Houston/Harris County Initiatives Healthy Vision 2010 Health Care Summit II Texas Medical Association August 30, 2006

The Emerging Alliance Save Our ERs Greater Houston Partnership Public Health Task Force Harris County Public Health Care System Council HARRIS COUNTY HEALTHCARE ALLIANCE

Increasing the # of Insured 1.1 million uninsured in Harris County ~ 31.4% No Single Silver Bullet What’s a County to Do? – Common Eligibility System – 3-Share Demonstration Project – Texas Dept. of Insurance Small Employer Product – BCBS Foundation Hospital Care

3-Share Demo Principles Sustainability Affordability Accountability Evidence-based Collaboration Stakeholder benefits Accessibility Additive value Cultural competence Defined parameters of success

3-Share Demo Three year pilot project to enroll 100,000 employees with incomes below $50,000 Targeting a $150 PMPM premium $600 PMPY subsidy needed for one-third Preventive and primary care service focus Locally managed Aimed at employers who have not offered insurance in past 12 months

3-Share Benefits & Features Low co-payments; BH service parity All preventive screenings covered $25,000 annual max Closed network – out of network for emergencies only – Includes FQHCs Medicare reimbursement rates Chronic disease management protocol participation incentives

3-Share Benefits & Features (cont.) 85+% spent on medical care Traditional and non-traditional marketing – Greater Houston Partnership – ACORN, TMO, Catholic Charities – Consumer & Employer Education

TDI Insure Houston Project TDI’s 3 rd State Planning Grant from HRSA Develop a low-cost product for small employers in Houston area Council’s Insurance & Finance Committee expanded as grant Steering Committee Actuarial support Marketing and consulting support

TDI Insure Houston Project Aiming for $150 or less PMPM product Available to small (<50 ees) employers only Eliminates all but age and gender as rate- impacting factors Hoping to negotiate lower than 75% required participation rates

TDI Insure Houston Project July - focus groups September - product design finalized October – RFP November – Marketing/Education campaign finalized Early 2007 – product available in market

Foundation Hospital Care Offered by BC/BS – began January 2006 Developed by Houston Uninsured Task Force Aimed at fastest growing segment of uninsured – individuals earning more than $50,000

Foundation Hospital Care Covers inpatient care only $5k individual/$15k family deductible (annual max) 80% coverage after deductible No outpatient drug coverage No maternity coverage $2 million lifetime max

For further information contact: Karen Love Harris County Healthcare Alliance