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Vermont Health Care Reform Catamount Health


... access to affordable health care for everyone ... and business should contribute to the cost of health care. ... Care/catamount.htm ... – PowerPoint PPT presentation

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Title: Vermont Health Care Reform Catamount Health

Vermont Health Care Reform Catamount Health
  • Representative Harry Chen M.D.
  • House Health Care Committee
  • August 1, 2006

Vermont Health Care Act of 1992 (Act 160)
  • It is the policy of the state of Vermont to
    insure that all residents have access to quality
    health services at costs which are affordable.

Vermont Health Care
  • Low rate of uninsured
  • Low costs
  • High quality
  • Vermonters want access to affordable health care
    for everyone
  • Major insurers are non-profit BC MVP
  • All hospitals are non-profit
  • Small state with challenging border issues

Underlying Principles of Health Care Reform- VT
  • Everyone is covered
  • Everyone pays according to their ability
  • Payment for quality not quantity
  • Health Care ? Health Insurance

VT Health Care Reform 05-06
  • House Health Care Committee
  • H.524, 2005- Governors Veto
  • Public Engagement and focus groups
  • Health Care Commission- studies and oversight
    (Dr. Kenneth Thorpe)
  • Multiple Reform Proposals
  • H.861 H.895, 2006- Catamount Health

H.524- Green Mountain Health
  • Every Vermonter should have a doctor.
  • Every Vermont resident and business should
    contribute to the cost of health care.
  • We need a long-term approach to cost containment
    through integrated health care delivery systems,
    better information systems and a focus on keeping
    Vermonters healthy.

Public Engagement
  • Health care is in crisis
  • Notable urgency to reform
  • Every Vermonter should have access to affordable
    health care
  • Be bold but be cautious
  • Build on and dont destroy what is good
  • Emphasize integration and prevention

2006 HealthCare Affordability Act
  • Control the steeply rising costs of health care
  • Making health care affordable and accessible for
    all Vermonters
  • Better managing chronic care

Catamount Health- Details
  • New comprehensive health insurance plan for
    uninsured Vermonters
  • Available 10/1/07 through private insurers (MVP,
  • More info
  • State provides premium assistance to lower-income
    individuals or families (300 FPL)
  • No cost-sharing for preventive services or
    chronic care management

Who is uninsured?
  • Does not qualify for Federal or State program
  • Has not had private insurance for the last 12
  • Has lost private coverage because of
  • loss of employment,
  • death of the principal insurance policyholder
  • divorce or dissolution of a civil union
  • no longer qualifying as a dependent
  • no longer qualifying for COBRA
  • Lost college or university-sponsored health
    insurance because termination of studies.
  • Lost eligibility for VHAP or Medicaid

Catamount Health Benefit
  • Based on typical plan in BCBSVT book of business
  • Plan design
  • In-network 250 deductible, 20 coinsurance,
    800 limit on out-of-pocket spending, 10 office
  • Out-of-network 500 deductible 30 coinsurance,
    1,500 limit on out-of-pocket spending
  • No co-payments on clinically recommended services
    for chronic disease and preventive care
  • No drug deductible, 10 co-pay for generic, 30
    for preferred brand and 50 for non-preferred

Catamount Health Premiums For those Enrolling in
  • Single premium for this benefit in the commercial
    market today 423 per mo.
  • The premium is high since commercial payers
    reimburse hospitals and other providers at 44
    above the cost of treatment!
  • CH will pay 10 above the cost of treatment,
    reducing the premium by 34

CH Premium Also Lower Due to Demographics
  • Age-adjusted prevalence of chronic illnesses
    including diabetes, hypertension, cancer, heart
    disease are higher in VTs employer-based system
    than among the uninsured.
  • Uninsured are also younger. Nearly 50 of
    uninsured adults are aged 19-34 compared to 25
    of privately insured adults.

