Colorado HealthOP A Health Insurance Cooperative That Is Turning Health Insurance Upside Down 12/4/2018 Colorado HealthOP Slides

Introductions Denise Denton, Rural Outreach Advisor denise.denton@cohealthop.org (303) 941-0181 Jack Westfall, MD, Chief Medical Officer jack.westfall@cohealthop.org (303)927-0770 12/4/2018 Colorado HealthOP Slides

Colorado HealthOP Overview Created through funds from the Affordable Care Act. Developed with the partnership of the Rocky Mountain Farmers Union. A new, statewide, non-profit health insurance cooperative. Board will be a majority of members who purchase CO-OP insurance and will help to make decisions about how funds are spent. Commitment to community health through on-going partnerships and campaigns 12/4/2018 Colorado HealthOP Slides

History of Health Insurance Cooperatives ACA included provisions for states to create non-profit, private, Consumer Operated and Oriented Plans, called CO-OPs. Provided an application process and low interest loans for entities in each state to develop CO-OP health insurance plans. 12/4/2018 Colorado HealthOP Slides

ACA CO-OP Requirements Must be private, non-profit organizations that sell health coverage. Subject to the same state rules and regulations as other health insurers. Focused on – but not limited to – individual and small group markets. Consumer oriented and operated. 12/4/2018 Colorado HealthOP Slides

Map of Health CO-OPs 12/4/2018 Colorado HealthOP Slides

Colorado HealthOP July 2012 – DHHS awarded Colorado CO-OP a loan of $69,396,000. $12M start up (to be paid back in 5 years) $57M reserves (paid back in 15 years) MISSION: To improve the health of individuals and communities through trusted partnerships with members, employers, and providers. 12/4/2018 Colorado HealthOP Slides

Cooperative Principles Governed by the people who use their products or services Controlled by their members, not outside investors Surplus revenues used to improve member services or lower member costs Motivated by service and members’ needs, not by profit Concerned for their communities 12/4/2018 Colorado HealthOP Slides

A Consumer Operated and Oriented Health Plan Members have a voice No profits   As a CO-OP, we are specifically designed for people who want to make a difference in their own health and that of their community. A Consumer Operated and Oriented Health Plan (CO-OP)   Gives members a voice in the CO-OP’s operations What is covered under benefit plans Members sit on the board No profits – if revenues exceed costs, the surplus will be reinvested to directly benefit members Lower premiums, expanded benefits and quality improvements  12/4/2018 Colorado HealthOP

Insurance Designed to Make Members Sustainably Healthy Preventive care incentives Shared responsibility Primary care provider partnerships Insurance is supposed to help when people get sick or injured; we think insurance should also be there to help people stay healthy. Insurance Designed to Make Members Sustainably Healthy   Incentives for preventive care: Until now, health insurance has only helped people who are sick or hurt. We think health insurance should also be there to help people stay healthy. That’s why we reward you for taking simple, healthy actions (like getting a yearly checkup) with more benefits and lower costs. Creates a shared sense of responsibility among members to advance their own health and the health of the CO-OP. Partnerships with primary care providers to improve quality and reduce costs. 12/4/2018 Colorado HealthOP

Get Healthy! Stay Healthy! Save Money! Rewards members for staying healthy Partners with providers that cost less Helps children remain cavity-free at three Covers home blood pressure monitoring Gives members tools to price shop 12/4/2018 Colorado HealthOP Slides

“No Surprises” Philosophy of Customer Service Philosophy of resolution Exceptional customer service Committed to paying members’ healthcare Easier claims process for all When it comes to customer service, we are not like other insurance companies; we aim to design it right the first time and do it right every time. “No Surprises” Philosophy   Philosophy of resolution: When it comes to customer service, we aim to do it right every time. We know health insurance is complicated, and we’re committed to helping members understand their benefits. We want them to know in advance what’s going to be covered and their share of the costs — no surprises — and if we make a mistake, we want members to let us know. Delivering exceptional, common-sense customer service. Committed to paying for members’ healthcare, not denying claims and hoping members won't fight it. Making the claims process easier for members and providers. 12/4/2018 Colorado HealthOP

Advancing Health in Colorado Bending the cost trend Healthcare decisions by members and providers Statewide partnerships   We are more than just an insurance company; we want to change the way healthcare is delivered now and in the future. Advancing Health in Colorado   Bending the trend – reversing the trend of the spiraling costs of insurance Putting healthcare decision-making back in the hands of members and providers Building partnerships statewide with providers and advocates to improve health at the local level 12/4/2018 Colorado HealthOP

A Collaborative Relationship Among Patient, Provider, and Payer Healthier patients Reduced costs Reduced inefficiencies www.COHealthOP.org A Collaborative Relationship Among Patient, Provider and Payer  Healthier, more engaged patients: Our benefits are designed to help patients and their families catch healthcare issues early — before they become major, expensive health problems — we’re working with healthcare providers like you on new ways to hold costs down and keep people healthy. Reduced costs for patient and provider Takes inefficiencies out of the system   12/4/2018 Colorado HealthOP

To Get Involved With CO-OP Efforts Host an educational event for your office, group, or association Volunteer at a local community event Share information with your network “Opt in” to join the movement Join us on social media Facebook: https://www.facebook.com/COHealthOP Twitter: @COHealthOP YouTube: http://www.youtube.com/user/COHealthOP 12/4/2018 Colorado HealthOP Slides

A brief overview of the ACA Health Insurance Marketplace for individual and small group market No annual dollar limits on essential health benefits No preexisting condition restriction for ANY enrollee No lifetime maximum dollar limits on essential health benefits Children eligible to remain covered under parents health plan until age 26 Individual mandate means there will be a penalty for not having minimal coverage; increases over time 12/4/2018 Colorado HealthOP Slides

Connect for Health Colorado (the Marketplace) Colorado HealthOP is one of the options on the marketplace (AKA: Exchange) Works like a airline booking website – you can compare plans and rates Guides/Navigators are individuals/organizations working across the state to help educate and sign people up on the marketplace (Certified agents/brokers can be guides.) Metal tiers help to distinguish each plan and its benefits (bronze, silver, gold, platinum) 12/4/2018 Colorado HealthOP Slides

Subsidies Available Tax Credits/Subsidies are available for many individuals and small businesses Individuals – generally earning $15,000-$46000; for families of four - $31,000-$94,000 Small Business – under 25 FTE; pay at least 50% of insurance cost; pay average annual wages below $50,000. With the expansion of Medicaid many new Coloradans may qualify The Marketplace will help identify any benefits a person would qualify for and send them to the right site to complete their sign-up or purchase 12/4/2018 Colorado HealthOP Slides

Connect for Health Colorado (the Marketplace) Plans available starting on October 1st Coverage begins on January 1st 2014 www.connectforhealthCO.com 12/4/2018 Colorado HealthOP Slides

QUESTIONS? Thank you! 12/4/2018 Colorado HealthOP Slides