entering the south carolina market in january 2014 a “consumer operated and oriented health...
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Entering the South Carolina market in January 2014 A “Consumer operated and oriented health plan” Or “Co-OP”. What this presentation will address. What is a “CO-OP”? How did it develop in South Carolina? Who owns and manages it? What is its Mission? How will it relate to Providers - PowerPoint PPT PresentationTRANSCRIPT
ENTERING THE SOUTH CAROLINA MARKET IN JANUARY 2014
A “CONSUMER OPERATED AND ORIENTED HEALTH PLAN”
OR“CO-OP”
1
What this presentation will address2
What is a “CO-OP”?How did it develop in South
Carolina?Who owns and manages it? What is its Mission?How will it relate to Providers What differentiates it?
Consumer Operated and Oriented Plan
3
A “CO-OP” is:
the private sector alternative to “public option” in the ACA
Not for profit
Funded by Federal loans paid back over 30 years
Governed by its Beneficiaries, including network
physicians and hospitals
Mandated to develop low cost options for individuals, small
groups, and to encourage the uninsured into the market
4
Consumers’ Choice Development
Senior Management5
Jerry Burgess, Chief Executive Officer
David Young, Chief Financial Officer
Judy Slagle, Chief Operating Officer
Jerry Reeves, MD, Chief Medical Officer
Francis G. Middleton, M.D., VP Network Development
Kimberly Coad-Ascue, Director Network Development
Robin Tester, Consultant for Network Development
Mission6
Provide affordable benefits for individuals
and small groups through the public
exchange
Reduce the ranks of the uninsured
Engage consumers in their health
Provide a platform for providers’
innovations
The Role of Providers7
1. In Governance - Three board seats will be
held by network providers
2. As Advisors - Network Providers, through a
Medical Advisory Committee, will report
directly to the Chief Executive Officer
3. As Network providers
Promote Medical Homes8
Support and reward “medical homes” processes
Enhanced access
Population management via robust analytics
Care plans supported by health care coaches
Engaging community support
Tracking and coordinating care
Continuous improvement in measures and
outcomes
Promote Medical Homes9
Referral Authority – PCP (not plan)
PCP/Patient contract and care plan
supported by Nurse Coach
Plan supports PCP to achieve three aims:
1. Cost Management
2. Quality Measures
3. Patient Satisfaction
Summary of Contracting Principles
10
Finding partners who share our vision
Gain sharing for quality improvement and
efficiency
Promotion of clinical coordination:
- medical home and nurse coach
- medical home, specialists and others
- “accountable care organizations”
Patients have Responsibilities, too
11
We will develop incentives designed to
promote:
patient compliance with care plans
Engagement with nurse coach
improvements in health status
Consumers’ Choice Differentiators
12
Gains go back to the community of
providers and members
Focus on reducing ranks of the
uninsured
Providers participate in governance
Strong support from the provider and
business communities
A Fresh StartA Fresh StartHelp us to get it rightHelp us to get it right
To discuss Network participation, contact:
Kimberly Coad-Ascue, Director, Network Development
Robin Tester, Consultant for Development803-466-4896
[email protected] G. Middleton, M.D., VP Network
Development843.608.9540