What is Catamount

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What is Catamount? FAQ List

• An extinct(?) Vermont mountain lion
• One of Vermonts first and finest microbreweries.
  
• (Also extinct)
• 1/38th of Vermonts landmark health reform
  legislation
• Act 191. Sec. 15. 8 V.S.A. 4080f. CATAMOUNT
  HEALTH
• (2) Catamount Health means the plan for
  coverage of primary care, preventive care,
  chronic care, acute episodic care, and hospital
  services as established in this section to be
  provided through a health insurance policy, a
  nonprofit hospital or medical service corporation
  service contract, or a health maintenance
  organization subscriber contract which is offered
  or issued to an individual and which meets the
  requirements of this section.

2

• Areas to cover in this presentation
• Quick review of the back story (politics and
  Medicaid)
• Is it better to pass imperfect legislation than
  to wait for the ideal?
• The new Catamount health insurance benefit
  center of the compromise
• Whats the deal with the Blueprint for Health?
• Vermonts statewide quest for systemness
• Resources for learning more about the other
  37/38ths of Vermonts Health Reform
• The bottom line first step? Half a step?

3

• Recent Health Policy history highlights
• Broad citizen support for systemic reform
• 2004 election Rep. Gov., Dem. legislature
• New House Health Care Cmt. created H.524
• Governors Veto
• Health Care Reform Commission, summer listening
  tour, Governors Health Care Summit
• consensus initiative common sense initiative
  (CSI Montpelier) S.310 Dr. Ken Thorpe new
  focus on chronic care H.864

4
Global Commitment 1115 WaiverOriginal
Medicaid waiver provided coverage of kids to 300
of FPL, Parents to 185, childless adults to
150. A new block grant waiver was a key
element of Gov.s budget in 2005. Submitted in
April. Approved 9/30/05.
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Global Commitment How the MCO is Funded
See more VT Legislative Council Joint Fiscal
Office info on Vermont Medicaid at
http//www.leg.state.vt.us/jfo/Healthcare.htm
And the Medicaid Global Commitment home page
at http//www.ovha.state.vt.us/globalhome.cfm
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Leveraged Federal Match
Key to Catamount financing. (And means DRA
citizenship identity applies to Catamount.)
Reduced Medicaid deficit in short term. But the
state at risk. Federal participation capped.
Trade off fixed trend rate, Special Terms
Conditions 39
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The Compromise
http//www.leg.state.vt.us/HealthCare/catamount.ht
m
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Implementation
http//hcr.vt.gov/
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Catamount Health

• A non-group insurance product for uninsured
  Vermont residents
• Offered as a Preferred Provider Organization Plan
  by private insurers in the small group market,
  beginning October 1, 2007
• Is required to be a comprehensive insurance
  package covering
• Primary care
• Preventative care
• Acute episodic care
• Chronic care
• Hospital services
• Pharmaceutical coverage
• Individuals may choose which insurer they would
  like to use.

See the entire PowerPoint from which the next 3
slides are borrowed (with permission) in their
complete, original form
http//hcr.vt.gov/
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Catamount Health

• The cost of Catamount Health will depend on your
  income and which insurer you sign up with.
• For the least expensive plan, Catamount Health
  will cost
• Income by federal poverty level Monthly
  premium cost
• (1 person/annual in 2006)
• Below 200 FPL (19,600) 60.00
• 200-225 (19,600 22,050) 90.00
• 225-250 (22,050 24,500) 110.00
• 250-275 (24,500 26,950) 125.00
• 275-300 (26,950 29,400) 135.00
• Over 300  (29,400)  Full cost, estimated at
  340.00

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Catamount Health

• LEGISLATIVELY-MANDATED COST-SHARING
• Deductibles In-Network Out-of-Network
  250/individual 500/individual
• 500/family 1,000/family
• Co-Payment 10/office visit
• Prescription Drugs No deductible
  Co-payments 10 generic drugs
• 30 drugs on preferred drug list
• 50 non-preferred drugs
• Preventive Care 0
• Chronic Care Not subject to deductible,
  co-insurance, co-payments
• Out-of-Pocket Maximum In-Network Out-of-Network
  
• (excluding Premium) 800/individual
  1,500/individual
• 1,600/family 3,000/family

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But what about that other 37/38ths of VT Reform?

