1 / 16

State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage. Vondie Woodbury, M.P.A. Director Muskegon Community Health Project. Eligible Businesses. Located in Muskegon County No health benefits for 12 months Offered to full and part-time employees

janna
Download Presentation

State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage • Vondie Woodbury, M.P.A. • Director • Muskegon Community Health Project

  2. Eligible Businesses • Located in Muskegon County • No health benefits for 12 months • Offered to full and part-time employees • Median wage of $10 per hour

  3. Access Health Benefits • Physician Services • In-patient hospital services • Out-patient services • Emergency Room services • Ambulance services • Prescription drugs (formulary) • Diagnostic lab and x-rays • Home health • Hospice Care • Accept pre-existing conditions

  4. Funding the Three-share Model    EMPLOYER   EMPLOYEE   COMMUNITY    TOTAL 30% 30% 40% 100% ADULT     $42 / mo.    $42 / mo.    $53.76 / mo.    $137.76 / mo. CHILD     $25 / mo.    $25 / mo.    $32.00 / mo.    $82.00 / mo.

  5. Community Match • Disproportionate Share Hospital (DSH) payment • DSH is matched with local funds • DSH matches local dollars at 1.29 rate

  6. Commercial Plans 102,000 Privately funded coverage Working uninsured 17,000 Access Health targets Medicare/caid 45,000 Government sources of coverage SMP 2,000 “Muskegon Care” Safety Net Coverage Profiling Coverage in Muskegon Distinctive Populations With Distinctive Needs

  7. Cost of Commercial Products as a Barrier • EPIC-MRA 1999 Survey of 200 Uninsured Businesses in Muskegon County with fewer than 20 employees • 69% “cost of premiums” barrier • 81% would offer affordable coverage • 95% able to afford $35-$50 • 67% coverage would reduce turnover

  8. Survey of Working Uninsured 48% not offered coverage 64% believe coverage extremely important 30% forgo treatment of current illnesses 65% able to pay $35 to $50 pm/pm

  9. Coverage & Co-Payments $5 PCP office visits $20 Specialist office visit $20 Urgent care center visit $5 Generic formulary drugs 50% Non-generic formulary drugs (total drug cost paid by Access Health not to exceed $6,000 per calendar year per member) $50 Emergency Room visit $50 Outpatient hospitalization $100 Inpatient hospitalization $5 Home Care visit $0 Hospice visit $20 Outpatient behavior health services

  10. Exclusion — Care • Any care received outside of Muskegon County • Certain highly specialized catastrophic care • limb reattachment • neo natal • transplants • severe burns

  11. Reduce cost shift to commercial Commercial 65% Medicare/caid 22% Uninsured 8% 4% Access Health 1% Indigent Reduce care shift to safety net Five Year Goals

  12. Access Health Accomplishments • Over 1,300 individual members to date • 300 businesses • 97% of all local physicians participate • 1 public dollar leverages 2 private dollars • Actuarial data in the range of $130 pm/pm • 725 kids identified for Medicaid or MIChild

  13. Improves Delivery of Care • Reduces deferred care • Reduces ER and urgent care use • Reduces stress on “safety net” • Promotes community collaboration • Adds revenue to health care system

  14. Complements Commercial Coverage • Entry level coverage • Transitional product • Nudges commercial market • New insurance markets • Brokerage partnership opportunities

  15. Three Share Funding Unlike entitlement plans — one public dollar leverages two private dollars for health Employer Funds Public Funds Employee funds Uses existing dollars in Michigan — budget neutral

  16. For More Information: For more information about Access Health and our other projects, please visit our website. http://www.mchp.org

More Related