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3. Environmental Pressures 3  Sluggish Economy  Financial Implications to Higher Education  Continuing Concerns over Campus Safety  Promise or Threat of Health Care Reform  Potential for Global Public Health Concerns  Increasing Internal and External Expectations

4. Current Funding Options 4 Institutional Funding – Tuition or General Fund – Allocation of Student Activity Fees – Designated Health Fee Fees-for-Service Grants and Research Funds Development or Donor Funding Strategic Outsourcing Funding in Combinations

5. Funding Sources and Systems Major Funding Sources Common Funding Systems X = Significant O = Nominal N/A = Not Applicable Traditional Pre-Paid Traditional Pre-Paid with Limited FFS Pre-Paid with 20% to 59% FFS Nominal Pre-Paid with > 60% FFS SHIBP Capitation Secondary Payor Institutional Allocations XXX000 Designated Health Fees XXX00X SHIPBs 0XXXXX Fee-for- Service Charges w/o Insurance Participation N/A0X 00 FFS with Participation with Private Insurance N/A XX0X Employee Health Services 000X00

6. ACHA Survey - 2010 6 57% had Designated Health Fee – 75% of publics – 29% of privates Billed Revenue – 50% received less than 10% from FFS – 34% of publics – 72% of privates – 16% received more than 50% from FFS – 20% of publics – 8% of privates Billing Source – 78% students (83% of publics – 69% of privates) – 41% campus SHIP (48% of publics – 31% of privates) – 24% other third-party payers (33% of publics – 11% of privates) – Combination of sources

7. ACHA Survey – 2010 (Cont’d) 7 Health Insurance (HI) Requirement * – 65% of private schools – 35% of public schools (20% over 2006 survey) Most Common Funding Arrangements – Publics: a health fee but no HI requirement – Privates: no health fee and HI requirement Overall SHIP Enrollment = 10% – 8% without HI requirement – 31% with HI requirement * Q13 : As a condition of enrollment, does your institution require ALL full-time students to have some form of health insurance coverage? Answer NO if you have requirements for some, but not all, full-time students.

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9. Variables for Choice of Funding Models 9 Public vs Private Status Enrollment Size and Eligibility for SHC Services Involvement of Students Scope of Services, Staffing, Hours of Service Insurance Status of Eligible Population Existence of SHIP and the Enrollment Mechanism Perceived Institutional Value of Campus Services Compatibility with Institutional Mission Institutional and Academic Financial Pressures Institutional Support for Financial Exploration Other environmental drivers?

10. Lingering Questions for College Health 10  What are the key features of HCR and how might they impact College Health?  What are the financial implications?  What could we be doing now to position ourselves in this dynamic environment?

11. The Challenges 11  Impact of Federal Health Care Reform  Changes in Employer-based Health Benefit Plans  Rising Costs of Higher Education  Rising Costs to Operate College Health Programs

12. Federal Health Care Reform 12  Almost Everyone Covered by Some Form of Insurance  First Dollar Coverage for Preventive Services  Improved Quality of Student Health Insurance/Benefit Programs (SHIBPs)

13. Changes in Employer-based Plans 13  Cost Shifting to Employees (including increasing use of high deductible plans)  Some Employers Will Shift Employees/Dependents to Exchanges  Employer-based Clinics

14. Rising Cost of Higher Education 14  Most Cost Centers Will Be Critically Reviewed  Activities Will Need to Justify Themselves on Basis of Importance to the Educational Mission  Non-essential Services Will Be Eliminated  Outsource Where Possible

15. Rising Costs of College Health Programs 15  Personnel  Technology  Aging Facilities

16. Opportunities 16  Fee-for-Service is Dead—Back to Capitation  Expand to Provide Services to Faculty/Staff+Dependents  Community Partnerships  Experiment with New Organizational Structures/Technology  Elimination of Current Silos

17. 17 “The pessimist sees difficulty in every opportunity. The optimist sees the opportunity in every difficulty.” --Winston Churchill

18. Questions and Discussion 18