Universal CoverageAccess

1

• Universal Coverage/Access
• The following identifies key issues to address
  and presumes that an individual coverage mandate
  will be legislated.
  
• Covered vs uninsured provided by

2

• Employer
• Individual
• Medicaid
• Medicare
• Indian Health Services
• Military ___________
• Uninsured
• who are these individuals race, gender, age,
  income, location
  
• Where are our physician practices located?
  Identify by specialty and overlay on above.
  Identify gaps to access.

3

• Determine affordability ceiling by income.
• Barriers to obtaining insurance
• Affordability
• Out of pocket cost limit by income
  (px,ded,copays)
  
• Basics plan availability, consider minimum
  coverage and care management requirements for
  primary and chronic care
  
• What preventative services are to be included
• Participation and contribution requirements for
  part time employees, how do we recognize full
  time equivalent employment made up of two or more
  part time jobs

4

• Underwriting
• Guaranteed issue for individual
• Restructures/eliminates high risk pool? Impact
  of federal funds?
  
• Calculate potential reduction in uncompensated
  care

5

• Barriers to access
• Medical manpower shortage, urban and rural
• Scope of practice debate
• Provider network inadequacies due to contracting
  
  
• Reimbursement disincentives, inequities and
  inadequacies
  
• ERISA implications

6

• Financing our Plan
• Dollars in the system from ______, for patient
  care
  
• Federal
• Medicare
• Medicaid
• GME
• High Risk Pool
• Military

7

• State
• Medicaid
• State and education employees plan
• Higher Ed
• Incarcerated
• Military

8

• Third Party Payors
• Health insurance (include HRP)
• Workers compensation
• Auto med-pay
• Self funded plans

9

• Personal Pay
• Uncompensated Care Third Party Personal
  Pay Govt
  
• Hospital
• Physician

10

• How do we determine reasonable cost of services
  to ensure equity and eliminate gross cost shift?
  
• How do we develop an appropriate transparency
  scheme to appropriately influence purchasing?
  
• What incentives/offsets can we afford to redirect
  to employer/individual to soften cost of mandated
  coverage?

11

• What are potential new revenue streams?
• Tax coercion available incentives through state
  and federal, personal and business

12

• Quality/Performance
• The SCI team has agreed to use the Commonwealth
  Fund report on High Performing Health Systems as
  a benchmark from which to identify our most
  urgent needs for improvement and benchmark reform
  success. Read the report.

13

• What is our low hanging fruit to improve
  quality and reduce cost short term
  implementation for sustainable impact?
  
• Elimination of unnecessary prescribed
  redundancies and duplications
  
• Health IT
• Insurance plan design requirements
• Medical malpractice reforms
• Financial incentives and dis-incentives in
  reimbursement

14

• Quantifiable treatment regimens for best patient
  outcomes
  
• Appropriate use of statins
• Subsequent insurance plan mandates
• Public health practices

15

• Link to access needs, i.e. everyone has a medical
  home
  
• What data do we have and what do we need to
  determine best ROI and patient care outcomes?

16

• Coalition Building
• How do we fund necessary coalition building and
  advocacy efforts.
  
• Assumption is that this effort begins post
  OK-Plan development. Two pronged effort in
  building necessary support
  
• 1) education 2) advocacy.
• Crystalize critical effort and develop
  appropriate key messages.

17

• Possible funds
• EDGE
• Re-engineering fund
• Other philanthropic who and who is best to
  contact
  
• Legislative appropriation/allocation
• What venue(s) is best to build consensus? Small
  groups, large statewide effort, combination of
  both

18

• Who are critical target populations?
• Who are critical important target populations?
• Are these groups different for education purposes
  vs advocacy?
  
• What consulting support is needed?
• Communications/Media
• Meeting facilitation

19

• What role do/should coalitions play in
  influencing legislation?
  
• (96 of voting public has insurance. Their
  greatest concern is sustainability.)

20

• Questions???