health insurance innovation task force...sep 12, 2019 · agenda. welcome. minutes. demographics...
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Health Insurance Innovation Task ForceSEPTEMBER 12, 2019
Agenda
WELCOMEMINUTESDEMOGRAPHICS AND TARGET POPULATIONTASK FORCE MEMBER PRESENTATIONSPRESENTATION ON IDAHO INSURANCE INNOVATIONSPRESENTATION ON THE COLORADO SECTION 1332 WAIVERTASK FORCE MEMBER PRESENTATIONSWRAP-UP AND NEXT STEPS
2
Task Force Webpage3
https://healthinsurancetaskforce.mo.gov/
Agenda
WELCOMEMINUTESDEMOGRAPHICS AND TARGET POPULATIONTASK FORCE MEMBER PRESENTATIONSPRESENTATION ON IDAHO INSURANCE INNOVATIONSPRESENTATION ON THE COLORADO SECTION 1332 WAIVERTASK FORCE MEMBER PRESENTATIONSWRAP-UP AND NEXT STEPS
4
Target PopulationANGELA NELSONDIRECTOR, INSURANCE MARKET REGULATION DIVISION
Focus on the target populations benefitting most from a Section 1332 Waiver
6
Data on health coverage by employment
status
Meet three Missourians
without health insurance
7
41%35%
26%35%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Metro Areas Non-Metro Areas
Missouri Metro - Rural Comparison Uninsured Population 2008 to 2016
8Who Is Uninsured?
15.80%
21.50%
24.40%
15.70%
16.00%
20.70%
15.00%
8.40%
0.00% 5.00% 10.00% 15.00% 20.00% 25.00%
Individuals aged 19 to 35
Did not graduate from high school, aged 18 – 64
Family income less than $25,000, aged 18-64
African-American, 18-64
Not married
Unemployed
Part-Time Worker
Total % of Missouri Uninsured
9
7.70%15.00% 14.70%
20.70%10.40% 14.50% 14.40%
20.30%
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Full Time Part Time Not in LaborForce
Unemployed Full Time Part Time Not in LaborForce
Unemployed
Total Private Missouri Employer-based Private MedicareMedicaid Other Gov't (Veterans, etc) % Uninsured
Health Insurance by Employment Status and Coverage Source, 18-64 (2017)
MISSOURI UNITED STATES
10Health Insurance by Employment Status and Source of Coverage, 2017
80.00%
4.00%2.60%
7.70%
Full Time
46.60%1.80%
10.90%
1.30%
15.00%
Part Time
11Health Insurance by Employment Status and Source of Coverage, 2017
29.50%
21.90%31.20%
5.00% 14.70%
Not in Labor Force
48.00%
4.80%
17.80%
9.00%
20.70%
Unemployed
12
Not Self-Employed
161,397
Self Employed
27,677
% Uninsured, Missouri 2017Full-time Employment, 18-64
13
% Uninsured Full-Time Workers, 18-64
14
# of Uninsured Full-Time Workers, 18-64
Who would benefit most from insurance innovations developed through a Section 1332 Waiver?
Who are the target populations?
The “Millennial”This uninsured population may qualify for big tax credits but still doesn’t buy.
01
The “Gen-Xer” This uninsured population may get some premium subsidy, but not enough to buy.
02
The “GenJoneser”This uninsured population needs and wants coverage, but with no subsidies, they won’t buy.
03
15
Meet Joshua, 30 years old Single High school graduate; attended Community
College for 1.5 years Laborer in local light manufacturing facility;
37.5 hours/week; $14.75/hour Annual income in 2018 was $28,763 Employer has a total of 35 employees;
doesn’t offer health insurance Joshua has a congenital spine condition but
has not been receiving treatment Joshua doesn’t have health insurance Joshua qualifies for APTC of $307/month on
the FFM; his cost for a silver plan would be about $189/month
Joshua says he doesn’t want to waste his money on health insurance and doesn’t think he needs it
16
Meet Jennifer, 44 years old 44 years old, one daughter Emma (15),
divorced College degree, Manager for local business Total annual income in 2018 was $59,000 Emma is covered under her Dad’s health plan.