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How much are the reduced premiums?
Whats wrong with chronic care now?
  • A chronic condition is defined as an established
    clinical condition that is expected to last a
    year or more and that requires ongoing clinical
  • Approximately 75 of all health care spending
    today is for people with chronic conditions
  • Well-documented and accepted national studies
    indicate that people with chronic conditions
    receive the right care at the right time only
    about 55 of the time.

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Delivery of Better Health Care
  • Catamount Health will include a chronic care
    management program that focuses on providing the
    right care at the right time.
  • Incentives to join co-pays deductibles will
    be waived
  • Aligns with the Vermont Blueprint for Health a
    statewide chronic care initiative for all Vermont
    residents (both publicly and privately insured)

Administrative Initiatives
  • Information Technology Coordination
  • Multi-Payer Database
  • Common Provider Credentialing
  • Common Claims Procedures
  • Master Provider Index
  • Cost Shift Review
  • Uniform Uncompensated Care Programs

Medicaid Initiatives
  • Chronic care management program
  • Outreach and reduced premiums for VHAP and Dr.
  • Employer sponsored insurance initiative for VHAP
    and Catamount Health
  • Loan repayment for providers
  • Enhanced reimbursement for providers
  • FQHC Uncompensated Care Pool

Public Health Initiatives
  • Free CDC recommended immunizations for every
  • Health Program Inventory
  • Community Wellness Grant Program
  • Medical Event Reporting and Hospital Infection
    Reporting Program
  • Codification of the Vermont Blueprint for Health

Consumer Initiatives
  • Healthy Lifestyle Discounts
  • Consumer Price and Quality Information
  • Individual Market subsidy and reform
  • Adverse Event and Infection Reporting
  • Safe Apology and Sorry Works

  • Income based premiums
  • Cigarette Tax increases
  • Coordinated with Medicaid to maximize federal
    funds (Global Commitment)
  • Employer assessment on those who do not offer
    insurance to employees

Employer Assessment
  • Quarterly assessment of 1 per day per FTE for
    workers who
  • Are not offered health insurance
  • Are not eligible for health insurance
  • Are uninsured
  • Eight FTE exemption decreases to four
  • Study of seasonal workers
  • Begins April 1, 2007

Reduction in Uncompensated Care
  • Today-private health insurers pay providers 183
    million (at least) more than the cost of treating
    their insured patients in hospitals
  • Under no reform and current law private health
    plans will pay 287 million more than the cost of
    treatment by 2010
  • CH will reduce these above cost payments by 53
    million by 2010 reducing the cost shift and
    slowing the growth in insurance premiums

Family Premiums Under No Reform and CH
  • Year No Reform Catamount Health
  • 2008 12,950 12,560
  • 2009 14,050 13,065
  • 2010 15,245 13,872

Ongoing Reform
  • Executive Branch Reform Coordination
  • Commission on Health Care Reform
  • Individual Mandate? 96 by 2010
  • The underinsured- quantifying benefits
  • Effect on the VT economy and Vermonters
  • Reduction in number of uninsured
  • Oversight structure

Future Opportunities
  • Make health care affordable and accessible to
  • Manage and coordinate chronic care for all
  • Build on employer-sponsored insurance
  • Outreach to Medicaid eligible uninsured
  • Reduce cost shift by
  • Insuring the currently uninsured and reimbursing
    at 110 of cost
  • Providing better chronic care
  • Increase Medicaid reimbursement
  • Finding common ground building broad based

Areas of Disagreement
  • Government-run health care
  • Taxpayer financing broad-based taxes
  • Who assumes the risk?
  • Hard cap to limit financial liability
  • Individual Mandate
  • Employer Sponsored Insurance
  • Changes to Community Rating

Lessons Learned
  • Build broad-based coalitions
  • Engage the public
  • Use public opinion to move the process
  • Use simple and consistent language
  • Dont get lost in vision- Do something!
  • Expect everyone to be a little uncomfortable
  • Be patient but persistent it wont come easily

Dr. Martin Luther King, Jr.
  • "Of all the forms of inequality, injustice in
    health care is the most shocking and inhumane."