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Champion A cure To Combat Heath coverage (CATCH) Closing the Gap on ABA Therapy
Ameenah Fuller
New England College
Professor Tafoya
August 11, 2010
Champion A cure To Combat Health coverage (CATCH)
What is CATCH? A non-profit group dedicated to closing the gap on ABA Therapy.
Problem: Most insurance plans provide insufficient or inadequate coverage for children with autism. Champion A cure To Combat Health coverage (CATCH) addresses this need. CATCH offers membership for parents with autistic children to assist in the cost of health coverage for treatments.
CATCH Thesis Statement
The project is designed to address the need for a health care discount plan to treat conditions relating to autism.
This project will develop an organizational structure for Champion A cure To Combat Health coverage to eliminate the gap of expensive treatment costs by negotiating with network providers participating in discounts on treatments for CATCH members.
CATCH
Review and contact State
Insurance Commission
Review cost of ABA therapy
Review history and contact AARP
Review and contact providers for discount rates
Literature Map
Review participants ABA therapy needs.
Review effective business model for healthcare
discount plan.
Review provider existing customized membership
plan.
Project Limitations
The healthcare discount membership limitations:
100 members to start the program.
ABA therapy discount for children with autism disorder.
Not considered a secondary form of insurance.
Not regulated by the California Department of Insurance.
Implementation Plan
Champion a cure to combat health coverage (CATCH) has
been created to provide education, access, and healthcare discounts for members.
The organization will recruit up to 100 new members to participate in the healthcare membership discount plan by circulating membership applications via mail, email and various groups.
The potential hazard for the project is the California Department of Managed Care proposed new legislation to require licensure of healthcare discount plans.
Implementation Plan The plan will demonstrate the development of Champion A cure To
Combat Health coverage (CATCH) offering a healthcare membership discount plan to close the gap on limited insurance resources to provide ABA therapy for autistic children
Currently, there are only 22 states that offer coverage for autistic disorders in the United States. Autism is manageable with appropriate treatment and early intervention.
The organization will measure success by the number of providers that contract to offer services for ABA therapy at discounted rates.
The member will have an option to customize the treatments according to the recommendations from the provider.
The healthcare membership card could offer discounts up to 40% to offset the cost of ABA therapy.
Closing the Benefit Gap
Some of the problems consist of the loopholes in health
insurance coverage for those with autism and autism disorders.
The Economics of our health care system in turmoil.
One tweak would be to provide health care membership discount plans and exchanges.
*Rising cost
*Exclusionary clauses
Effective healthcare membership plans
• The American Association of Retired Persons (AARP) is the largest American non-profit organization that addresses issues for retirees, including health care.
What type of early intervention treatments work for children with
autism disorders? Applied Behavior Analysis (ABA) therapy is the most popular type
utilized to increase positive behaviors in children with autism (Martin, 2010 ).
Family training and counseling
Speech-language pathology services
Occupational therapy
Physical therapy
Psychological services
Medical services
Social work services
Nutrition services
Primary Research
This primary research design will demonstrate the process to develop a healthcare discount plan to treat conditions relating to autism.
Stakeholders :
Project stakeholders include parents, providers, and advocacy groups.
The gaps in health insurance coverage impact parents and their children with autism because of the high cost of treatment.
The gaps in health insurance coverage also impacts medical providers and therapists. Additionally, insurance companies remain an integral part of healthcare coverage so it is important to understand that they must be worked with to close these gaps.
Survey-Pre/Post
• The pre-test poll
*The pre-test for providers
• The post-test poll
*The post-test for providers
• Random survey
Strategic Implementation Plan
CONCEPT
GOALS
OBJECTIVES
BOARD MEMBERS
BY-LAWS
PROVIDER CONTRACT
PROMOTION AND ADVERTISEMENT
FINANCIAL IMPLICATIONS OF CATCH
LONG-TERM PLAN
CONTINGENCY PLAN
SWOT Analysis
• Threats • Opportunities
• Weaknesses • Strengths
Promote early intervention which, in
turn, will help to reduce the need for future long-
term, and ultimately more costly, treatments
The potential for low provider participation is
likely to reduce the marketability of a stable
provider network.
Newly proposed legislation supported by the CA. Department of
Managed Care threatens the existing system of health care membership discount
programs.
The impact of early intervention utilizing ABA
therapy may support efforts to expand the
program benefits to more children with autism
disorders.
Goals and Objectives
Phase 1 Champion A cure To Combat Health coverage (CATCH) will submit a 501(c)(3) application to obtain non-profit status.