Jennifer’s current employer doesn’t offer health coverage (4 employees)
Jennifer hasn’t had health coverage since she divorced 6 years ago. Jennifer is very healthy She says she can’t afford health insurance that will actually cover anything
Jennifer qualifies for $2,501 in subsidies, or $208 per month. Her cost for a silver plan in 2019 after subsidies - $500/month, $5,500 deductible. Her cost after subsidies for a bronze plan in 2019 - $230/month, $6,700 deductible
17
Meet David, 53 years old Married to Lisa (50); two kids Hannah (19) and
Andrew (17) High school graduate, farmer. Lisa works as a
teacher at a local school district Total annual income in 2018 was $99,000 Lisa and the kids are covered under Lisa’s school
district plan; David’s premiums would be $750/month
David’s relatively healthy, but he has high blood pressure and high cholesterol. He chews tobacco
David says health insurance is just too expensive. He’s been uninsured for nearly 15 years
David doesn’t qualify for any premium tax subsidies. His cost for a silver plan in 2019 -$1,050/month, $6,000 deductible. His cost for a bronze plan in 2019 - $830/month, $5,000 deductible
18
How do our three Missourians fit within Missouri’s uninsured population?
Joshua Jennifer David
19
What’s driving their decision?
Jennifer Premium $500/month for coverage Deductible is $6,000/year ($500/month)
Considerations: $1,000 a month up front No coverage for anything but
preventive services No major medical need --- yet $1,000 a month or use that for other
needs – car for Emma?
David Premium $1,000/month for coverage Deductible is $6,000/year ($500/month)
Considerations: $1,500 a month up front No coverage for anything but
preventive services No major medical need --- yet $1,500 a month or use that for
Hannah’s college tuition?
20
Sources
Slide 3 – “Health Insurance Coverage in Small Towns and Rural America”, Rural Health Policy Project. Georgetown University Health Policy Institute and University of North Carolina. September 2018. https://ccf.georgetown.edu/wp-content/uploads/2018/09/FINALHealthInsuranceCoverage_Rural_2018.pdf
Slide 4 - “Annual Social and Economic Supplement” Current Population Survey. September 2018.
Slide 5 – id Slide 6 - id Slide 7 - id Slide 8 - id Slide 9 - id Slide 10 - id
21
Agenda
WELCOMEMINUTESDEMOGRAPHICS AND TARGET POPULATIONTASK FORCE MEMBER PRESENTATIONSPRESENTATION ON IDAHO INSURANCE INNOVATIONSPRESENTATION ON THE COLORADO SECTION 1332 WAIVERTASK FORCE MEMBER PRESENTATIONSWRAP-UP AND NEXT STEPS
22
Hospital Financing OverviewHealth Insurance Innovation Task Force September 12, 2019
CMH Counties Served
Insurance Coverage and Hospital Payor Mix in Missouri
Medicare 18.7%
Medicaid 14.8%
VA, Champus 5.3%
Private Commercial (Individual and
Employer)29.3%
Private Commercial
(Self-Insured) 33.5%
8.4%
INSURANCE COVERAGEUninsured
Medicare and HMO
45.1%
Medicaid and HMO 14.6%Other Govt.
