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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

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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 Private Insurance Coverage

  • Located in Muskegon County

  • No health benefits for 12 months

  • Offered to full and part-time employees

  • Median wage of $10 per hour


Access Health Benefits Private Insurance Coverage

  • 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


Funding the Three-share Model Private Insurance Coverage

   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.


Community Match Private Insurance Coverage

  • Disproportionate Share Hospital (DSH) payment

  • DSH is matched with local funds

  • DSH matches local dollars at 1.29 rate


Commercial Plans Private Insurance Coverage

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


Cost of Commercial Products Private Insurance Coverage

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


Survey of Working Uninsured Private Insurance Coverage

48% not offered coverage

64% believe coverage extremely important

30% forgo treatment of current illnesses

65% able to pay $35 to $50 pm/pm


Coverage & Co-Payments Private Insurance Coverage

$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


Exclusion — Care Private Insurance Coverage

  • Any care received outside of Muskegon County

  • Certain highly specialized catastrophic care

    • limb reattachment

    • neo natal

    • transplants

    • severe burns


Reduce cost shift to commercial Private Insurance Coverage

Commercial

65%

Medicare/caid

22%

Uninsured

8%

4%

Access Health

1%

Indigent

Reduce care shift to safety net

Five Year Goals


Access Health Accomplishments Private Insurance Coverage

  • 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


Improves Delivery of Care Private Insurance Coverage

  • Reduces deferred care

  • Reduces ER and urgent care use

  • Reduces stress on “safety net”

  • Promotes community collaboration

  • Adds revenue to health care system


Complements Commercial Coverage Private Insurance Coverage

  • Entry level coverage

  • Transitional product

  • Nudges commercial market

  • New insurance markets

  • Brokerage partnership opportunities


Three Share Funding Private Insurance Coverage

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


For more information
For More Information: Private Insurance Coverage

For more information about Access Health and our other projects, please visit our website.

http://www.mchp.org


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