Small Business Partnership

1
Small Business Partnership

• Providing affordable primary health care to
  small employers

2
The Relationship

• The SC Primary Health Care Association (PCA) met
  with the SC Small Business Chamber Commerce (SBC)
  while participating on a Department of Insurance
  Coalition to address strategies to provide
  insurance coverage for employees of small
  businesses.

3
South Carolina Data

• The majority (75) of the employers in South
  Carolina are small businesses
• Small businesses are defined as employers with
  500 or less employees
• Survey of small employers showed 60 of small
  businesses with 100 or less employees did not
  provide any type health benefit to their
  employees

4
South Carolina Data

• The average cost of health insurance for an
  individual is 3,700/year according to SC Fair
  Share.

5
The Partnership

• The PCA and SBC formed an alliance to address
  the provision of health care services as opposed
  to health care coverage.
• The PCA and SBC held informational meetings
  across the state of SC, inviting small businesses
  and health center directors.

6
The First Pilot

• The first pilot was started in September, 2005
  between Mid-Carolina (small employer) and two
  community health centers in the area (Eau Claire
  and Richland).
• Mid-Carolina provided information on their
  employees (age, income category, dependents)

7
The First Pilot

• The two centers provided visit cost information
  based on the data Mid-Carolina provided and
  developed two options fee-for-service and
  capitation
• Results
• Mid-Carolina chose the fee-for-service option.
  Employees are appropriately assessed based on
  income - sliding fee scale.
• Mid-Carolina is billed for the difference after
  the employees 10 co-pay

8
The First Pilot

• Mid-Carolina has extended this benefit to
  dependents of their employees
• A MOU was signed between Mid-Carolina and each
  health center (Eau Claire Richland) stating the
  terms and billing procedures (handout)
• Each employee was given a fact sheet explaining
  the benefit (handout)

9
The First Pilot

• Each employee was given a membership card which
  clearly states the card is NOT an insurance card.
  (handout)

10
The Department of InsuranceThe DOI is
constantly updated and consulted.
11
The Greenville News(Excerpt from February 8,
2006 editorial)

• A small coalition of organizations has offered
  several realistic solutions to this crisis. The
  S.C. Small Business Chamber of Commerce, S.C.
  Appleseed Justice Center, S.C. Fair Share and the
  S.C. Association of Non-Profit Organizations have
  taken steps to move the health-care issue onto
  the state's agenda.
• These organizations believe that a combination of
  public/private hybrid solutions is needed to
  address both the cost of health care and health
  insurance.

12

• Here is a summary of just two proposals.
• The Small Business Chamber and the S.C. Primary
  Health Care Association have launched what
  appears to be a first-in-the-nation pilot program
  to make health care more affordable for small
  businesses without insurance. Affordability
  results from these community health centers being
  both nonprofits and qualified to draw down
  federal money to subsidize services to
  uninsured patients with incomes up to 200
  percent of poverty.

13

• Last September, Columbia-based Mid-Carolina Steel
  and Recycling entered into a private sector
  agreement with two community health centers. The
  workers and family members had a 10 co-payment
  and the employer paid the rest of the cost on a
  fee-for-service basis.
• This pilot program has been a tremendous success
  for the employees, the health centers and the
  employer who now can afford to offer important
  health care to all his workers.

14

• Efforts are under way to help other small
  businesses in the same way and to secure 5
  million in state funding to enable community
  health centers to serve 12,000 to 15,000 more
  similarly uninsured across the state.

15
Front of Card
SC Health Care Services Partnership This is not
an insurance card.

• Employer Name __________________________________
  _______
• Employer Code __________________________________
  ________
• Employee Name __________________________________
  ______
• First
  Last
• Service Type ?Employee Only
  ?Employee/Family
• Please check with the health site to determine
  which services are available at that site.

16
Back of Card

• Because your employer has partnered with a member
  health care provider organization of the South
  Carolina Primary Health Care Association, you can
  present this card at any site of the Eau Claire
  Cooperative or Richland Community Health Care
  Association to receive primary and preventive
  health care services.

17
Pilot Results

• Total employees 38 (9 managers with insurance
  coverage 27 employees with no insurance
  coverage)
• Total visits between 9/28/05 and 3/28/06 21
  (10 individuals)
• Of the 21 visits 13 dependents, 8 employees
• Total cost to-date 1,907.52

18
Expansion of the Pilot

• Long Drugs (DME Department) 35 employees
• SC Manufacturers Extension Program partnership
• 400 businesses participate in a catastrophic
  insurance program
• The health centers will provide primary and
  preventive care