1.6%
Private Commercial
31.9%
WorkersComp0.8%
Self Pay 5.9%
HOSPITAL PAYOR MIX
Source: Estimate produced by DIFP derived from the Current Population Survey, American Community Survey and Insurers’ Financial Statements Source: Annual licensing survey
Medicare and HMO
48.5%
Medicaid and HMO 15.5%
Other Govt.1.4%
Private Commercial
25.1%
Workers Comp 0.7%
Self Pay8.8%
RURAL HOSPITAL PAYOR MIX
Rural Hospital Medicare Utilization
• Medicare utilization is significantly higher in rural hospitals
• Medicare cuts are a bigger share of budget• Less commercial volume to subsidize Medicare cuts
Medicare Percent of
Category Days* Discharges*
US Urban Hospital Average 50% 44%
US Rural Hospital Average 63% 56%
Citizens Memorial Hospital Average 57% 54%
*Includes Medicare HMO volume
Missouri Hospital Average Operating Margins
5
2.3%
2.8%
2.3%
2.5%
2.0%
2.9%
2.2% 2.1%
1.4%1.4%
0.3%
2.0%
1.8%
1.5%
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
37% 18% 45%
Profitability Distribution - Missouri Hospitals
Profitability Distribution - Missouri Rural Hospitals
Source: Annual licensing survey
1.4% after ACA2.4% before ACA
45% 14% 42%
Loss Profit < 3 Percent Profit > 3 Percent
6
Nationally, 113 rural hospitals have closed since 2010
Medicare Cuts• Sequestration – 2% cut on all Medicare
payments, effective 4/1/13 (PPS & CAH)• Medicare bad debts – 35% reduction (PPS & CAH)• ACA cuts (PPS) – 3.65% fixed cut, spread over 9
years, & annual productivity cuts averaging 0.6%• Outpatient lab fee schedule cut 1/1/18 (PPS)
• Since 2010, hospitals have received 8.95 percent in rate cuts under the ACA (excluding sequestration) 7
30
130%
120%
110%
100%
90%
80%
70%
60%
50%1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
31
Missouri Hospital Medicare Percent of Cost Paid
32
Medicaid Disproportionate Share Cuts
• Medicaid disproportionate share hospital (DSH) cuts under the ACA originally were to total $18.1 billion
• Cuts have increased annually under subsequent legislation – cuts now total $44 billion, starting at $4 billion in 2020 and $8billion per year through 2025 (Missouri’s share is $146 million in 2020)
• Cuts apply even if state did NOT expand Medicaid
Annual Impact of Cuts on CMHIssue Annual Impact
FY 2019
Sequestration $(1,000,000)
Bad Debts (98% dual eligible) $ (160,000)
ACA Fixed Cuts $(1,100,000)
ACA Productivity Cuts $(1,600,000)
Subtotal – Cuts Already in Effect $(3,860,000)
Full Impact of Lab Fee Schedule Cut $ (530,000)
Medicaid DSH Cuts When Fully Implemented $(1,100,000)
Pro Forma Total Annual Impact of Cuts $(5,490,000)
33
Premium Costs & Enrollee Spending on Employer-Sponsored Plans in Missouri
12
Premium costs for employer-sponsored health plans outpacing medical inflation in Missouri, while value is decreasing (OOP limits, high deductible plans, etc.)
2013-2017 Percent Change in Enrollee Costs for Employer-Sponsored Health Plans in Missouri Compared to Total Medical Costs
23.8%
36.3%
11.8%
45%
40%
35%
30% 30.2%
25%
20%
15%
10%
5%
0%2013 2014 2015 2016 2017
Sources: U.S. Bureau of Labor Statistics and State Health Access Data Assistance Center using Medical Expenditure Panel Survey—Insurance Component.
Avg. Annual Premiums (Family Coverage)Avg. Annual Deductible (Family Coverage)Avg. Annual OOP Limit (Family Coverage)CPI for Medical Care
Hospital Spending for Employer-Sponsored Insurance Plans in Missouri
13
Missouri hospitals offset high utilization with low prices to contain spending
.
