Insurance Products – Galveston - The University of Texas School of by yaofenji


									          Galveston County
          3-share Proposal

              Dr. Barbara Breier,
 Asst. Vice President for Strategic Initiatives &
Director, Center to Eliminate Health Disparities
                February 9, 2007
        What is the 3-Share Plan?

• A collaborative effort
  – UTMB
  – Galveston County Chambers of Commerce
  – Member businesses
• A program to provide coverage for the
  working uninsured, modeled after a
  successful effort in Muskegon, Michigan.
           Galveston 3-Share Plan
• Provide health benefits for working individuals
  & families
   – Focus on primary and preventive care needs
   – Emphasizing the improvement of health status
     through managing chronic diseases and involving
     individuals in managing their own care
• Costs of the coverage split between
   – employer
   – employee
   – state and local government.
• Allow for low monthly health premiums, thus
  improving accessibility
               Key Legislation
• Social Security Act, Section 1115
  – Modify SCHIP & Medicaid Programs

• Health Insurance Flexibility Accountability Waiver
  – Modify Benefits packages
  – Public private partnerships
  – Expand to previously uncovered adults
                     Development Process

  Community Activities               Outside Validation
• 21 Focus Groups (CHAT)             Saurage Marketing Study:
                                     Representative Sample of
• Galveston Employers Survey        Galveston County Employers
• Galveston County Chambers of                 n=160
                                        Media Coverage
• Civic Organizations
                                    •Galveston Daily News
• Cover the Uninsured Week:         •Houston’s FOX News
  Letters to the editor, Lecture    •Texas Medicine Magazine
  Series, & Religious Leaders’
  Breakfast                         •Guidry News Website
Galveston Employer Survey
   248 Employers Surveyed
       4819 Employees

     Employee Profile
 Average age of employee: 41
         54% Male
        46% Female
  53% White Non Hispanic
       26% Hispanic
   22% African American
          1% Asian
    CHAT Software Program
• Choosing Health Plans All Together –
  created by the U. of Michigan and NIH
• Utilizes national averages to compute cost of
  health care coverage
• Players are allotted 50 markers to “purchase”
  health benefits
• 15 benefits are available –full range
• 4 Rounds of game played – individual, small
  group, community, and individual
CHAT Game Board
        CHAT Preliminary Results
Top Priorities                   Lowest Priorities

1.   Pharmacy                    9. Dental
2.   Primary Care                10. Mental Health
3.   Hospitalization             11. Uninsured
4.   Specialty Care              12. Home Health
5.   Tests                       13. Vision
6.   Other Medical (ambulance,   14. Infertility (N/A)
     equipment)                  15. Alternative Med (N/A)
7.   Long Term Care/Last
     Chance (tied)
              Actuarial Analysis

• Can achieve $180 pmpm with limitations:
   • Primary care/Specialty care –12v/yr
   • Hospitalization – 30 day annual maximum
   • Pharmacy - $1200/yr
   • Mental Health – 20v/yr
   • 10% coinsurance w/$1000 annual maximum
   • $50,000 Annual Maximum
   • Exclusions of high risk, experimental, vision, dental, etc.
   • Care limited to UTMB HMO providers in Galveston
   • No ER coverage outside of Galveston County
 Eligibility Criteria for Businesses

• Has been conducting business operations for at
  least one year (verified by IRS statements.)
• Has a minimum of 2 employees (including self)
  that have been employed in the business for one
  year (does not have to be the same employee).
• Has filed appropriate IRS documentation for
  the reporting of income.
• Has filed W-2’s for eligible employees noted
Eligibility Criteria for Businesses
 • Has its principle business location in
   Galveston County.
 • Employs 50 percent of its employees in
   Galveston County if employer has locations
   outside the county;
 • Has a median income of $50,000 per year or
   less for all employees;
 • Has not offered group health coverage for
   the previous 12 months.
Eligibility Criteria for Employees
Employee eligibility is determined by
their income level and assets. They must
be below 200% FPL and meet the State’s
to be eligible for the federal match.

*Additional funding is being secured to cover
employees who do not meet SCHIP asset test criteria.
            Where we are now
• Waiver document has been reviewed by Texas

• Texas DHHS has given approval and has sent
  to CMS for review

• Met with CMS officials and have responded to
  their questions and are waiting further review
  and approval.
Business Plan & Marketing Next Steps

• Business plan provides for 3,000
  participants for break-even over 5-year
• UTMB HMO will administer the plan
• Development of this program could not
  have been possible without support from
  the Kempner Fund
 Market Potential for Statewide Model
• Program can serve as a statewide model as an
  increasing number of businesses seek viable
• Individuals involved in decisions about their own
  healthcare create healthier workforces and
• Other communities have expressed strong interest
  including Harris, Travis, Dallas, Bexar and El Paso

                Multi-share Legislation
                       H.B. 882
• Allows for regional health care programs that provide health care
  services or benefits to the employees (and their dependents )of
  small employers (< 50 employees)

• Flexibility for communities to address their own health needs with
  eligibility for counties, regional multi-county consortia or other
  non-profit entities designated by commissioners courts to run the

• Employers and employees are required to pay a share or cost of the

• No funding available in this bill, however encourages governing
  bodies to seek funds from grants, gifts, & donations
      A Proposal for a Statewide Model for
      Multi-Share Plans for Small Business
• Legislation would provide funding ($50 million) for the
  development of multi-share plans targeted to small businesses with
  <50 employees.
• Flexibility for communities to address their own health needs with
  eligibility for municipalities, counties, hospital districts or regional
  multi-county consortia.
• Provide planning and infrastructure grants as well as cost-sharing
  for the 3rd Share.
• Encourage the use of EMR and telemedicine as a tool for
  improving health outcomes.
• Eliminate the need for a HIFA waiver by authorizing on a state-
  wide basis.
• Limited to 5 year grants for each entity.

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