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

2. Introductions Denise Denton, Rural Outreach Advisor
(303)
Jack Westfall, MD, Chief Medical Officer
(303)
12/4/2018
Colorado HealthOP Slides

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

10. 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

11. 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

12. “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

13. 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

14. A Collaborative Relationship Among Patient, Provider, and Payer
Healthier patients
Reduced costs
Reduced inefficiencies
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

15. 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:
YouTube:
12/4/2018
Colorado HealthOP Slides

16. 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

17. 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

18. 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

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

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