Source: Health Care Cost Institute, 2017
1,000
3,000
2,000
4,000
5,000
6,000
HI CA NV AZ DC MD FL CO SD GA TX NC TN VA
12th Highest in U.S.In hospital utilization per 1,000
0
$0
$5,000
$10,000
$15,000
$30,000
$25,000
$20,000
AR UT MD AL LA MS IA MO KY MA KS TN MI RI DC OK
ND NC IL NM AZ PA GA NE NV VA WI NJ TX ID DE NH WY NY HI WA
WV SC SD CA
8th Lowest in the U.S.In average hospital prices
$4,000
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0 HI MD AR DC AZ AL TN UT KS MA OR NV MI LA GA RI CA MO NC NY MS
WA IA NJ VA FL MN US CO CT IL MT KY OK
NM PA NE DE TX ID WI
ND OH VT AK ME SC WY NH IN SD WV
18th Lowest in the U.S.In average hospital spending
MO HealthNet Primary Care Health HomeProgram
• Approximately 29,000 participants enrolled statewide
• CMH has approximately 2,000 enrollees• Hospitals are paid $64.68 per member per
month, funded by Federal Medicaid dollarswith state share paid by MHA through FRA
• Statewide savings to MO HealthNet of $98.35 per member per month
14
CMS’ CMMI Participants in Missouri
180 total participants in Missouri 53 – Comprehensive Primary Care Plus 40 – avoidable hospitalizations among nursing facility
residents 27 – Bundled Payments for Care Improvement Advanced 17 – Accountable Care Organizations * 17 – FQHC Advanced Primary Care Practice Demonstration 10 – Million Hearts 16 – other
* 3 – Two sided risk ACOs15
Potential Ideas to Move the Needle
For discussions purposes only
Missouri Health Insurance Innovation Task Force
Simplify Product Design
• Establish standardized cost sharing • Consumers buy based on price, network and customer service
• Reduce the number of plans offered • Each insurer offers one Silver* and one Bronze
• Eliminate requirement to offer Gold plan
*In addition to the six cost-sharing variants
EHBs
• Exclude pediatric vision
• Eliminate hearing aid coverage for adult
Enhance Off-Exchange Product Offerings
• Eliminate the Exchange tax on policies sold Off-Exchange
• Allow both On and Off Exchange plans to reflect actual administrative costs
• Eliminate pediatric dental Off-Exchange
Reduce Administrative Burdens
• Eliminate Summary of Benefits and Coverage (SBC)
• Eliminate machine readable files
Improve Risk Pool
• Increase subsidies for younger individuals
• Prohibit third party payments
• Prohibit Missouri Medicaid program from buying individual exchange policies for the costliest Medicaid beneficiaries
• Reform what qualifies for Special Enrollment Periods and require proof of residency
• Qualifying events - birth, qualify for subsidy and loss of group coverage
High Cost Health Conditions
• Establish a list of specific high cost health conditions where the state facilitates a Medicaid reimbursement
• High quality providers are identified and receive higher volume and provider a greater discount in exchange for the Medicaid reimbursement
• Extremely premature babies
• Hemophilia
• HIV
• Organ transplants
Missouri 1332 Reinsurance Options
September 12, 2019
For Discussion Purposes Only
Overview
For Discussion Purposes Only
1. Affordability Overview2. Reinsurance Overview3. 1332 Waivers and Traditional Reinsurance4. Reinsurance Concepts for Consideration5. Appendix
a) 1332 Reinsurance Waiver Overviewb) Lowest and Highest Cost Counties, 2019c) 2019 Ambetter Plan Offerings in Missouri
Premium Affordability
For Discussion Purposes Only
• The federal government considers affordable health insurance tobe roughly 10% of household income1.
• Individuals who earn less than 400% of the Federal Poverty Level (FPL) are eligible for federal subsidies for Marketplace coverage.
• Despite the availability of Marketplace subsidies, coverage remains unaffordable for many consumers, particularly those above 400% FPL.
• For example, in 2019, an individual earning > $24 an hour or $50,000ayear must pay the full amount of health insurance themselves.
• ~10% of their monthly income is roughly $400 a month, but for many individuals monthly premiums will exceed this.
1. This percentage of income is roughly a level that 26 CFR §1.36B-3 and 1.36V-2 establish as an affordable premium for individuals at 400% FPL.
Marketplace Premiums in MO – All Issuers
For Discussion Purposes Only
• The 2019 average Marketplace premium rate in Missouri is$645 PMPM and the average premium for consumers with Advanced Premium Tax Credits (APTC) is $86 PMPM1.
• Unsubsidized rural premiums are unaffordable.
2019 Age 40 Monthly Premium2 Lowest Cost Bronze Lowest Cost Silver
MO Average $394 $479
Highest County (14) $551 $693
Lowest County (7-10) $325 $419
KEY Monthly Premium
Green Less than $400
Yellow $400-$500
Red $500+1. Source: Kaiser Family Foundation2. Source: QHP data available on Healthcare.gov
Note: The list of counties are reflected on slide 19 in the Appendix.
