2.Improve benefits3.Improve Quality4.Re-Pay CMS start up loans5.Provide sufficient reserves for growth, statutory requirements, provider payments and plan stability
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Consumers Mutual Consumers Mutual Development Development
• Consumers Mutual initial organizers- 15 County Health Plans representing 61 Michigan Counties
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Consumers Mutual Consumers Mutual BoardBoard
• President-Bruce Miller, Executive Director of Northern and TENCON Health Plans
• V.P.-Robin Reynolds, Executive Director Ingham County Health Plan
• Treasurer-Bruce Bragg, past Executive Director Ingham County Health Department
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Consumers Mutual Consumers Mutual BoardBoard
• Assistant Treasurer-Joan Moiles, former OFIR regulator
• Secretary-Jan Hudson, Sr. Policy Analyst MI. League for Public Policy
• Chris Shea, CEO, Cherry Street Health Services (FQHC)
• Frank Belsito, D.O., EVP Metro Health Medical Group
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Consumers Mutual Consumers Mutual BoardBoard
• Mitchell Tomlinson, President & CEO, Peckham, Inc.
• David Jahn, President & CEO, Chippewa County War Memorial Hospital
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Consumers Mutual Consumers Mutual StatusStatus
• May 2012 CMS awards $72,000,000 Loan ( $18,000,000 Start Up, $54,000,000 Solvency)
• Senior Staff in place• Health Plan Design and Actuary
work near completion
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Consumers Mutual Consumers Mutual StatusStatus
• TPA and PBM contracted• Network Development- 65 LOIs
moving toward final contract from PHOs, Hospitals, FQHCs, IPAs, and Ancillary Providers
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Network Network DevelopmentDevelopment
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Consumers Mutual Consumers Mutual ProductProduct
• Gold, Silver, and Bronze plans both on and off Exchange to Individuals and Small Groups
• Initial population targeted is 138% to 400% of poverty; over 400% also eligible
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Consumers Mutual Consumers Mutual Enrollment ProjectionsEnrollment Projections
• Michigan has 11th highest state uninsured population: 1,209,000
• Total population available from 138% to 400% of poverty: 542,000
• Enrollment projections: 37,000 lives in 2014 and 85,000 lives in 2017
• Projected penetration rate of 6.8% in year one and 15.6%in year four of uninsured between 138% and 400%
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Michigan UninsuredMichigan Uninsured
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Employer Based Employer Based CoverageCoverage
Non-ElderlyNon-Elderly
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Individual Coverage Individual Coverage Non-ElderlyNon-Elderly
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Consumers Mutual Consumers Mutual MarketMarket
•The 542,149 uninsured between 138% and 400% of poverty•Individuals above 400% and Small Groups
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Why Consumers Mutual Why Consumers Mutual will be Attractive to will be Attractive to
MichigandersMichiganders• CO-OPs have a history of
acceptance in the farming industry states
• Credit Unions are widely successful under a similar governance model
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Why Contract with Why Contract with Consumers MutualConsumers Mutual
• Consumer driven • Transparency• Fair commercial rates to providers• Expanded health benefits• Low premium rates• Population health management
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Provider, Business and Provider, Business and Consumer Benefit Consumer Benefit
• Affordable alternative for the uninsured population and small business
• Reduce uncompensated care for Providers thereby improving Profitability
• Reduction in cost shifting of uncompensated care to Individuals and Businesses
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CO-OPs Breaking the CO-OPs Breaking the Cost Shift & Uninsured Cost Shift & Uninsured
CycleCycle
Source: Texas State Comptroller Office 2626
ACA Savings for ACA Savings for Families and Small Families and Small
Businesses Businesses
• HHS claims middle class families could save $2,300 in premiums and small businesses $350 for each family covered
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Some Others ThoughtsSome Others Thoughts
• “CO-OPs are tough enough to keep Insurance Companies feet to the fire” ~ Senator Max Baucus of Montana
• “Supporters know, here in Minnesota and other farm states, that CO-OPs could solve at least a big chunk of the healthcare access and affordability problem” ~John King of CNN
Sources: New York Times (2009). Co-op Health Plan Emerging as a Senate Option. NYTimes.comKing, J. (2009). Interview With Senators Klobuchar, Nelson; Interview With Governor Pawlenty. State of the Union with John King. CNN.com
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Some Others ThoughtsSome Others Thoughts
• Bill Oemichen, President of the Minnesota Cooperative Network, stated that 65% of those who switched from typical insurance to a CO-OP reported better coverage and service
• Regarding CO-Ops: “If it’s all done entirely within the private sector, you know, it doesn’t seem to me it has the faults that you have by having the government institute something.” ~Republican Senator Chuck GrassleySource: King, J. (2009). Interview With Senators Klobuchar, Nelson; Interview With Governor Pawlenty. State of the Union with John King. CNN.com
Source: Wangsness L. (2009) Health Debate Shifting to Public vs Private. Boston Globe. Boston.com 2929
Concluding ThoughtsConcluding Thoughts• Consumers Mutual and the other
State funded CO-OPs plan to be partners with the Purchasers, Providers and Consumer recipients of health care services
• Consumers Mutual is a transparent organization and will strive to create a High Quality, Financially Viable, and Efficient Health Plan to serve the Michigan Community
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