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Dirigo Health Reform

Dirigo Health Reform . COST, QUALITY AND ACCESS: A SYSTEM APPROACH Trish Riley, Director Governor’s Office of Health Policy and Finance State of Maine. 1. Overview .

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Dirigo Health Reform

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  1. Dirigo Health Reform COST, QUALITY AND ACCESS: A SYSTEM APPROACH Trish Riley, Director Governor’s Office of Health Policy and Finance State of Maine 1

  2. Overview • Goal: Sustainability • - Achieve universal access for all • Mainers by making health care • more affordable and of high quality. • - Begin with a voluntary, public/private approach. 2 2

  3. Need for Reform • 140,000 uninsured – 80% work in small business or are self-employed; 75% below 300% FPL. • Family premiums rose 77% between ’96 and ’02. • Median household income rose 6%. • We pay higher percent of our income on care than 45 other states. 3

  4. Need for Reform • High rates of chronic illness . • $200 million in bad debt and charity care – 30% from people with insurance. • High rates of utilization. • High hospital costs. • Lowest rate of employer sponsored insurance and highest rate of uninsured in New England. 4

  5. Cost Containment • CON and Capital Investment Fund & State Health Plan • Voluntary Expenditure Targets • Transparency – Price Posting • Insurance Reforms • Hospital Study Commission • End “hidden tax” of bad debt and charity • Enhanced public purchasing • Single portal for providers to access eligibility, benefit and claims info from multiple insurers 5

  6. Quality Improvement • Maine Quality Forum • State Health Plan - Make Maine the healthiest state in the nation • Pay for Performance – Public Purchasers • All Payor Data Base • Statewide EMR 6

  7. Increased Access • Dirigo Health Agency • DirigoChoice - Anthem • Small business, self-employed, individuals • Discounts for employees • Modest MaineCare Expansion – Eliminate cliffs • Comprehensive coverage –100% prevention, no Pre-X, Mental Health Parity, Healthy Me Rewards • Commercial Rate Reimbursement 7

  8. Affordability • Discount Program • Dirigo Choice • Monthly payments and deductibles based on ability to pay to 300% FPL • Marketplace Trend • B Deductible $1,250/$1,750 • B Discounts reduce average deductible to $850 • Employer must pay 60% of employee share • System Reforms 8

  9. Discounts – To 300% FPL 9

  10. Financing DirigoChoice • DirigoChoice is self-financed through pooled revenues: • Member and employer payments • $53 million state funds in 1st year • Savings Offset Payment – linking cost containment and access • MaineCare for those eligible 10

  11. Early Success • 8,100 Enrollees in 7 months • 2,000 Maine businesses (1,300 sole proprietors + 650 small businesses) • Selling statewide 11

  12. Challenges • Linking access expansions to cost constraints • - Public health improvements and quality initiatives take concerted effort over a long period to yield results. • - Reluctance to embrace short term, more immediate cost containment. 12 12 12

  13. Challenges • - “Tough Choices” campaign (Hand-out Attached) • ▪ AmericaSpeaks – Neutral facilitator • ▪ Random sample selection of Maine citizens • ▪ 1 day, 2 sites – “Town Hall Meeting” – • Interactive • ▪Conclusion: It’s tough to make tough choices. • - Need continuing dialogue – State Health Plan 13

  14. Challeges • Financing • Limits of voluntary approach 14

  15. Roles for Federal Government • Cover Uninsured • Federal roles • - Support state initiative with financing • - Federal-State partnerships to cover those unlikely to afford private options • (< 200%? 300% FPL) • Use Medicare & Medicaid • - Consistent & timely data • - Quality measures • - Address perceived cost shifting • - Simplify eligibility pathways for Medicaid 15

  16. More Info • www.dirigohealth.maine.gov • GOHPF: • (207) 624-7442 or GOHPF@maine.gov 16

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