Premiums Unaffordable in High Cost Counties and for Older Individuals
For Discussion Purposes Only
• Older adults, not yet eligible for Medicare, are often also ineligible for subsidies.
• Families without Federal subsidies have to pay the full premium amount for family coverage.
Lowest Cost County PMPM
Lowest Cost Bronze
Lowest Cost Silver
Age 40 $325 $419Age 50 $454 $585Age 60 $689 $889Age 64 $762 $983
2019 Age 40Monthly Premium
Lowest Cost Bronze
Lowest Cost Silver
MO Average $394 $479
Highest County $551 $693
KEY Monthly Premium
Green Less than $400
Yellow $400-$500
Red $500+
2019 Average Marketplace Monthly Premiums After APTC
For Discussion Purposes Only
Percentage of Federal Poverty Level
Average 2019 Monthly SilverPlan Premium* After Federal Subsidies
< 133% $28133 – 138% $42 – $48138 – 150% $48 – $63150 – 200% $63 – $132200 – 250% $132 – $211250 – 300% $211 – $299300 – 400% $299 – $399
> 400% Ineligible for federal tax credits*Based off 2019 average national monthly premiums for an individual selecting the second lowest cost silver plan.
2019 Missouri Exchange Enrollment
For Discussion Purposes Only
1. Source: 2019 Marketplace Open Enrollment Period Public Use Files available on CMS.gov
2019 Missouri Exchange Enrollment1
Percentage of Federal Poverty Level CSR Level Bronze Silver Gold Total
100 – 150% 94% AV 11,919 72,318 212 84,449
150 – 200% 87% AV 7,747 39,303 212 47,263
200 – 250% 73% AV 8,939 18,866 242 28,047
250 – 400% 70% AV 17,878 17,293 515 35,687
> 400% 70% AV 12,515 11,005 1,848 25,367
Overall - 58,998 158,785 3,029 220,812
Improvements to Traditional Reinsurance
For Discussion Purposes Only
• Reinsurance models should be evaluated to identify the bestapproach to:
• Address premium affordability where needed the most within the state, including for the unsubsidized population;
• Foster a competitive Marketplace with a level playing field;• Mitigate the risk of issuers receiving overlapping payments
from risk adjustment and reinsurance; and,• Allow states to achieve policy goals in the most cost-effective
manner.
Reinsurance Considerations
For Discussion Purposes Only
Traditional reinsurance could be improved in the following ways to allow states to achieve policy goals in the most cost-effective manner. Regionally-focused model:
Would allow states to address regional affordability targets; rural/urban variation, etc.
Utilize a percentage of claims vs. attachment point model: Would mitigate the risk of issuers receiving overlapping payments
from risk adjustment and reinsurance. Would foster a competitive Marketplace with a level playing field.
Reinsurance Concepts for Consideration
For Discussion Purposes Only
1332 Waiver Options forMissouri I. Traditional Reinsurance II. % of Claims
State funding will pay for part of Claims Claims
Funding will be paidby % of Claims above a threshold % of all Claims
Premium Rates may be impacted (1) State Wide or by regions By Rating Area
Impact on providers andinsurersDiminishes provider contract
advantage / allows double dipping
Issuers’ relative premiumdifferences stay similar toencourage competition
(1) CMS approved Colorado’s 1332 Waiver for 2020 that allows geographic pricingadjustments.
$90M
For Discussion Purposes Only 11
$104M
$87M $91M
$149 PMPM
$174 PMPM
$145 PMPM
$151 PMPM
$140
$150
$160
$170
$180
$190
$200
$0
$20
$40
$60
$80
$100
$120
Lower Estimate Higher EstimateTraditional Reinsurance
Lower Estimate Higher Estimate% of Claims Reinsurance
• Average monthly 2019 lowest cost bronze premiums in MO are $536, which was used as the reference for this analysis.• If Missouri established a State Based Marketplace, the PMPM decrease ($136), funded by the state, could be provided directly to the
consumer, allowing the state to achieve the same policy goal with a more efficient use of state funds.