Phase 2 recruit and elect five board members to govern
CATCH.
Phase 3 Develop a provider contract with customized healthcare discount plans to include ABA therapy.
Champion A cure To Combat Health coverage (CATCH)
Board member application
CHAMPION A CURE TO COMBAT HEALTH COVERAGE (CATCH) BOARD MEMBER APPLICATION
Name _____________________________________________ Phone ____________
Address _____________________________________________________________
Relevant Experience and/or Employment (attach a resume) _____________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Why are you interested in our organization? _________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Area(s) of expertise/Contribution you feel you can make________________________
_____________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Other current volunteer commitments _______________________________________
______________________________________________________________________
For Board Use Only
__ Nominee has had a personal meeting with either (circle one): chief executive, board chair, or other
board member _________________. Date ______
__ Nominee reviewed by the committee. Date ______
__ Nominee attended a board meeting. Date ______
__ Nominee interviewed by the board. Date ______
Example of Board Member Application
Action taken by the board __________________________________________________
Champion A cure To Combat Health coverage (CATCH)
By-Laws •ARTICLE I ORGANIZATION
•ARTICLE II PURPOSES
•ARTICLE III MEMBERSHIP
•ARTICLE IV MEETINGS
•ARTICLE V VOTING
•ARTICLE VI ORDER OF BUSINESS
•ARTICLE VII BOARD OF DIRECTORS
•ARTICLE VIII OFFICERS
•ARTICLE IX SALARIES
•ARTICLE X COMMITTEES
•ARTICLE XI DUES
•ARTICLE XII AMENDMENTS
Champion A cure To Combat Health coverage (CATCH)
Provider Contract CHAMPION A CURE TO COMBAT HEALTH COVERAGE (CATCH) PROVIDER CONTRACT
Example of Provider Contract
This contract agreement shall serve as the legal and binding agreement by and between the CATCH ABA
therapy discount membership program, a non-profit organization, and ______________________ , the
contracting entity of the health care provider. This agreement shall be effective on [Specific date] and continue
through [Specific date]. The contract includes an agreement by which the contracting [Entity] that sells or grants
access to provider’s health care services, will offer discounted rates or reduced fees to CATCH members as
agreed upon and established in this contract. Each contracting entity that sells or grants access to any covered
entity, physician group or a health care provider's health care services, discounted rates or reduced fees will be
required to:
(1) maintain a website and/or a toll-free telephone number through which a health care provider may obtain a
listing of the entities to which such provider's services, discounted rates or fees have been sold or granted
access.
(2) make available a list to the health care provider of all known covered entities to which such contracting
entity may sell or grant access to such provider's health care services, discounted rates or fees.
(3) accept payments in full from the individual members for the health care provider's discounted rates or fees
in accordance with the terms and conditions set forth in the contract between the contracting entity and such
provider.
(4) allow this agreement to be subject to any applicable continuity of care requirements or contractual health
care discount provisions with a health care provider. A covered entity's right to exercise a contracting entity's
rights and responsibilities under a contract shall terminate on the date such contracting entity's contract with
such provider is terminated
(5) provide all remittance advices, whether paper or electronic, that clearly identify the following: (a) the name
of the covered entity responsible for payment to the health care provider
(b) the name of the contracting entity through which the payment rate and any discounts are claimed
(6) In the event that a contracting entity issues a member identification card, the card shall be clearly marked
with the address of the Internet website or toll-free telephone number set forth in (1).
CATCH website
CATCH Social Media Facebook page
Champion a Cure to Combat Health Coverage (CATCH) Brochure
Champion a Cure to Combat Health Coverage (CATCH) Inside Brochure
Champion a Cure to Combat Health Coverage (CATCH)
• Membership Application Card
Champion a Cure to Combat Health Coverage (CATCH)
• Membership card
Measuring success of the organization
• 100 participants
*Providers
*Parents
*Advocacy groups
• 50 network provider agreements
Financial implications of the organization
The budget analysis
Revenue: Year 1 $62,515 Year 2 $70,815 Year 3 $95,815
operational cost Year 1 $55,770 Year 2 $56,570 Year 3 $81,870
capital cost Year1 $6,745 Year 2 $14,245 Year 3 $13,945
Revenue Operating Cost
Capital Cost
Long-term plan
Seek grants
Modify provider services
Work with home health agencies
Contingency plan
• Providing three month trial memberships
• Special rebates
• 5% rebate on the membership plan
• Adopt new policies and procedures
• Work to reduce the rates