Monthly Affordable Care Act (ACA) Webinar Series November 14, 2013
Purpose We strive to provide objective updates of useful information as the ACA moves into a key phase of implementation over the coming months. 2013-2014 Webinars
Today’s Objectives 1. Provide an update on ACA Healthcare Insurance Exchanges 2. Provide an update on ACA Healthcare Insurance Navigators and Certified Application Counselors in Ohio. 3. Provide an update on Medicaid expansion and changes in Ohio.
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December 12
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January 9
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February 13
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March 13
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Today’s agenda •
Welcome & Introduction -Jeff Biehl, Access HealthColumbus
• Update on Healthcare Insurance Exchanges -Doug Anderson, Bailey Cavalieri LLC
• Update on Navigators and Certified Application Counselors (CAC) -Isi Ikharebha, Physicians CareConnection
• Update on Medicaid Expansion -Jeff Biehl
• Update on System Reforms -Jeff Biehl
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ACA: Key Areas of Change
Near Universal Insurance Coverage
Health Benefit Exchanges
Affordable Care Act
Improvement Initiatives
Guaranteed Issue & Insurance Mandate
By 2020… not 1/1/2014
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Healthcare Insurance Exchanges
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New Insurance Marketplace
Health Benefit Exchanges
Near Universal Insurance Coverage
Affordable Care Act
Improvement Initiatives
Effort to Bring All into Guaranteed Insurance Marketplace Guaranteed Issue & Insurance Mandate
Affordable Care Act Key insurance provisions: – – – – –
–
Guaranteed issuance of coverage No pre-existing condition exclusions Premium rates cannot vary based on health status, but only based on age and smoking status Subsidies for people from 100% to 400% FPL Medicaid up to 133% of FPL Exchanges (ie., Marketplaces)
Key Dates for Exchanges October 1, 2013 - Open enrollment begins
December 15, 2013 - Open enrollment for coverage effective January 1, 2014 ends March 31, 2014 - Open enrollment ends – Coverage bought before the 15th of the month is effective the first day of the next month. – People must buy coverage by March 31, 2014 to avoid any penalties April 1 to October 14, 2013 – open enrollment closed – Only special enrollments are allowed October 15 to December 7, 2014 – open enrollment for 2015
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BREAKING NEWS
White House will grant state insurance commissioners permission to allow consumers to keep existing policies through 2014 even if they do not meet required minimum benefits.
Insurance companies will be required to notify consumers how the existing plan compares to those being offered through their state’s marketplace.
Source: The Washington Post (11/14/2013)
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Hot Topics Exchange/Marketplace Glitches –
Speculation that will not be fixed by November 30th
Avoiding the Mandate –
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Must buy coverage by March 31 to avoid paying tax penalty related to the individual mandate in 2014.
Provider Networks Average Premium Cost Highest
Lowest
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Plan
Mt. Carmel
Molina
X
Medical Mutual
X
Anthem
X
OhioHealth
CareSource
Source: Columbus Dispatch, October 7, 2013 Molina
OSU X
X
X
X
InHealth Mutual—Ohio’s CO-OP • The ACA allowed for the creation of nonprofit consumer operated and oriented health plans (CO-OPs). There are 23 CO-OPS nationwide. • InHealth is Ohio’s CO-OP. It started with federal funding. • CO-Ops are governed by a board that includes policy holders. As non-profits, all profits are used to enhance benefits or lower premium.
Community Involvement • InHealth’s Mission: InHealth is a nonprofit insurer built for members by members to provide quality, affordable health insurance that is responsive to the needs and wants of all Ohioans. • InHealth will be selling individual and small group market products in 2014, and will begin to sell coverage on the Marketplace for 2015.
• InHealth is forming regional Community Advisory Committees across Ohio to get community input.
Contact Information • Want to learn more about when, where and how to get involved?
• Contact: Jen Patterson, VP of Community Relations jpatterson@inhealthohio.org 614-212-6004 www.inhealthohio.org
Delayed Rules
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SHOP Exchange online enrollment delayed
Spanish-language individual exchange delayed
Employer mandate and reporting requirements delayed until 2015
Employee choice of plans in the SHOP Exchange delayed until 2015
Coordinated out-of-pocket spending limits for medical and dental plans sold by separate companies delayed until 2015
Navigators and Certified Application Counselors (CAC)
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Navigators and Certified Application Counselors
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Source: Ohio Hospital Association, August 2013
Consumer Assistance Funding State-Based Exchange
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State-Partnership Exchange Federally-Facilitated Exchange
16 States + DC
8 States
26 States
Consumer assistance entities: 319
Consumer assistance entities: 107
Consumer assistance entities: 85
Total Funding: $161,191,503
Total Funding: $62,446,474
Total Funding: $53,793,991
Funding per uninsured person: ~$11
Funding per uninsured person: ~$16
Funding per uninsured person: ~$2
The federal government distributed a total of $67 million in Navigator grants to Partnership and FFE states
Source: Manatt Health Solutions
Certified Application Counselor Experience
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Medicaid Expansion
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Expansion of Medicaid
Health Benefit Exchanges
Near Universal Insurance Coverage
Affordable Care Act
Improvement Initiatives
Subsidized commercial insurance for middle-income families (market based) Guaranteed Issue & Insurance Mandate
Source: Health Policy Institute of Ohio
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History of Medicaid Participation by States 30 25
25 20 15
States 11
10
8
6
5 1 0 1965
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1966
1967
1970
1982 Source: The Washington Post
Where does Medicaid expansion stand?