Tota
l Cos
t to
Mis
sour
i (in
Milli
ons)
Total PMPM
Cost
Associated Costs to Reduce MonthlyLowest Cost Bronze Premium from $536 to $400 PMPM
Different reinsurance proposals fund proportional decreases in the average all product premium of $645 PMPM.
Associated Costs to Reduce MonthlyLowest Cost Bronze Premium from $536 to $500 PMPM
$24M
For Discussion Purposes Only
$28M
$23M $24M
$40 PMPM
$46 PMPM
$38 PMPM
$30
$32
$34
$36
$38
$40 PMPM $40
$42
$44
$46
$48
$50
$0
$5
$10
$15
$20
$25
$30
Lower Estimate Higher EstimateTraditional Reinsurance
Lower Estimate Higher Estimate% of Claims Reinsurance
Different reinsurance proposals fund proportional decreases in the average all product premium of $645 PMPM.
• Average monthly 2019 lowest cost bronze premiums in MO are $536, which was used as the reference for this analysis.• If Missouri established a State Based Marketplace, the PMPM decrease ($36), funded by the state, could be provided directly to the
consumer, allowing the state to achieve the same policy goal with a more efficient use of state funds.
Tota
l Cos
t to
Mis
sour
i (in
Milli
ons)
Total PMPM
Cost
Appendix
For Discussion Purposes Only
Overview of Reinsurance
For Discussion Purposes Only
• Generally, reinsurance is a way to mitigate risk and offset the cost of high or unexpected claims.
• For example, it could provide reimbursement to issuers for high cost claims above a specified threshold (e.g., an individual’s claim above $500,000).
• This type of reimbursement mechanism allows for premium reductions in a state’s market.
• Multiple states have recently implemented state reinsurance programs through a 1332 State Innovation Waivers as a means to address premium affordability concerns.
• This type of reinsurance program is different from the reinsurance that an issuer may purchase on their own (i.e., stop loss).
1332 Waivers and Traditional Reinsurance Program
For Discussion Purposes Only
• Several states (AK, ME, MD, MN, NJ, OR, and WI) implemented 1332 Waivers in 2018 or 2019, with a Traditional Reinsurance Program (TRP), to offset premium increases by 5% to 30%1.
• 1332 Waivers allow states to pay reinsured claims and set up away for federal dollars to be “passed-through” to help fund thecost of the program.
• States fund their share of the program through premium taxes, hospital fees, general fund, health insurance provider fee, assessments, shared responsibility tax, etc.
• The federal government typically pays non-Medicaid expansion states 70% to 80% of the cost of the TRP with the state covering the remaining 20% to 30%.
Note: Federal costs under 1332 waivers must be deficit neutral, therefore the state bears the financial risk if actual program costs are higher than anticipated.
1. As of September 2019, 5 other states (CO, DE, MT, ND, and RI) have approved 1332 reinsurance waivers set to go into effect in 2020.
Interaction of 1332 Waiver Reinsurance and Premiums
For Discussion Purposes Only
• In a 1332 Waiver reinsurance program, states typically use a combination of state funding (e.g., state general funds,assessments on issuers/providers, etc.) and federal “pass-through” funding to finance a 1332 Waiver reinsurance program.
• Pass-through funding is defined as federal funds received by the state for its 1332 Waiver based on the financial assistance the federal government would have spent on tax credits without the waiver in place.
• Because issuers are reimbursed for claims through a 1332 Waiver reinsurance program, premium rates are lowered, thereby generating federal savings that result in federal pass-through funding.
Financing Reinsurance
For Discussion Purposes Only
• When issuers purchase reinsurance on their own, they include that cost in the premium rates for members.
• If the federal government or the state pays for the reinsurance, such as through the 1332 Waiver program, then the premiums for consumers can decrease.• If the premiums become more affordable, a greater number of
healthier individuals may enroll in Marketplace coverage, which would prompt issuers to lower their premium rates further.
