Vondie Woodbury, M.P.A. Director Muskegon Community Health Project State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage
Eligible Businesses l Located in Muskegon County l No health benefits for 12 months l Offered to full and part-time employees l Median wage of $10 per hour
l Physician Services l In-patient hospital services l Out-patient services l Emergency Room services l Ambulance services l Prescription drugs (formulary) l Diagnostic lab and x-rays l Home health l Hospice Care l Accept pre-existing conditions Access Health Benefits
EMPLOYER EMPLOYEE COMMUNITY TOTAL 30% 30% 40% 100% ADULT $42 / mo. $42 / mo. $53.76 / mo. $ / mo. CHILD $25 / mo. $25 / mo. $32.00 / mo. $82.00 / mo. Funding the Three-share Model
l Disproportionate Share Hospital (DSH) payment l DSH is matched with local funds l DSH matches local dollars at 1.29 rate Community Match
Profiling Coverage in Muskegon Distinctive Populations With Distinctive Needs Commercial Plans 102,000 Working uninsured 17,000 Medicare/caid 45,000 SMP 2,000 Privately funded coverage Access Health targets Government sources of coverage “Muskegon Care” Safety Net Coverage
l EPIC-MRA 1999 Survey of 200 Uninsured Businesses in Muskegon County with fewer than 20 employees —69% “cost of premiums” barrier —81% would offer affordable coverage —95% able to afford $35-$50 —67% coverage would reduce turnover Cost of Commercial Products as a Barrier
Survey of Working Uninsured 48% not offered coverage 64% believe coverage extremely important 30% forgo treatment of current illnesses 65% able to pay $35 to $50 pm/pm
Coverage & Co-Payments $5PCP office visits $20Specialist office visit $20 Urgent care center visit $5Generic formulary drugs 50%Non-generic formulary drugs (total drug cost paid by Access Health not to exceed $6,000 per calendar year per member) $50Emergency Room visit $50 Outpatient hospitalization $100Inpatient hospitalization $5Home Care visit $0Hospice visit $20Outpatient behavior health services
Exclusion — Care l Any care received outside of Muskegon County l Certain highly specialized catastrophic care —limb reattachment —neo natal —transplants —severe burns
Five Year Goals Reduce cost shift to commercial 65% 22% 1% Reduce care shift to safety net Indigent Medicare/caid Commercial Uninsured Access Health8%4%
Access Health Accomplishments l Over 1,300 individual members to date l 300 businesses l 97% of all local physicians participate l 1 public dollar leverages 2 private dollars l Actuarial data in the range of $130 pm/pm l 725 kids identified for Medicaid or MIChild
Improves Delivery of Care l Reduces deferred care l Reduces ER and urgent care use l Reduces stress on “safety net” l Promotes community collaboration l Adds revenue to health care system
Complements Commercial Coverage l Entry level coverage l Transitional product l Nudges commercial market l New insurance markets l Brokerage partnership opportunities
Three Share Funding Unlike entitlement plans — one public dollar leverages two private dollars for health Public Funds Employer Funds Employee funds Uses existing dollars in Michigan — budget neutral
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