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How Maine Community Health Options is Changing Health Insurance. June 28, 2013 25 th Annual Maine Deaf, Hard of Hearing and Late Deafened Conference Colby College. You know this Maine. You may not know this Maine. 250,000 Mainers are Smokers 300,000 Mainers are obese

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slide1

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

you may not know this maine
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

today s topics
Today’s Topics

Michael Gendreau Director, Outreach, Education and Communications

the affordable care act
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
effects
Effects

Michael Gendreau Director, Outreach, Education and Communications

affordable care act in 2014
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

the dates to remember
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
slide9

The Health Insurance Marketplace

Michael Gendreau Director, Outreach, Education and Communications

slide10

Source: www.cciio.cms.gov

Michael Gendreau Director, Outreach, Education and Communications

slide11

Marketplace Tax Credits for Premiums

QUESTION: Who gets tax credits?

ANSWER:

Tax Credits for Premiums

Sources: Mitchell Stein, CAHC, Michael Deschaine, Cross Agency

slide12

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

subsidy calculator simulation
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

our mission and vision
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.

co op s not just for food
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

triple aim
Triple Aim

We want to work in partnership with Maine people, businesses and health professionals to:

Michael Gendreau Director, Outreach, Education and Communications

our different approach
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

slide18

Value-Based Insurance Design

Michael Gendreau Director, Outreach, Education and Communications

chronic illness support program
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

slide20

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

great resources
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/

slide22

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