How Maine Community Health Options is Changing Health Insurance

1. How Maine Community Health Options is Changing Health Insurance June 28, 2013 25th Annual Maine Deaf, Hard of Hearing and Late Deafened Conference Colby College

2. You know this Maine

3. You may not know this Maine • 250,000 Mainers are Smokers • 300,000 Mainers are obese • Over 135,000 Mainers are uninsured • *Source: Kaiser Family Foundation http://kff.org/statedata/ Michael Gendreau Director, Outreach, Education and Communications

4. Today’s Topics Michael Gendreau Director, Outreach, Education and Communications

5. The Affordable Care Act Michael Gendreau Director, Outreach, Education and Communications • Moving toward three goals… • 1. Improve the experience of care • 2. Improve the health of all peoples • 3. Reduce the total cost of our health care system

6. Effects Michael Gendreau Director, Outreach, Education and Communications

7. Affordable Care Act in 2014: Michael Gendreau Director, Outreach, Education and Communications There’s an Individual Mandate Insurance plans have to cover doctor visits, hospitalizations, maternity care, emergency room visits, prescriptions, and more You might be able to get financial help to pay for your health insurance All insurance plans have to show the costs and benefits in simple language with no fine print

8. The Dates to Remember Beth O'Hara-Miklavic, Outreach & Education Specialist • October 1, 2013: Health Insurance Marketplace slated to become operational • October 1, 2013: Enrollment begins • January 1, 2014: Healthcare coverage becomes effective

9. The Health Insurance Marketplace Michael Gendreau Director, Outreach, Education and Communications

10. Source: www.cciio.cms.gov Michael Gendreau Director, Outreach, Education and Communications

11. Marketplace Tax Credits for Premiums QUESTION: Who gets tax credits? ANSWER: Tax Credits for Premiums Sources: Mitchell Stein, CAHC, Michael Deschaine, Cross Agency

12. Employees who are not offered coverage Income Requirements • Employees who are offered coverage Household income between 100 and 400% of Federal Poverty Line1 Person$11,490-$45,9604 People$23,550-$94,200 -At or below 133% FPL and your employee plan covers less than 60% of health care expenses 1 Person$15,282 and below4 People$31,322 and below -At or below 400% FPL and your employee plan would cost more than 9.5% of income 1 Person$45,960 and below4 People$94,200 and below Source: “Subsidy Calculator: Premium Assistance for Coverage in Exchanges,” The Henry J. Kaiser Family Foundation, www.kff.org Sources: Mitchell Stein, CAHC,Michael Deschaine, Cross Agency

13. Subsidy Calculator Simulation Source: “Subsidy Calculator: Premium Assistance for Coverage in Exchanges,” The Henry J. Kaiser Family Foundation, www.kff.org Beth O'Hara-Miklavic, Outreach & Education Specialist

14. Our Mission and Vision Maine’s CO-OP: Maine Community Health Options Michael Gendreau Director, Outreach, Education and Communications “To partner with Maine people, businesses and health professionals to provide affordable, high quality benefits that promote health and well-being” To be a leader in transforming the health of Maine people and positively affecting the Maine economy.

15. CO-OP’s: not just for food Maine has a strong co-op tradition, they’re part of our communities Our plans offer more than insurance: you become a member of MCHO, making decisions and having your voice heard All the profits we make stay out of executive hands, they’re required to go back into yours or into better coverage

16. Triple Aim We want to work in partnership with Maine people, businesses and health professionals to: Michael Gendreau Director, Outreach, Education and Communications

17. Our Different Approach • Patient-centered with shared decision making • Focus on disease prevention and management • Support for strong local systems • Integrate Behavioral Health for better outcomes • Quality over quantity mindset Michael Gendreau Director, Outreach, Education and Communications

18. Value-Based Insurance Design Michael Gendreau Director, Outreach, Education and Communications

19. Chronic Illness Support Program Michael Gendreau Director, Outreach, Education and Communications Beginning with four chronic conditions: Asthma, Diabetes, Hypertension and Chronic Obstructive Lung Disease (COPD) Significant reduction of financial barriers to high value care for these targeted conditions Reliance on evidence-based medicine Promotion of behavioral health integration Promotion of tobacco cessation treatment Production of data and quality reporting for clinicians and consumers

20. Shared Decision Making • Doctor works with patient to choose from all treatment options, weighing pros and cons • Individual makes treatment decision based on her/his personal values & preferences Michael Gendreau Director, Outreach, Education and Communications

21. Great Resources Beth O'Hara-Miklavic, Outreach & Education Specialist www.maineoptions.org http://kff.org/health-reform/ http://www.choosingwisely.org/ www.healthcare.gov http://cciio.cms.gov/programs/coop/index.html http://kff.org/interactive/subsidy-calculator/

22. Summary We’re trying to change health insurance You can help us do that, and keep doing it We hope to see you October 1st Thank You Michael Gendreau Director, Outreach, Education and Communications