Summary of Reinsurance Concepts for
For Discussion Purposes Only
Consideration1332 Waiver Options for Missouri I. Traditional Reinsurance II. % of Claims
State funding will pay for partof Claims Claims
Funding will be paidby % of Claims above a threshold % of all Claims
Premium Rates may beimpacted1 State wide or by regions By Rating Area
Impact on providers and insurersDiminishes provider contract
advantage / allows double dipping
Issuers’ relative premium differences stay similar to encourage
competition
Examples basedon 2019 premiums and enrollment
LCB Premium Reduction to $400 -$136 PMPM Premium Reduction(-25.4%)
Estimates Low High Low HighTotal PMPM Cost of Option2 $149 $174 $145 $151Total MO Cost in Millions3 $90 $104 $87 $91
LCB Premium Reduction to $500 -$36 PMPM Premium Reduction(-6.7%)Estimates Low High Low HighTotal PMPM Cost of Option2 $40 $46 $38 $40Total MO Cost in Millions3 $24 $28 $23 $24
1. CMS approved Colorado’s 1332 Waiver for 2020 that allows geographic pricingadjustments.2.Total PMPM are based on 2019 MO statewide average low cost Bronze premium of $536 and average premium of $645. Average premium rates are equivalent to statewide average age 49 premium rates. Option I assumes traditional reinsurance is 3 to 15% higher costing than Option II.3. Assumes no change in MO’s 2019 Marketplace all carrier enrollment of 240,000 members, and CMS covers 75% of the cost.Note: The savings above do not reflect offsetting lower state or federal tax revenue.
Highest and Lowest Cost Counties in Missouri, 2019
For Discussion Purposes Only
• Lowest Cost Counties• Lowest cost Bronze plan found in Franklin, Jefferson, Lincoln,
Saint Charles, Saint Francois, Saint Louis, Saint Louis City, Sainte Genevieve, Warren, and Washington (all of Rating Area 6)
• Lowest cost Silver plan found in Franklin, Jefferson, Lincoln, SaintCharles, Saint Louis, Saint Louis City, and Warren
• Highest Cost Counties• Lowest cost Bronze plan (in highest cost counties) found in Adair,
Clark, Knox, Lewis, Linn, Macon, Marion, Pike, Putnam, Ralls, Schuyler, Scotland, Shelby, and Sullivan (all of Rating Area 2)
• Lowest cost Silver plan found in same counties as above
2019 Missouri Ambetter Plans Plan Feature Standard 73% CSR 87% CSR 94% CSR
Bronze - EssentialCare 1
Deductible $7,900 N/A N/A N/AMOOP $7,900 N/A N/A N/A
MedicalCoinsurance
0% N/A N/A N/A
Silver - Balanced Care 11
Deductible $6,000 $2,625 $0 $0MOOP $7,900 $6,300 $2,600 $1,050
Medical Coinsurance
40% 40% 40% 25%
Silver - BalancedCare 3
Deductible $3,000 $2,350 $850 $200MOOP $6,750 $6,300 $2,600 $700
MedicalCoinsurance 30% 30% 30% 30%
Gold - Secure Care 1
Deductible $1,000 N/A N/A N/AMOOP $6,350 N/A N/A N/A
MedicalCoinsurance 20% N/A N/A N/A
For Discussion Purposes Only
2019 Ambetter Plan Offerings in Missouri
Agenda
WELCOMEMINUTESDEMOGRAPHICS AND TARGET POPULATIONTASK FORCE MEMBER PRESENTATIONSPRESENTATION ON IDAHO INSURANCE INNOVATIONSPRESENTATION ON THE COLORADO SECTION 1332 WAIVERTASK FORCE MEMBER PRESENTATIONSWRAP-UP AND NEXT STEPS
65
Presentations on Idaho Insurance Innovations
DIRECTOR DEAN L. CAMERONIDAHO DEPARTMENT OF INSURANCE
66
Agenda
WELCOMEMINUTESDEMOGRAPHICS AND TARGET POPULATIONTASK FORCE MEMBER PRESENTATIONSPRESENTATION ON IDAHO INSURANCE INNOVATIONSPRESENTATION ON THE COLORADO SECTION 1332 WAIVERTASK FORCE MEMBER PRESENTATIONSWRAP-UP AND NEXT STEPS
67
Presentation on the Colorado 1332 Waiver
COMMISSIONER MICHAEL CONWAYCOLORADO DIVISION OF INSURANCE
68
Agenda
WELCOMEMINUTESDEMOGRAPHICS AND TARGET POPULATIONTASK FORCE MEMBER PRESENTATIONSPRESENTATION ON IDAHO INSURANCE INNOVATIONSPRESENTATION ON THE COLORADO SECTION 1332 WAIVERTASK FORCE MEMBER PRESENTATIONSWRAP-UP AND NEXT STEPS
69
Missouri Health Insurance Innovation Task Force Presentation
September 11, 2019David K. Hill
