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Vermont Health Care Reform Catamount Health

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

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Title: Vermont Health Care Reform Catamount Health


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

2
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.

3
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

4
Underlying Principles of Health Care Reform- VT
2005-06
  • Everyone is covered
  • Everyone pays according to their ability
  • Payment for quality not quantity
  • Health Care ? Health Insurance

5
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

6
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.

7
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

8
2006 HealthCare Affordability Act
  • Control the steeply rising costs of health care
    by
  • Making health care affordable and accessible for
    all Vermonters
  • Better managing chronic care

9
Catamount Health- Details
  • New comprehensive health insurance plan for
    uninsured Vermonters
  • Available 10/1/07 through private insurers (MVP,
    BC)
  • More info www.leg.state.vt.us/Health
    Care/catamount.htm
  • State provides premium assistance to lower-income
    individuals or families (300 FPL)
  • No cost-sharing for preventive services or
    chronic care management

10
Who is uninsured?
  • Does not qualify for Federal or State program
  • Has not had private insurance for the last 12
    months
  • 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

11
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
    co-pay.
  • 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
    brand

12
Catamount Health Premiums For those Enrolling in
CH
  • 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

13
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.

14
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15
How much are the reduced premiums?
16
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
    management.
  • Approximately 75 of all health care spending
    today is for people with chronic conditions
    (25).
  • 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.

17
(No Transcript)
18
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)

19
Administrative Initiatives
  • Information Technology Coordination
  • Multi-Payer Database
  • Common Provider Credentialing
  • Common Claims Procedures
  • Master Provider Index
  • Cost Shift Review
  • Uniform Uncompensated Care Programs

20
Medicaid Initiatives
  • Chronic care management program
  • Outreach and reduced premiums for VHAP and Dr.
    Dynasaur
  • Employer sponsored insurance initiative for VHAP
    and Catamount Health
  • Loan repayment for providers
  • Enhanced reimbursement for providers
  • FQHC Uncompensated Care Pool

21
Public Health Initiatives
  • Free CDC recommended immunizations for every
    Vermonter
  • Health Program Inventory
  • Community Wellness Grant Program
  • Medical Event Reporting and Hospital Infection
    Reporting Program
  • Codification of the Vermont Blueprint for Health

22
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

23
Financing
  • 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

24
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

25
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

26
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

27
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

28
Future Opportunities
  • Make health care affordable and accessible to
    uninsured
  • 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
    coalitions

29
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

30
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

31
Dr. Martin Luther King, Jr.
  • "Of all the forms of inequality, injustice in
    health care is the most shocking and inhumane."
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