Addressing the Needs of the Uninsured in a Challenging Economic Environment

Slide Presentation by Vondie Woodbury, M.P.A.

On March 13, 2002, Vondie Woodbury, M.P.A., made a presentation in a Web-assisted teleconference at Session 2, which was entitled "State and Local Efforts to Close the Gaps between Public and Private Insurance Coverage."

This is the text version of Ms. Woodbury's slide presentation. Select to access the PowerPoint® slides (548 KB).

State and Local Efforts to Close the Gaps between Public and Private Insurance Coverage

Vondie Woodbury, M.P.A.
Director
Muskegon Community Health Project

Slide 1

Eligible Businesses

• Located in Muskegon County.
• No health benefits for 12 months.
• Offered to full and part-time employees.
• Median wage of $10 per hour.

Slide 2

Access Health Benefits

• Physician Services.
• In-patient hospital services.
• Out-patient services.
• Emergency Room services.
• Ambulance services.
• Prescription drugs (formulary).
• Diagnostic lab and x-rays.
• Home health.
• Hospice Care.
• Accept pre-existing conditions.

Slide 3

Funding the Three-share Model

Slide 4

Community Match

• Disproportionate Share Hospital (DSH) payment.
• DSH is matched with local funds.
• DSH matches local dollars at 1.29 rate.

Slide 5

Profiling Coverage in Muskegon

This slide shows coverage categories in Muskegon as an upside-down triangle.

Distinctive Populations With Distinctive Needs:

Commercial Plans (102,000): Privately funded coverage.
Working uninsured (17,000): Access Health targets.
Medicare/caid (45,000): Government sources of coverage.
SMP (2,000): "Muskegon Care" Safety Net Coverage.

Slide 6

Cost of Commercial Products as a Barrier

EPIC-MRA 1999 Survey of 200 Uninsured Businesses in Muskegon County with fewer than 20 employees:

• 69% "cost of premiums" barrier.
• 81% would offer affordable coverage.
• 95% able to afford $35-$50.
• 67% coverage would reduce turnover.

Slide 7

Survey of Working Uninsured

• 48% not offered coverage.
• 64% believe coverage extremely important.
• 30% forgo treatment of current illnesses.
• 65% able to pay $35 to $50 pm/pm.

Slide 8

Coverage & Co-Payments

• $5 PCP (primary care physician) office visits.
• $20 Specialist office visit.
• $20 Urgent care center visit.
• $5 Generic formulary drugs.
• 50% Non-generic formulary drugs. (Total drug cost paid by Access Health not to exceed $6,000 per calendar year per member.)
• $50 Emergency Room visit.
• $50 Outpatient hospitalization.
• $100 Inpatient hospitalization.
• $5 Home Care visit.
• $0 Hospice visit.
• $20 Outpatient behavior health
services.

Slide 9

Exclusion—Care

• Any care received outside of Muskegon County.
• Certain highly specialized catastrophic care.
• Limb reattachment.
• Neo natal.
• Transplants.
• Severe burns.

Slide 10

Five Year Goals

This slide shows the coverage profile of Muskegon County as a reverse triangle.

Commercial: 65%
Medicare/aid: 22%
Uninsured: 8% [4% Access Health]
Indigent: 1%

The slide then has an arrow pointing from the uninsured up to the commercial plan, illustrating the goal to reduce the cost shift to commercial, and another arrow pointing from the uninsured to the indigent illustrating the goal to reduce the care shift to the safety net.

Slide 11

Access Health Accomplishments

• Over 1,300 individual members to date.
• 300 businesses.
• 97% of all local physicians participate.
• 1 public dollar leverages 2 private dollars.
• Actuarial data in the range of $130 pm/pm.
• 725 kids identified for Medicaid or MIChild.

Slide 12

Improves Delivery of Care

• Reduces deferred care.
• Reduces ER and urgent care use.
• Reduces stress on "safety net."
• Promotes community collaboration.
• Adds revenue to health care system.

This slide also includes a picture of a healthcare provider taking a man's blood pressure.

Slide 13

Complements Commercial Coverage

• Entry level coverage.
• Transitional product.
• Nudges commercial market.
• New insurance markets.
• Brokerage partnership opportunities.

Slide 14

Three Share Funding

This slide shows a visual illustration of the three-share funding model. There is a box labeled "public funds" with two arrows coming out of the box, one pointing toward "employer funds" and the other toward "employee funds."

Unlike entitlement plans—one public dollar leverages two private dollars for health.

Uses existing dollars in Michigan—budget neutral.

Slide 15

For More Information

For more information about Access Health and our other projects, please visit our website: http://www.mchp.org

This slide also includes a picture of the Muskegon County Health Project homepage.

Internet Citation

State and Local Efforts to Close the Gaps between Public and Private Insurance Coverage. Slide Presentation by Vondie Woodbury, M.P.A., at Web-Assisted Teleconference, "Addressing the Needs of the Uninsured in a Challenging Economic Environment." Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/uninsuredtele/session2/woodburytxt.htm

Return to Teleconference
State & Local Policymakers
AHRQ Home Page