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Complex Coverage Pools
Agenda
71
Adjusted Plan Options
High Deductible Health Plan Ideas
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Complex Coverage Pools(Complex Care Plan)
72
● Similar to old high risk pools
● Opportunity to offer better coverage for complex care
● Promote quality and decrease cost
● Cost containment and care management
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Complex Coverage Pools
73
CCPs can be administered by State-enabled public-private partnerships with organizations that have expertise in managing patients with complex conditions, coordinating their care providers, and ensuring accountability for improving outcomes. Key components of a CCP should include:
• Predefined conditions designating individuals for automatic enrollment in coverage;
• Enrollment limited to those not eligible for Federal health programs or employer-sponsored insurance;
• Dedicated Federal funding for the CCPs;
• Rigorous participation requirements established to maintain eligibility;
• A reduction to premiums and out-of-pocket costs and other barriers to coverage and care;
• Custom referrals to high-performing providers most capable of coordinating care to address the specific needs of the individual; and
• Provider payment rates set at Medicare levels (approximately 60% of commercial rates) with incentives to practice high-quality, evidence-based medicine with effective use of health care resources.
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Estimated Impact – An Illustration
74
Assuming that the individual market is approximately 15 million consumers, CCPs would:
• Cover approximately 1 million consumers, or 7.2% of the individual market;
• Have a gross cost of approximately $17.0 billion annually; and
• Reduce annual individual market premiums by 27%, from $7,000 to $5,100.
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Estimated Impact – An Illustration (continued)
75
Percent of Population Covered by
CCPs
Percent of Total Health Care Costs
CCP Enrollment
Annual Cost Per Capita at Commercial
Payment1
Annual MarketPremium with
2
Reduction inIndividual
Market Premium
Total Reduction inPremium & Cost
Sharing for a High-Cost CCPMember3
7.2% 37% 1,080,000 $29,900 $5,100 27% 62%
Annual CCP Funding Required atMedicarePayment4,5
Federal ACA Tax Credit Savings due toPremium Reductions6
Net Cost of CCP Funding atMedicare Payment Levels
$17.0 Billion ($17.0 Billion) $0.0
Re sults: By implementing CCPs, the 93% of the individual market that is not enrolled in a CCP would experiencepremium reductions of 27%. For the 7% of the individual market in a CCP, members would receive the same 27%premium reduction and the additional benefit of resulting federal tax credit savings. This would total as much as62% savings – in premium and cost sharing combined – for CCP members, depending on their income levels.
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Conditions List
76
Predefined health conditions designating individuals for automatic enrollment in Complex Coverage Pools would be organized and ranked by intensity of care.
Caring for Those with Complex Conditions – Summary of Chronic Conditions
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Conditions List (continued)
77
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Adjusted Plan Options
• Actuarial Value
• Metal Level
78
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
High Deductible Health Plan Ideas
79
Pre-deductible
Primary Care
Behavioral Health
Virtual Visits
Rx
Agenda
WELCOMEMINUTESDEMOGRAPHICS AND TARGET POPULATIONTASK FORCE MEMBER PRESENTATIONSPRESENTATION ON IDAHO INSURANCE INNOVATIONSPRESENTATION ON THE COLORADO SECTION 1332 WAIVERTASK FORCE MEMBER PRESENTATIONSWRAP-UP AND NEXT STEPS
80