Galveston County

1

• Galveston County
• 3-share Proposal
• Dr. Barbara Breier,
• Asst. Vice President for Strategic Initiatives
• Director, Center to Eliminate Health Disparities
• February 9, 2007

2
What is the 3-Share Plan?

• A collaborative effort
• UTMB
• Galveston County Chambers of Commerce
• Member businesses
• A program to provide coverage for the working
  uninsured, modeled after a successful effort in
  Muskegon, Michigan.

3
Galveston 3-Share Plan

• Provide health benefits for working individuals
  families
• Focus on primary and preventive care needs
• Emphasizing the improvement of health status
  through managing chronic diseases and involving
  individuals in managing their own care
• Costs of the coverage split between
• employer
• employee
• state and local government.
• Allow for low monthly health premiums, thus
  improving accessibility

4
Key Legislation

• Social Security Act, Section 1115
• Modify SCHIP Medicaid Programs
• Health Insurance Flexibility Accountability
  Waiver
• (HIFA)
• Modify Benefits packages
• Public private partnerships
• Expand to previously uncovered adults

5
Development Process

• Community Activities
• 21 Focus Groups (CHAT)
• Galveston Employers Survey
• Galveston County Chambers of Commerce
• Civic Organizations
• Cover the Uninsured Week
• Letters to the editor, Lecture Series,
  Religious Leaders Breakfast

Outside Validation Saurage Marketing
Study Representative Sample of Galveston County
Employers n160

• Media Coverage
• Galveston Daily News
• Houstons FOX News
• Texas Medicine Magazine
• Guidry News Website

6
Galveston Employer Survey 248 Employers
Surveyed 4819 Employees
Employee Profile Average age of employee 41 54
Male 46 Female 53 White Non Hispanic 26
Hispanic 22 African American 1 Asian
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CHAT Software Program

• Choosing Health Plans All Together created by
  the U. of Michigan and NIH
• Utilizes national averages to compute cost of
  health care coverage
• Players are allotted 50 markers to purchase
  health benefits
• 15 benefits are available full range
• 4 Rounds of game played individual, small
  group, community, and individual

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CHAT Game Board
9
CHAT Preliminary Results

• Top Priorities
• Pharmacy
• Primary Care
• Hospitalization
• Specialty Care
• Tests
• Other Medical (ambulance, equipment)
• Long Term Care/Last Chance (tied)

• Lowest Priorities
• 9. Dental
• 10. Mental Health
• 11. Uninsured
• 12. Home Health
• 13. Vision
• 14. Infertility (N/A)
• 15. Alternative Med (N/A)

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Actuarial Analysis

• Can achieve 180 pmpm with limitations
• Primary care/Specialty care 12v/yr
• Hospitalization 30 day annual maximum
• Pharmacy - 1200/yr
• Mental Health 20v/yr
• 10 coinsurance w/1000 annual maximum
• 50,000 Annual Maximum
• Exclusions of high risk, experimental, vision,
  dental, etc.
• Care limited to UTMB HMO providers in Galveston
  County
• No ER coverage outside of Galveston County

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Eligibility Criteria for Businesses

• Has been conducting business operations for at
  least one year (verified by IRS statements.)
• Has a minimum of 2 employees (including self)
  that have been employed in the business for one
  year (does not have to be the same employee).
• Has filed appropriate IRS documentation for the
  reporting of income.
• Has filed W-2s for eligible employees noted
  above.

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Eligibility Criteria for Businesses

• Has its principle business location in Galveston
  County.
• Employs 50 percent of its employees in Galveston
  County if employer has locations outside the
  county
• Has a median income of 50,000 per year or less
  for all employees
• Has not offered group health coverage for the
  previous 12 months.

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Eligibility Criteria for Employees

• Employee eligibility is determined by their
  income level and assets. They must be below 200
  FPL and meet the States SCHIP ASSET TEST POLICY
  in order to be eligible for the federal match.

Additional funding is being secured to cover
employees who do not meet SCHIP asset test
criteria.
14
Where we are now

• Waiver document has been reviewed by Texas DHHS
• Texas DHHS has given approval and has sent to CMS
  for review
• Met with CMS officials and have responded to
  their questions and are waiting further review
  and approval.

15
Business Plan Marketing Next Steps

• Business plan provides for 3,000 participants for
  break-even over 5-year period
• UTMB HMO will administer the plan
• Development of this program could not have been
  possible without support from the Kempner Fund

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Market Potential for Statewide Model

• Program can serve as a statewide model as an
  increasing number of businesses seek viable
  alternatives.
• Individuals involved in decisions about their own
  healthcare create healthier workforces and
  communities.
• Other communities have expressed strong interest
  including Harris, Travis, Dallas, Bexar and El
  Paso Counties.
• www.utmb.edu/cehd

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Multi-share LegislationH.B. 882

• Allows for regional health care programs that
  provide health care services or benefits to the
  employees (and their dependents )of small
  employers (lt 50 employees)
• Flexibility for communities to address their own
  health needs with eligibility for counties,
  regional multi-county consortia or other
  non-profit entities designated by commissioners
  courts to run the program
• Employers and employees are required to pay a
  share or cost of the program
• No funding available in this bill, however
  encourages governing bodies to seek funds from
  grants, gifts, donations

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A Proposal for a Statewide Model for Multi-Share
Plans for Small Business

• Legislation would provide funding (50 million)
  for the development of multi-share plans targeted
  to small businesses with lt50 employees.
• Flexibility for communities to address their own
  health needs with eligibility for municipalities,
  counties, hospital districts or regional
  multi-county consortia.
• Provide planning and infrastructure grants as
  well as cost-sharing for the 3rd Share.
• Encourage the use of EMR and telemedicine as a
  tool for improving health outcomes.
• Eliminate the need for a HIFA waiver by
  authorizing on a state-wide basis.
• Limited to 5 year grants for each entity.