Presentation on theme: "What is Catamount? FAQ List An extinct(?) Vermont mountain lion One of Vermonts first and finest microbreweries. (Also extinct) 1/38 th of Vermonts landmark."— Presentation transcript:
What is Catamount? FAQ List An extinct(?) Vermont mountain lion One of Vermonts first and finest microbreweries. (Also extinct) 1/38 th of Vermonts landmark health reform legislation: Act 191. Sec V.S.A. § 4080f. CATAMOUNT HEALTH (2) Catamount Health means the plan for coverage of primary care, preventive care, chronic care, acute episodic care, and hospital services as established in this section to be provided through a health insurance policy, a nonprofit hospital or medical service corporation service contract, or a health maintenance organization subscriber contract which is offered or issued to an individual and which meets the requirements of this section.
Areas to cover in this presentation: Quick review of the back story (politics and Medicaid) Is it better to pass imperfect legislation than to wait for the ideal? The new Catamount health insurance benefit: center of the compromise Whats the deal with the Blueprint for Health? Vermonts statewide quest for systemness Resources for learning more about the other 37/38 ths of Vermonts Health Reform The bottom line: first step? Half a step?
Recent Health Policy history highlights Broad citizen support for systemic reform 2004 election: Rep. Gov., Dem. legislature New House Health Care Cmt. created: H.524 Governors Veto Health Care Reform Commission, summer listening tour, & Governors Health Care Summit consensus initiative; common sense initiative (CSI Montpelier): S.310… Dr. Ken Thorpe… new focus on chronic care: H.864
Global Commitment 1115 Waiver Original Medicaid waiver provided coverage of kids to 300% of FPL, Parents to 185%, & childless adults to 150%. A new block grant waiver was a key element of Gov.s budget in Submitted in April. Approved 9/30/05.
Global Commitment How the MCO is Funded See more VT Legislative Council & Joint Fiscal Office info on Vermont Medicaid at And the Medicaid Global Commitment home page at
Leveraged Federal Match Key to Catamount financing. (And means DRA citizenship & identity applies to Catamount.) Reduced Medicaid deficit in short term. But the state at risk. Federal participation capped. Trade off: fixed trend rate, Special Terms & Conditions #39
Catamount Health A non-group insurance product for uninsured Vermont residents Offered as a Preferred Provider Organization Plan by private insurers in the small group market, beginning October 1, 2007 Is required to be a comprehensive insurance package covering: Primary care Preventative care Acute episodic care Chronic care Hospital services Pharmaceutical coverage Individuals may choose which insurer they would like to use. See the entire PowerPoint from which the next 3 slides are borrowed (with permission) in their complete, original form:
Catamount Health The cost of Catamount Health will depend on your income and which insurer you sign up with. For the least expensive plan, Catamount Health will cost: Income by federal poverty level Monthly premium cost (1 person/annual in 2006) –Below 200% FPL ($19,600) $60.00 – % ($19,600 – 22,050)$90.00 – % ($22,050 – 24,500)$ – % ($24,500 – 26,950)$ – % ($26,950 – 29,400)$ –Over 300% ($29,400) Full cost, estimated at $340.00
Catamount Health LEGISLATIVELY-MANDATED COST-SHARING: Deductibles: In-Network:Out-of-Network: $250/individual $500/individual $500/family $1,000/family Co-Payment: $10/office visit Prescription Drugs: No deductible Co payments: $10 generic drugs $30 drugs on preferred drug list $50 non-preferred drugs Preventive Care & $0 Chronic Care*: Not subject to deductible, co-insurance, co-payments Out-of-Pocket Maximum In-Network:Out-of-Network: (excluding Premium)$800/individual $1,500/individual $1,600/family $3,000/family * For people enrolled in Chronic Care Management Program
But what about that other 37/38ths of VT Reform? Vermonts Quest for Systemness
We know the Health Care system is Not Monolithic Its not THE HEALTH CARE SYSTEM Its MANYMANY SYSTEMS MANY HEALTH CARE
Actually its worse: its Many Overlapping Systems Its MANY SYSTEMS MANY HEALTH CARE MANY MANYMANY
Health Care Reform Goals Increase AccessImprove Quality Contain Costs See the entire PowerPoint from which the next 3 slides are borrowed (with permission) in their complete, original form:
