Champion A cure To Combat Heath coverage (CATCH) Closing the Gap on ABA Therapy

Ameenah Fuller

New England College

Professor Tafoya

August 11, 2010

Champion A cure To Combat Health coverage (CATCH)

What is CATCH? A non-profit group dedicated to closing the gap on ABA Therapy.

Problem: Most insurance plans provide insufficient or inadequate coverage for children with autism. Champion A cure To Combat Health coverage (CATCH) addresses this need. CATCH offers membership for parents with autistic children to assist in the cost of health coverage for treatments.

CATCH Thesis Statement

The project is designed to address the need for a health care discount plan to treat conditions relating to autism.

This project will develop an organizational structure for Champion A cure To Combat Health coverage to eliminate the gap of expensive treatment costs by negotiating with network providers participating in discounts on treatments for CATCH members.

CATCH

Review and contact State

Insurance Commission

Review cost of ABA therapy

Review history and contact AARP

Review and contact providers for discount rates

Literature Map

Review participants ABA therapy needs.

Review effective business model for healthcare

discount plan.

Review provider existing customized membership

plan.

Project Limitations

The healthcare discount membership limitations:

100 members to start the program.

ABA therapy discount for children with autism disorder.

Not considered a secondary form of insurance.

Not regulated by the California Department of Insurance.

Implementation Plan

Champion a cure to combat health coverage (CATCH) has

been created to provide education, access, and healthcare discounts for members.

The organization will recruit up to 100 new members to participate in the healthcare membership discount plan by circulating membership applications via mail, email and various groups.

The potential hazard for the project is the California Department of Managed Care proposed new legislation to require licensure of healthcare discount plans.

Implementation Plan The plan will demonstrate the development of Champion A cure To

Combat Health coverage (CATCH) offering a healthcare membership discount plan to close the gap on limited insurance resources to provide ABA therapy for autistic children

Currently, there are only 22 states that offer coverage for autistic disorders in the United States. Autism is manageable with appropriate treatment and early intervention.

The organization will measure success by the number of providers that contract to offer services for ABA therapy at discounted rates.

The member will have an option to customize the treatments according to the recommendations from the provider.

The healthcare membership card could offer discounts up to 40% to offset the cost of ABA therapy.

Closing the Benefit Gap

Some of the problems consist of the loopholes in health

insurance coverage for those with autism and autism disorders.

The Economics of our health care system in turmoil.

One tweak would be to provide health care membership discount plans and exchanges.

*Rising cost

*Exclusionary clauses

Effective healthcare membership plans

• The American Association of Retired Persons (AARP) is the largest American non-profit organization that addresses issues for retirees, including health care.

What type of early intervention treatments work for children with

autism disorders? Applied Behavior Analysis (ABA) therapy is the most popular type

utilized to increase positive behaviors in children with autism (Martin, 2010 ).

Family training and counseling

Speech-language pathology services

Occupational therapy

Physical therapy

Psychological services

Medical services

Social work services

Nutrition services

Primary Research

This primary research design will demonstrate the process to develop a healthcare discount plan to treat conditions relating to autism.

Stakeholders :

Project stakeholders include parents, providers, and advocacy groups.

The gaps in health insurance coverage impact parents and their children with autism because of the high cost of treatment.

The gaps in health insurance coverage also impacts medical providers and therapists. Additionally, insurance companies remain an integral part of healthcare coverage so it is important to understand that they must be worked with to close these gaps.

Survey-Pre/Post

• The pre-test poll

*The pre-test for providers

• The post-test poll

*The post-test for providers

• Random survey

Strategic Implementation Plan

CONCEPT

GOALS

OBJECTIVES

BOARD MEMBERS

BY-LAWS

PROVIDER CONTRACT

PROMOTION AND ADVERTISEMENT

FINANCIAL IMPLICATIONS OF CATCH

LONG-TERM PLAN

CONTINGENCY PLAN

SWOT Analysis

• Threats • Opportunities

• Weaknesses • Strengths

Promote early intervention which, in

turn, will help to reduce the need for future long-

term, and ultimately more costly, treatments

The potential for low provider participation is

likely to reduce the marketability of a stable

provider network.

Newly proposed legislation supported by the CA. Department of

Managed Care threatens the existing system of health care membership discount

programs.

The impact of early intervention utilizing ABA

therapy may support efforts to expand the

program benefits to more children with autism

disorders.

Goals and Objectives

Phase 1 Champion A cure To Combat Health coverage (CATCH) will submit a 501(c)(3) application to obtain non-profit status.

