Vermont Health Care Reform Catamount Health

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Vermont Health Care Reform Catamount Health

• Representative Harry Chen M.D.
• House Health Care Committee
• August 1, 2006

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Vermont Health Care Act of 1992 (Act 160)

• It is the policy of the state of Vermont to
  insure that all residents have access to quality
  health services at costs which are affordable.

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Vermont Health Care

• Low rate of uninsured
• Low costs
• High quality
• Vermonters want access to affordable health care
  for everyone
• Major insurers are non-profit BC MVP
• All hospitals are non-profit
• Small state with challenging border issues

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Underlying Principles of Health Care Reform- VT
2005-06

• Everyone is covered
• Everyone pays according to their ability
• Payment for quality not quantity
• Health Care ? Health Insurance

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VT Health Care Reform 05-06

• House Health Care Committee
• H.524, 2005- Governors Veto
• Public Engagement and focus groups
• Health Care Commission- studies and oversight
  (Dr. Kenneth Thorpe)
• Multiple Reform Proposals
• H.861 H.895, 2006- Catamount Health

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H.524- Green Mountain Health

• Every Vermonter should have a doctor.
• Every Vermont resident and business should
  contribute to the cost of health care.
• We need a long-term approach to cost containment
  through integrated health care delivery systems,
  better information systems and a focus on keeping
  Vermonters healthy.

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Public Engagement

• Health care is in crisis
• Notable urgency to reform
• Every Vermonter should have access to affordable
  health care
• Be bold but be cautious
• Build on and dont destroy what is good
• Emphasize integration and prevention

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2006 HealthCare Affordability Act

• Control the steeply rising costs of health care
  by
• Making health care affordable and accessible for
  all Vermonters
• Better managing chronic care

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Catamount Health- Details

• New comprehensive health insurance plan for
  uninsured Vermonters
• Available 10/1/07 through private insurers (MVP,
  BC)
• More info www.leg.state.vt.us/Health
  Care/catamount.htm

• State provides premium assistance to lower-income
  individuals or families (300 FPL)
• No cost-sharing for preventive services or
  chronic care management

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Who is uninsured?

• Does not qualify for Federal or State program
• Has not had private insurance for the last 12
  months
• Has lost private coverage because of
• loss of employment,
• death of the principal insurance policyholder
• divorce or dissolution of a civil union
• no longer qualifying as a dependent
• no longer qualifying for COBRA
• Lost college or university-sponsored health
  insurance because termination of studies.
• Lost eligibility for VHAP or Medicaid

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Catamount Health Benefit

• Based on typical plan in BCBSVT book of business
• Plan design
• In-network 250 deductible, 20 coinsurance,
  800 limit on out-of-pocket spending, 10 office
  co-pay.
• Out-of-network 500 deductible 30 coinsurance,
  1,500 limit on out-of-pocket spending
• No co-payments on clinically recommended services
  for chronic disease and preventive care
• No drug deductible, 10 co-pay for generic, 30
  for preferred brand and 50 for non-preferred
  brand

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Catamount Health Premiums For those Enrolling in
CH

• Single premium for this benefit in the commercial
  market today 423 per mo.
• The premium is high since commercial payers
  reimburse hospitals and other providers at 44
  above the cost of treatment!
• CH will pay 10 above the cost of treatment,
  reducing the premium by 34

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CH Premium Also Lower Due to Demographics

• Age-adjusted prevalence of chronic illnesses
  including diabetes, hypertension, cancer, heart
  disease are higher in VTs employer-based system
  than among the uninsured.
• Uninsured are also younger. Nearly 50 of
  uninsured adults are aged 19-34 compared to 25
  of privately insured adults.

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How much are the reduced premiums?
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Whats wrong with chronic care now?

• A chronic condition is defined as an established
  clinical condition that is expected to last a
  year or more and that requires ongoing clinical
  management.
• Approximately 75 of all health care spending
  today is for people with chronic conditions
  (25).
• Well-documented and accepted national studies
  indicate that people with chronic conditions
  receive the right care at the right time only
  about 55 of the time.

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Delivery of Better Health Care

• Catamount Health will include a chronic care
  management program that focuses on providing the
  right care at the right time.
• Incentives to join co-pays deductibles will
  be waived
• Aligns with the Vermont Blueprint for Health a
  statewide chronic care initiative for all Vermont
  residents (both publicly and privately insured)

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Administrative Initiatives

• Information Technology Coordination
• Multi-Payer Database
• Common Provider Credentialing
• Common Claims Procedures
• Master Provider Index
• Cost Shift Review
• Uniform Uncompensated Care Programs

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Medicaid Initiatives

• Chronic care management program
• Outreach and reduced premiums for VHAP and Dr.
  Dynasaur
• Employer sponsored insurance initiative for VHAP
  and Catamount Health
• Loan repayment for providers
• Enhanced reimbursement for providers
• FQHC Uncompensated Care Pool

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Public Health Initiatives

• Free CDC recommended immunizations for every
  Vermonter
• Health Program Inventory
• Community Wellness Grant Program
• Medical Event Reporting and Hospital Infection
  Reporting Program
• Codification of the Vermont Blueprint for Health

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Consumer Initiatives

• Healthy Lifestyle Discounts
• Consumer Price and Quality Information
• Individual Market subsidy and reform
• Adverse Event and Infection Reporting
• Safe Apology and Sorry Works

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Financing

• Income based premiums
• Cigarette Tax increases
• Coordinated with Medicaid to maximize federal
  funds (Global Commitment)
• Employer assessment on those who do not offer
  insurance to employees

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Employer Assessment

• Quarterly assessment of 1 per day per FTE for
  workers who
• Are not offered health insurance
• Are not eligible for health insurance
• Are uninsured
• Eight FTE exemption decreases to four
• Study of seasonal workers
• Begins April 1, 2007

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Reduction in Uncompensated Care

• Today-private health insurers pay providers 183
  million (at least) more than the cost of treating
  their insured patients in hospitals
• Under no reform and current law private health
  plans will pay 287 million more than the cost of
  treatment by 2010
• CH will reduce these above cost payments by 53
  million by 2010 reducing the cost shift and
  slowing the growth in insurance premiums

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Family Premiums Under No Reform and CH

• Year No Reform Catamount Health
• 2008 12,950 12,560
• 2009 14,050 13,065
• 2010 15,245 13,872

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Ongoing Reform

• Executive Branch Reform Coordination
• Commission on Health Care Reform
• Individual Mandate? 96 by 2010
• The underinsured- quantifying benefits
• Effect on the VT economy and Vermonters
• Reduction in number of uninsured
• Oversight structure

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Future Opportunities

• Make health care affordable and accessible to
  uninsured
• Manage and coordinate chronic care for all
• Build on employer-sponsored insurance
• Outreach to Medicaid eligible uninsured
• Reduce cost shift by
• Insuring the currently uninsured and reimbursing
  at 110 of cost
• Providing better chronic care
• Increase Medicaid reimbursement
• Finding common ground building broad based
  coalitions

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Areas of Disagreement

• Government-run health care
• Taxpayer financing broad-based taxes
• Who assumes the risk?
• Hard cap to limit financial liability
• Individual Mandate
• Employer Sponsored Insurance
• Changes to Community Rating

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Lessons Learned

• Build broad-based coalitions
• Engage the public
• Use public opinion to move the process
• Use simple and consistent language
• Dont get lost in vision- Do something!
• Expect everyone to be a little uncomfortable
• Be patient but persistent it wont come easily

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Dr. Martin Luther King, Jr.

• "Of all the forms of inequality, injustice in
  health care is the most shocking and inhumane."