Transcript A Consumer Operated and Oriented Plan: "CO-OP"

A Consumer Operated and
Oriented Plan
“CO-OP”
Why the Health
Reform Debate?
• CMS forecasts growth for Private Plan
Medicare and Medicaid spending to
grow from:
• $2.6 trillion and 17.5% of GDP in 2010 to
$4.5 trillion and 19.6% of GDP by 2019
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Why the Health
Reform Debate?
• CMS forecasts project consumer out-ofpocket spending to grow from $284
billion in 2009 to $466 billion in 2019
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Post Reform Business Model
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CO-OP-Mission
• Foster creation of “consumer” governed
nonprofit health plans offering plan
accountability, high quality, low cost,
and coordinated care
• Enhance competition by providing
additional choices for consumers and
small businesses
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Governance
• Initial Board candidates who bring
health insurance and health care
expertise
• Within 2 years Board consists of at least
51% consumer members
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National Association of State
Health CO-OPs (NASHCO)
• Arizona, Colorado, Connecticut,
Illinois, Iowa/Nebraska, Kentucky,
Louisiana, Maine, Maryland,
Massachusetts, Michigan, Montana,
Nevada, New Jersey, New Mexico, New
York, Ohio, Oregon, South Carolina,
Tennessee, Utah, Vermont, Wisconsin
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CO-OP Profit Standards
Surplus Revenue used to:
1. Lower premiums
2. Improve benefits
3. Improve Quality
4. Re-Pay CMS start up loans
5. Provide sufficient reserves for growth,
statutory requirements, provider
payments and plan stability
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Consumers Mutual
Development
• Consumers Mutual initial organizers15 County Health Plans representing 61
Michigan Counties
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Consumers Mutual Board
• President-Bruce Miller, Executive
Director of Northern and TENCON
Health Plans
• V.P.-Robin Reynolds, Executive
Director Ingham County Health Plan
• Treasurer-Bruce Bragg, past Executive
Director Ingham County Health
Department
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Consumers Mutual Board
• Assistant Treasurer-Joan Moiles, former
OFIR regulator
• Secretary-Jan Hudson, Sr. Policy
Analyst MI. League for Public Policy
• Chris Shea, CEO, Cherry Street Health
Services (FQHC)
• Frank Belsito, D.O., EVP Metro Health
Medical Group
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Consumers Mutual Board
• Mitchell Tomlinson, President & CEO,
Peckham, Inc.
• David Jahn, President & CEO,
Chippewa County War Memorial
Hospital
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Consumers Mutual Status
• May 2012 CMS awards $72,000,000
Loan ( $18,000,000 Start Up, $54,000,000
Solvency)
• Senior Staff in place
• Health Plan Design and Actuary work
near completion
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Consumers Mutual Status
• TPA and PBM contracted
• Network Development- 65 LOIs
moving toward final contract from
PHOs, Hospitals, FQHCs, IPAs, and
Ancillary Providers
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Network Development
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Consumers Mutual Product
• Gold, Silver, and Bronze plans both on
and off Exchange to Individuals and
Small Groups
• Initial population targeted is 138% to
400% of poverty; over 400% also eligible
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Consumers Mutual
Enrollment Projections
• Michigan has 11th highest state
uninsured population: 1,209,000
• Total population available from 138% to
400% of poverty: 542,000
• Enrollment projections: 37,000 lives in
2014 and 85,000 lives in 2017
• Projected penetration rate of 6.8% in year
one and 15.6%in year four of uninsured
between 138% and 400%
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Michigan Uninsured
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Employer Based Coverage
Non-Elderly
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Individual Coverage
Non-Elderly
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Consumers Mutual Market
• The 542,149 uninsured between 138%
and 400% of poverty
• Individuals above 400% and Small
Groups
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Why Consumers Mutual will
be Attractive to Michiganders
• CO-OPs have a history of acceptance in
the farming industry states
• Credit Unions are widely successful
under a similar governance model
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Why Contract with
Consumers Mutual
• Consumer driven
• Transparency
• Fair commercial rates to providers
• Expanded health benefits
• Low premium rates
• Population health management model
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Provider, Business and
Consumer Benefit
• Affordable alternative for the uninsured
population and small business
• Reduce uncompensated care for
Providers thereby improving
Profitability
• Reduction in cost shifting of
uncompensated care to Individuals and
Businesses
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CO-OPs Breaking the Cost
Shift & Uninsured Cycle
Source: Texas State Comptroller Office
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ACA Savings for Families
and Small Businesses
• HHS claims middle class families could
save $2,300 in premiums and small
businesses $350 for each family covered
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Some Others Thoughts
• “CO-OPs are tough enough to keep
Insurance Companies feet to the fire”
~ Senator Max Baucus of Montana
• “Supporters know, here in Minnesota
and other farm states, that CO-OPs
could solve at least a big chunk of the
healthcare access and affordability
problem” ~John King of CNN
Sources: New York Times (2009). Co-op Health Plan Emerging as a Senate Option. NYTimes.com
King, J. (2009). Interview With Senators Klobuchar, Nelson; Interview With Governor Pawlenty.
State of the Union with John King. CNN.com
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Some Others Thoughts
• Bill Oemichen, President of the Minnesota
Cooperative Network, stated that 65% of
those who switched from typical insurance to
a CO-OP reported better coverage and
service
• Regarding CO-Ops: “If it’s all done entirely
within the private sector, you know, it
doesn’t seem to me it has the faults that you
have by having the government institute
something.” ~Republican Senator Chuck Grassley
Source: King, J. (2009). Interview With Senators Klobuchar, Nelson; Interview With Governor Pawlenty. State of the Union with John King. CNN.com
Source: Wangsness L. (2009) Health Debate Shifting to Public vs Private. Boston Globe. Boston.com
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Concluding Thoughts
• Consumers Mutual and the other State
funded CO-OPs plan to be partners
with the Purchasers, Providers and
Consumer recipients of health care
services
• Consumers Mutual is a transparent
organization and will strive to create a
High Quality, Financially Viable, and
Efficient Health Plan to serve the
Michigan Community
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•Questions and Discussion
CEO Contact: [email protected]
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