Phase 2 recruit and elect five board members to govern

CATCH.

Phase 3 Develop a provider contract with customized healthcare discount plans to include ABA therapy.

Champion A cure To Combat Health coverage (CATCH)

Board member application

CHAMPION A CURE TO COMBAT HEALTH COVERAGE (CATCH) BOARD MEMBER APPLICATION

Name _____________________________________________ Phone ____________

Address _____________________________________________________________

Relevant Experience and/or Employment (attach a resume) _____________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Why are you interested in our organization? _________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Area(s) of expertise/Contribution you feel you can make________________________

_____________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Other current volunteer commitments _______________________________________

______________________________________________________________________

For Board Use Only

__ Nominee has had a personal meeting with either (circle one): chief executive, board chair, or other

board member _________________. Date ______

__ Nominee reviewed by the committee. Date ______

__ Nominee attended a board meeting. Date ______

__ Nominee interviewed by the board. Date ______

Example of Board Member Application

Action taken by the board __________________________________________________

Champion A cure To Combat Health coverage (CATCH)

By-Laws •ARTICLE I ORGANIZATION

•ARTICLE II PURPOSES

•ARTICLE III MEMBERSHIP

•ARTICLE IV MEETINGS

•ARTICLE V VOTING

•ARTICLE VI ORDER OF BUSINESS

•ARTICLE VII BOARD OF DIRECTORS

•ARTICLE VIII OFFICERS

•ARTICLE IX SALARIES

•ARTICLE X COMMITTEES

•ARTICLE XI DUES

•ARTICLE XII AMENDMENTS

Champion A cure To Combat Health coverage (CATCH)

Provider Contract CHAMPION A CURE TO COMBAT HEALTH COVERAGE (CATCH) PROVIDER CONTRACT

Example of Provider Contract

This contract agreement shall serve as the legal and binding agreement by and between the CATCH ABA

therapy discount membership program, a non-profit organization, and ______________________ , the

contracting entity of the health care provider. This agreement shall be effective on [Specific date] and continue

through [Specific date]. The contract includes an agreement by which the contracting [Entity] that sells or grants

access to provider’s health care services, will offer discounted rates or reduced fees to CATCH members as

agreed upon and established in this contract. Each contracting entity that sells or grants access to any covered

entity, physician group or a health care provider's health care services, discounted rates or reduced fees will be

required to:

(1) maintain a website and/or a toll-free telephone number through which a health care provider may obtain a

listing of the entities to which such provider's services, discounted rates or fees have been sold or granted

access.

(2) make available a list to the health care provider of all known covered entities to which such contracting

entity may sell or grant access to such provider's health care services, discounted rates or fees.

(3) accept payments in full from the individual members for the health care provider's discounted rates or fees

in accordance with the terms and conditions set forth in the contract between the contracting entity and such

provider.

(4) allow this agreement to be subject to any applicable continuity of care requirements or contractual health

care discount provisions with a health care provider. A covered entity's right to exercise a contracting entity's

rights and responsibilities under a contract shall terminate on the date such contracting entity's contract with

such provider is terminated

(5) provide all remittance advices, whether paper or electronic, that clearly identify the following: (a) the name

of the covered entity responsible for payment to the health care provider

(b) the name of the contracting entity through which the payment rate and any discounts are claimed

(6) In the event that a contracting entity issues a member identification card, the card shall be clearly marked

with the address of the Internet website or toll-free telephone number set forth in (1).

CATCH website

CATCH Social Media Facebook page

Champion a Cure to Combat Health Coverage (CATCH) Brochure

Champion a Cure to Combat Health Coverage (CATCH) Inside Brochure

Champion a Cure to Combat Health Coverage (CATCH)

• Membership Application Card

Champion a Cure to Combat Health Coverage (CATCH)

• Membership card

Measuring success of the organization

• 100 participants

*Providers

*Parents

*Advocacy groups

• 50 network provider agreements

Financial implications of the organization

The budget analysis

Revenue: Year 1 $62,515 Year 2 $70,815 Year 3 $95,815

operational cost Year 1 $55,770 Year 2 $56,570 Year 3 $81,870

capital cost Year1 $6,745 Year 2 $14,245 Year 3 $13,945

Revenue Operating Cost

Capital Cost

Long-term plan

Seek grants

Modify provider services

Work with home health agencies

Contingency plan

• Providing three month trial memberships

• Special rebates

• 5% rebate on the membership plan

• Adopt new policies and procedures

• Work to reduce the rates