Goal: Increase Access to Affordable Health Care Coverage Everyone In Enhance Private Insurance Coverage Catamount Health Plan for the Uninsured Non-Group Market Reform Promotion of traditional Employer-sponsored Insurance Local Health Care Coverage Planning Grant Potential Individual Insurance Mandate (2010) Improve Outreach to Uninsured Bi-State Report findings and recommendations more or less adopted in total to be implemented as the plan… Comprehensive, integrated approach: a continuum of options for a continuum of uninsured. Aggressive, community-based outreach coordinators web-based screening and enrollment tracking tool Assist with Affordability Premium Assistance (ESI, Catamount) Reduction in VHAP Premiums Non-Group Market Security Trust to reduce premiums
Goal: Improve Quality of Care Chronic Care Management Expand Blueprint Statewide OVHA Chronic Care Management Program Medicaid Reimbursement Incentives State Employee Health Plan ESI Premium Assistance plan approval, cost-sharing Catamount Health coverage, cost-sharing Chronic Fatigue Syndrome Information Increase Provider Access to Patient Information Health Information Technology Electronic Medical Records Loans Master Provider Index Promote Quality Improvement Consumer Health Care Price & Quality System Multi-payer Database Adverse Events Monitoring System Hospital-acquired Infections data Safe staffing reporting SorryWorks! Advanced Directives Increase Provider Availability Loan Repayment Program Loan Forgiveness Program FQHC Look-alike Funding Uncompensated Care Pool Promote Wellness Immunizations CHAMPPS Grants Catamount Health Coverage, Cost-sharing Healthy Lifestyles Insurance Discounts AHS Inventory of Health and Wellness Programs
Goal: Contain Costs Increased Access to Coverage and Care Decreased Uncompensated Care Lower Premium Costs Decrease Cost Shift Increased Medicaid provider rates Cost Shift Task Force Standardize Policy for Hospital Uncompensated Care and Bad Debt Hospital Cost Shift Reporting Reforms Improve Quality of Health Care Less Unnecessary Care Lower Costs Simplify Administration Common Claims and Procedures Uniform Provider Credentialing
And then theres the Blueprint The Core of Act 191 Chronic Disease Prevention and Care Management Takes the Ed Wagner (Group Health) / Don Berwick (IHI) practice level population disease management model and applies it statewide as a population- based public health initiative. Except its a public/private health partnership. Legislature codified it in statute more than it had been. Still a work in progress.
Public Policy Public Health Health Systems Community Health Provider Team Patients and Families Policies Infrastructure Financing Resources Advocacy Regulation Info. Systems System policy Quality care Service development Reimbursement Financing Continuity Coordination Info. Systems Built environment Programs and services Health awareness Healthy options Info. Systems Practice standards Info. Systems Decision support Office systems Coaching/support Health knowledge Self-management Skill and practice Supportive home Environment Info. Systems Blueprint for Health Model Healthier Vermonters
Blueprint Principles OVHA VDH ESI Catamount CCM RFP Care Coordination Third Party Payers Blueprint Implementation State Employees Health Plan Other Commercial Products AHS Chronic Care Coordination Team Blueprint Executive Committee BISHCA DCF Blueprint Alignment But how to actually change payment incentives & align motivations in a public/private partnership? Answer remains elusive.
Problematic, Unresolved issues: Catamount reinforces the link of insurance to employment Through ESI and the employer assessment as well as traditional commercial insurance paradigm. Creates more risk pools instead of fewer Arguably, it means were going in the wrong direction. Core problem is that the risk is borne by private capital, not the public capital, so the carriers pass off the risk to others and will to do continue so in pursuit of profit. Theyre in business to make money, not to assure care. Change the health care financing paradigm: Why isnt it like other Public Structures (schools, fire departments)?
More papers, reports, Power Points, and policy details than most normal people would want to see are available at: Legislative Site Susan Besios Site Bi-State Outreach Report Hunt Blair: