Galveston CountyGalveston County3-share Proposal3-share Proposal

Dr. Barbara Breier, Dr. Barbara Breier, Asst. Vice President for Strategic Initiatives & Asst. Vice President for Strategic Initiatives & Director, Center to Eliminate Health DisparitiesDirector, Center to Eliminate Health Disparities

February 9, 2007February 9, 2007

          

What is the 3-Share Plan?

• A collaborative effort A collaborative effort – UTMB UTMB – Galveston County Chambers of Galveston County Chambers of

Commerce Commerce – Member businesses Member businesses

• A program to provide coverage for A program to provide coverage for the working uninsured, modeled the working uninsured, modeled after a successful effort in after a successful effort in Muskegon, Michigan.Muskegon, Michigan.

Galveston 3-Share Plan• Provide health benefits for working Provide health benefits for working

individuals & familiesindividuals & families– Focus on primary and preventive care Focus on primary and preventive care

needsneeds– Emphasizing the improvement of health Emphasizing the improvement of health

status through managing chronic diseases status through managing chronic diseases and involving individuals in managing and involving individuals in managing their own caretheir own care

• Costs of the coverage split between Costs of the coverage split between – employer employer – employee employee – state and local government.state and local government.

• Allow for low monthly health Allow for low monthly health premiums, thus improving accessibilitypremiums, thus improving accessibility

Key Legislation

• Social Security Act, Section 1115Social Security Act, Section 1115– Modify SCHIP & Medicaid ProgramsModify SCHIP & Medicaid Programs

• Health Insurance Flexibility Health Insurance Flexibility Accountability WaiverAccountability Waiver(HIFA)(HIFA)– Modify Benefits packagesModify Benefits packages– Public private partnershipsPublic private partnerships– Expand to previously uncovered adultsExpand to previously uncovered adults

Community ActivitiesCommunity Activities• 21 Focus Groups (CHAT)21 Focus Groups (CHAT)

• Galveston Employers Galveston Employers SurveySurvey

• Galveston County Chambers of Galveston County Chambers of CommerceCommerce

• Civic OrganizationsCivic Organizations

• Cover the Uninsured Week:Cover the Uninsured Week:Letters to the editor, Lecture Letters to the editor, Lecture Series, & Religious Leaders’ Series, & Religious Leaders’ BreakfastBreakfast

Outside Validation Outside Validation Saurage Marketing Study:Saurage Marketing Study:Representative Sample of Representative Sample of

Galveston County EmployersGalveston County Employersn=160n=160

Media CoverageMedia Coverage

•Galveston Daily NewsGalveston Daily News•Houston’s FOX NewsHouston’s FOX News•Texas Medicine MagazineTexas Medicine Magazine•Guidry News WebsiteGuidry News Website

Development Process

Employee ProfileEmployee ProfileAverage age of employee: 41Average age of employee: 41

54% Male54% Male

46% Female46% Female

53% White Non Hispanic53% White Non Hispanic

26% Hispanic26% Hispanic

22% African American 22% African American

1% 1% AsianAsian

Galveston Employer Survey Galveston Employer Survey 248 Employers Surveyed248 Employers Surveyed

4819 Employees4819 Employees

CHAT Software Program• CChoosing hoosing HHealth Plans ealth Plans AAll ll TTogether – ogether –

created by the U. of Michigan and created by the U. of Michigan and NIHNIH

• Utilizes national averages to compute Utilizes national averages to compute cost of health care coveragecost of health care coverage

• Players are allotted 50 markers to Players are allotted 50 markers to “purchase” health benefits“purchase” health benefits

• 15 benefits are available –full range15 benefits are available –full range• 4 Rounds of game played – individual, 4 Rounds of game played – individual,

small group, community, and small group, community, and individualindividual

CHAT Game Board

CHAT Preliminary Results

Top PrioritiesTop Priorities

1.1. PharmacyPharmacy2.2. Primary CarePrimary Care3.3. HospitalizationHospitalization4.4. Specialty CareSpecialty Care5.5. TestsTests6.6. Other Medical Other Medical

(ambulance, (ambulance, equipment)equipment)

7.7. Long Term Care/Last Long Term Care/Last Chance (tied)Chance (tied)

Lowest PrioritiesLowest Priorities

9. Dental9. Dental10. Mental Health10. Mental Health11. Uninsured11. Uninsured12. Home Health12. Home Health13. Vision13. Vision14. Infertility (N/A)14. Infertility (N/A)15. Alternative Med 15. Alternative Med

(N/A)(N/A)

Actuarial Analysis

• Can achieve $180 pmpm with limitations:Can achieve $180 pmpm with limitations:• Primary care/Specialty care –12v/yrPrimary care/Specialty care –12v/yr• Hospitalization – 30 day annual maximumHospitalization – 30 day annual maximum• Pharmacy - $1200/yrPharmacy - $1200/yr• Mental Health – 20v/yrMental Health – 20v/yr• 10% coinsurance w/$1000 annual maximum10% coinsurance w/$1000 annual maximum• $50,000 Annual Maximum$50,000 Annual Maximum• Exclusions of high risk, experimental, vision, Exclusions of high risk, experimental, vision,

dental, etc. dental, etc. • Care limited to UTMB HMO providers in Care limited to UTMB HMO providers in

Galveston CountyGalveston County• No ER coverage outside of Galveston CountyNo ER coverage outside of Galveston County

Eligibility Criteria for Businesses

• Has been conducting business operations for Has been conducting business operations for at least one year (verified by IRS statements.)at least one year (verified by IRS statements.)

• Has a minimum of 2 employees (including Has a minimum of 2 employees (including self) that have been employed in the business self) that have been employed in the business for one year (does not have to be the same for one year (does not have to be the same employee).employee).

• Has filed appropriate IRS documentation for Has filed appropriate IRS documentation for the reporting of income.the reporting of income.

• Has filed W-2’s for eligible employees noted Has filed W-2’s for eligible employees noted above.above.

Eligibility Criteria for Businesses

• Has its principle business location Has its principle business location in Galveston County.in Galveston County.

• Employs 50 percent of its employees Employs 50 percent of its employees in Galveston County if employer has in Galveston County if employer has locations outside the county;locations outside the county;

• Has a median income of $50,000 Has a median income of $50,000 per year or less for all employees;per year or less for all employees;

• Has not offered group health Has not offered group health coverage for the previous 12 coverage for the previous 12 months.months.

Eligibility Criteria for Employees

Employee eligibility is Employee eligibility is determined by their income determined by their income level and assets. They must be level and assets. They must be below 200% FPL and meet the below 200% FPL and meet the State’s SCHIP ASSET TEST State’s SCHIP ASSET TEST POLICY in order to be eligible POLICY in order to be eligible for the federal match. for the federal match. *Additional funding is being secured to cover *Additional funding is being secured to cover

employees who do not meet SCHIP asset test criteria.employees who do not meet SCHIP asset test criteria.

Where we are now

• Waiver document has been reviewed Waiver document has been reviewed by Texas DHHSby Texas DHHS

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

• Met with CMS officials and have Met with CMS officials and have responded to their questions and are responded to their questions and are waiting further review and approval.waiting further review and approval.

Business Plan & Marketing Next Steps

• Business plan provides for 3,000 Business plan provides for 3,000 participants for break-even over 5-participants for break-even over 5-year periodyear period

• UTMB HMO will administer the UTMB HMO will administer the planplan

• Development of this program Development of this program could not have been possible could not have been possible without support from the Kempner without support from the Kempner FundFund

Market Potential for Statewide Model

• Program can serve as a statewide model Program can serve as a statewide model as an increasing number of businesses as an increasing number of businesses seek viable alternatives.seek viable alternatives.

• Individuals involved in decisions about Individuals involved in decisions about their own healthcare create healthier their own healthcare create healthier workforces and communities.workforces and communities.

• Other communities have expressed strong Other communities have expressed strong interest including Harris, Travis, Dallas, interest including Harris, Travis, Dallas, Bexar and El Paso Counties. Bexar and El Paso Counties.

www.utmb.edu/cehdwww.utmb.edu/cehd

Multi-share LegislationH.B. 882

• Allows for regional health care programs that provide Allows for regional health care programs that provide health care services or benefits to the employees (and health care services or benefits to the employees (and their dependents )of small employers (< 50 their dependents )of small employers (< 50 employees)employees)

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

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

• No funding available in this bill, however encourages No funding available in this bill, however encourages governing bodies to seek funds from grants, gifts, & governing bodies to seek funds from grants, gifts, & donationsdonations

A Proposal for a Statewide Model for

Multi-Share Plans for Small Business• Legislation would provide funding ($50 million) for the Legislation would provide funding ($50 million) for the

development of multi-share plans targeted to small development of multi-share plans targeted to small businesses with <50 employees.businesses with <50 employees.

• Flexibility for communities to address their own health Flexibility for communities to address their own health needs with eligibility for municipalities, counties, needs with eligibility for municipalities, counties, hospital districts or regional multi-county consortia.hospital districts or regional multi-county consortia.

• Provide planning and infrastructure grants as well as Provide planning and infrastructure grants as well as cost-sharing for the 3cost-sharing for the 3rdrd Share. Share.

• Encourage the use of EMR and telemedicine as a tool Encourage the use of EMR and telemedicine as a tool for improving health outcomes.for improving health outcomes.

• Eliminate the need for a HIFA waiver by authorizing on Eliminate the need for a HIFA waiver by authorizing on a state-wide basis.a state-wide basis.

• Limited to 5 year grants for each entity. Limited to 5 year grants for each entity.