• Vermonts Quest for Systemness

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• We know the Health Care system is Not
  Monolithic

Its not THE HEALTH CARE SYSTEM
Its
M A N Y
MANY
MANY
HEALTH CARE
SYSTEMS
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• Actually its worse
• its Many Overlapping Systems

Its
MANY
MANY
M A N Y
MANY
MANY
HEALTH CARE
SYSTEMS
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(No Transcript)
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Health Care Reform Goals
Increase Access
Improve Quality
Contain Costs
See the entire PowerPoint from which the next 3
slides are borrowed (with permission) in their
complete, original form
http//hcr.vt.gov/
17
Goal Increase Access to Affordable Health Care
CoverageEveryone In

• Enhance Private Insurance Coverage
• Catamount Health Plan for the Uninsured
• Non-Group Market Reform
• Promotion of traditional Employer-sponsored
  Insurance
• Local Health Care Coverage Planning Grant
• Potential Individual Insurance Mandate (2010)

• Improve Outreach to
• Uninsured
• Bi-State Report ? findings and recommendations
  more or less adopted in total to be implemented
  as the plan
• Comprehensive, integrated approach a continuum
  of options for a continuum of uninsured.
• Aggressive, community-based outreach
  coordinators
• web-based screening and enrollment tracking tool

• Assist with Affordability
• Premium Assistance (ESI, Catamount)
• Reduction in VHAP Premiums
• Non-Group Market Security Trust to reduce
  premiums

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Goal Improve Quality of Care

• Chronic Care Management
• Expand Blueprint Statewide
• OVHA Chronic Care Management Program
• Medicaid Reimbursement Incentives
• State Employee Health Plan
• ESI Premium Assistance plan approval,
  cost-sharing
• Catamount Health coverage, cost-sharing
• Chronic Fatigue Syndrome Information

• Increase Provider Availability
• Loan Repayment Program
• Loan Forgiveness Program
• FQHC Look-alike Funding
• Uncompensated Care Pool

• Increase Provider Access
• to Patient Information
• Health Information Technology
• Electronic Medical Records Loans
• Master Provider Index

• Promote Quality Improvement
• Consumer Health Care Price Quality System
• Multi-payer Database
• Adverse Events Monitoring System
• Hospital-acquired Infections data
• Safe staffing reporting
• SorryWorks!
• Advanced Directives

• Promote Wellness
• Immunizations
• CHAMPPS Grants
• Catamount Health Coverage, Cost-sharing
• Healthy Lifestyles Insurance Discounts
• AHS Inventory of Health and Wellness Programs

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Goal Contain Costs
Increased Access to Coverage and Care ?
Decreased Uncompensated Care ? Lower Premium Costs

• Decrease Cost Shift
• Increased Medicaid provider rates
• Cost Shift Task Force
• Standardize Policy for Hospital
• Uncompensated Care and Bad Debt
• Hospital Cost Shift Reporting Reforms

• Simplify Administration
• Common Claims and Procedures
• Uniform Provider Credentialing

Improve Quality of Health Care ? Less Unnecessary
Care ? Lower Costs
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And then theres the BlueprintThe Core of Act 191

• Chronic Disease Prevention and Care Management

Takes the Ed Wagner (Group Health) / Don Berwick
(IHI) practice level population disease
management model and applies it statewide as a
population-based public health initiative. Except
its a public/private health partnership.
Legislature codified it in statute more than it
had been. Still a work in progress.
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Blueprint for Health Model
Public Policy Public Health
Community
Healthier

• Policies
• Infrastructure
• Financing
• Resources
• Advocacy
• Regulation
• Info. Systems

• Built environment
• Programs and services
• Health awareness
• Healthy options
• Info. Systems

V e r m o n t e r s
Patients and Families

• Health knowledge
• Self-management
• Skill and practice
• Supportive home
• Environment
• Info. Systems

Health Provider Team
Health Systems

• System policy
• Quality care
• Service development
• Reimbursement
• Financing
• Continuity
• Coordination
• Info. Systems

• Practice standards
• Info. Systems
• Decision support
• Office systems
• Coaching/support

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Decentralized
Distributed
Centralized
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Blueprint Alignment
Blueprint Principles
Blueprint Executive Committee
BISHCA
DCF
VDH
Third Party Payers
ESI
AHS Chronic Care Coordination Team
OVHA
Catamount
State Employees Health Plan
CCM RFP
Care Coordination
Blueprint Implementation
Other Commercial Products
But how to actually change payment incentives
align motivations in a public/private
partnership? Answer remains elusive.
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• Problematic, Unresolved issues
• Catamount reinforces the link of insurance to
  employment
• Through ESI and the employer assessment as well
  as traditional commercial insurance paradigm.
• Creates more risk pools instead of fewer
• Arguably, it means were going in the wrong
  direction.
• Core problem is that the risk is borne by
  private capital, not the public capital, so the
  carriers pass off the risk to others and will to
  do continue so in pursuit of profit. Theyre in
  business to make money, not to assure care.
• Change the health care financing paradigm Why
  isnt it like other Public Structures (schools,
  fire departments)?

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More papers, reports, Power Points, and policy
details than most normal people would want to
see are available at Legislative
Site http//www.leg.state.vt.us/HealthCare/catamou
nt.htm Susan Besios Site http//hcr.vt.gov/
Bi-State Outreach Report http//www.bistatepca.o
rg Hunt Blair hblair_at_bistatepca.org
802-229-0002