The Controlling Board approved Medicaid expansion in 5-2 vote on Oct. 21, 2013, allowing Gov. John Kasich (R) to expand the program on Jan. 1, 2014, without approval from the Republican-controlled Legislature.
Six state representatives and Right to Life chapters in Cleveland and Cincinnati filed a suit with Ohio Supreme Court claiming the vote violated state law and the Ohio Constitution.
Ohio Supreme Court agreed to expedite case, and is expected to start in early December. Source: The Columbus Dispatch, 10/22/13
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Medicaid Reform
Ohio Senate working on bill that would create a Joint Medicaid Oversight Committee
Bill would set Medicaid growth at the lesser of the 3 year average medical inflation rate, or the rate projected by the oversight committee
Committee would hire an actuary to perform cost analysis and conduct investigations of Medicaid agencies—investigations need to be approved by the Senate president and House speaker.
Bill “shall not be construed with endorsing, validating or otherwise approving (Medicaid) expansion.” Source: The Columbus Dispatch, 11/13/13
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2014 Medicaid Expansion – Franklin County Planning Est. 46,300 adults Medicaid eligibles up to 138% FPL with no regular source of primary health care
0 - 499
500 - 999
1,000 – 1,499
1,500 – 1,999
2,000+
= FQHC health center =Hospital/ED
= New FQHC 2014
= Sliding Fee Primary Care Site
Source: Ohio Governor’s Office of Health Transformation
Benefits.ohio.gov
Open for applications on December 9th. -Governor’s Office of Health Transformation (11/13/2013)
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Near Universal Insurance Coverage
Health Benefit Exchanges
Shift from volume to value-based health care
Affordable Care Act
Improvement Initiatives
Guaranteed Issue & Insurance Mandate
Ohio: Current Initiatives Modernize Medicaid Reform nursing facility reimbursement Integrate Medicare and Medicaid benefits Rebalance spending on long-term services and supports Create health homes for people with mental illness Restructure behavioral health system financing Improve Medicaid managed care plan performance Streamline Health and Human Services Consolidate mental health and addiction services Create a cabinet-level Medicaid department Modernize eligibility determination systems Integrate HHS information capabilities Coordinate programs for children Share services across local jurisdictions Improve Overall Health System Performance Pay for health care based on value instead of volume Encourage Patient-Centered Medical Homes Accelerate electronic Health Information Exchange
Public & Private: Payment Reform Framework
Source: Catalyst for Payment Reform www.catalyzepaymentreform.org
State Innovation Model Grants • Federal funding for states to design and test comprehensive State Health Care Innovation Plans. Innovation plans must: - Be Governor-led and multi-payer - Improve health, improve health care, and reduce costs - Incorporate a broad range of stakeholder input
• Significant funding pool - 16 design grants of $1-3 million each - 6 testing grants of $20-60 million each and Medicare participates - Ohio received a $3 million design grant ($4.1 million in kind) and will apply for a second round of testing grants early in 2014 SOURCE: www.innovation.cms.gov/initiatives/state-innovations
State Innovation Models Initiative Model Testing Awards
Model Pre-Testing Awards
Model Design Awards
Ohio’s SIM Grant Activities • Governor’s Office of Health Transformation convened experts to provide detailed input on State Innovation Model (SIM) design - 100+ experts from 40+ organizations deeply engaged - 50+ multi-stakeholder meetings to align across payers and providers - Top 5 payers aligned on overall strategy
• Ohio selected McKinsey & Company to assist in producing: -
State of Ohio Healthcare Diagnostic Report PCMH and Episode “Charters” to align payer decisions Analytics and implementation plans to support the models Ohio’s Healthcare Innovation Plan (to submit October 30, 2013) SOURCE: www.healthtransformation.ohio.gov
5-Year Goal for Payment Innovation Goal
80-90 percent of Ohio’s population in some value-based payment model (combination of episodes- and population-based payment) within five years
State’s Role
▪ ▪ ▪
Year 1
Year 3 Year 5
Shift rapidly to PCMH and episode model in Medicaid fee-for-service Require Medicaid MCO partners to participate and implement Incorporate into contracts of MCOs for state employee benefit program
Patient-centered medical homes
Episode-based payments
▪
In 2014 focus on Comprehensive Primary Care Initiative (CPCi)
▪
▪
Payers agree to participate in design for elements where standardization and/or alignment is critical
State leads design of five episodes: asthma (acute exacerbation), perinatal, COPD exacerbation, PCI, and joint replacement
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Payers agree to participate in design process, launch reporting on at least 3 of 5 episodes in 2014 and tie to payment within year
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Multi-payer group begins enrollment strategy for one additional market
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Model rolled out to all major markets 50% of patients are enrolled Scale achieved state-wide 80% of patients are enrolled
▪ 20 episodes defined and launched across payers
▪ 50+ episodes defined and launched across payers
Next Steps 1. Convene clinical workgroups to create Ohio specific technical definitions for five episodes (next 3 months) 2. Continue CPCi efforts in SW Ohio (ongoing) 3. Submit a State Healthcare Innovation Plan to CMMI (by October 30, 2013) 4. Apply for a federal SIM Testing Award (early 2014) www.HealthTransformation.Ohio.gov
Q&A
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Future ACA Learning Sessions
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Monthly webinar to provide objective information about ACA implementation.
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Sessions held the second Thursday of the month from 1:00-2:00PM
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2013-2014 Webinars •
December 12
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January 9
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February 13
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March 13