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HomeMy WebLinkAboutMINUTES - 10051993 - 2.3 (4) ' ! t MILT CAMHI Executive Director CONTRA COSTA HEALTH PLAN 595 Center Avenue Suite 100 Martinez,California 94553 510 313-6004 510 313-6002 FAX I . C NIRA COSTA: HEALTH PLAN dill I co gra o n th 11 H a! P144ti and H6dAthreRe0 s I . . ..-ca I j --�—.?�� "•¢-:ems'- ._ October 1993 1.2 ,::. .<; ,..:f. r >' M :Xy } CLQ *Poo :sC� .. 0 ZOO cc3 � Poo ,� to 1.3 Contra Costa Health Plan: Serving the Contra Costa Community's Need forAccess to Affordable Quality Health Care Services 1.4 II Contra Costa Health Plan has: Prepaid i PnmaryC are Based Public Hospital Centered Public Health Focused Prevention Oriented System of Care 1.5 41. W095.. PioneeringPrepaid History i 1973 First county-sponsored plan in California to sign prepaid Medi-Cal con- tract i :1976 First county-sponsored plan in nation to have prepaid Medicare j contract i 1980 First county-sponsored HMO in nation to receive federal qualification First county-sponsored HMO in California to enroll Medically Indigent 1983 Adults (Medically Needy BACs) into prepaid plan i First federally qualified prepaid plan in nation to give non-smoking dis- 1987 count to groups First prepaid plan in Northern California to offer"For Kids Only" and 1988 single parent premiums i First county-sponsored prepaid plan to participate in California's Major :1991 Risk Medical Insurance Program for uninsurables First HMO in the nation to manage the homeless in a prepaid i health plan First prepaid plan in Northern California to offer"On Your Own" (young adults ages 19-24) premiums First county-sponsored plan to participate in California's Access for 1992 Infants and Mothers (AIM) Program for low income pregnant women i First county-sponsored plan to participate in California's Small Business 1993 Purchasing Pool (Health Insurance Plan of California or HIPC) �I 1.6 r i County M.D.s Merrithew County Memorial Health Hospital nters Contra Costa Health Plan Contra Costa Health Plan is part of an integrated County sponsored system of care. Together, the Health Plan, the county hospital and clinics, and county physicians are the safety net for the under- served residents in the community. i CIA M tn w v �N cv Is G = s. UA 0V. O ,. O G• 4.0 to ... ti.. ... .O v C 1•$ oa � U r 1 t+F„ tV ?01 ° c x r G c c3 v o 1.1 V w � � - � �, .� e� .� `� � � � � U � � o �, � `� � � � �, � � � U � � �a ox' .� � � � U 0 a� � O � r""' � � � � x � � � .� �, tj � � N � N � �� � O � � � O � � � � � � � � v � � �., U, • • • • F •Okawt i 2.1 t �14, +tea w a Qrd v �Ll` un L, w un ... w C� w w � J 2.2 f 0 nA 0 CST U f Y � 41 N , xzX 9 Q a00 v-4 roll V'4 C SII � �• in In e4 N c eta 30 2.3 Managed Lessons Learned Contra Costa Health Plan members have equal access to the same high quality health care system. Yet our managed care experience reveals that on average . . . `:?�r A typical Medi-Cal (AFDC) member uses the emergency room more than twice as often as a commercial member such as county employee '�' And a typical medically indigent adult uses primary care three times as often and a senior uses almost three and a half times as much pharmacy services Seniors on Medi-cal will use almost 4x as much specialty care �� A Medi-cal recipient who is blind or disabled will use almost 7x as much inpatient hospital services 7� A SeniorHealth Plan member typically needs 10 times as much acute hospital services �, And AIM mothers have 25 times as much inpatient care 2.4 ___ N ATI NAL WALM CQXRE REFORM -i r Secuiity r S1 nipl.icity r Savings -i r Choice -i r Quality -i r Responsibility .......................------------------------------------------------ .................................................................................................................................................................................. � | 2.5 CONMClinton's Plan �A Security Security Proposes universal access: CCHP now offers almost Security of guaranteed universal access to the health coverage for all uninsured, under-insured, legal residents of U.S. and uninsurable in Contra Costa County. Merrithew Memorial Hospital and Clinics is provider of last resort. Proposes no denial of CCHP now offers cover coverage because of age without regard to health, employment or medical conditions for financial status, age, Medi-Cal, Medicare, medical condition BAC, Small Businesses, large Businesses, MRMIP, AIM. 4 �rk''•' 1, 2.7 CO Clinton's Plan HEALS PLANA Simplicity Simplicity r Proposes streamlining CCHP now offers one insurance complexities Health Plan card for all and redundancies members Proposes reducing CCHP administration administrative costs costs lower than national average for similar sized HMOs Requires standard CCHP members enjoy simplified forms for reim- practically no paperwork bursement claims Proposes reducing dupli- CCHP will need to coor- cation and waste in auto dinate auto and workers' and workers' compensation compensation in a seam- less 24-hour system of care 2,8 •� rJV.. J t. \ \ ti \ or 2.9 Clinton's Plan HEALS COSTA" Savings Savings Proposes consumers pay Most CCHP members less for low-cost plans and already have several plans more for high-cost plans, to choose from to fit their creating incentives for budget, encouraging cost- cost-conscious choice conscious choice Proposes health plans In CCHP today there are have incentives to spend no incentives to overtreat resources cost effectively or undertreat patients; primary care M.D.s on salary; specialists on flat fee Proposes subsidies for low CCHP currently offers income individuals and special pricing for child- small business ren, young adults, single parents, young families, medically needy, AIM, and small business Proposes community CCHP has been comm- rating unity rated since 1980 S ! x � 1 l� � 5/ 6` a r �1 ! .. ,. r , r r y s ! Fr h v r - dW • '► � � c f y z, dop • r r ! a • dw � < f f •Y < r / tir f , k � ! 2.11 CO11URA COSTA Clintons Plan HEALTH PLAN Choice Choice Proposes choice of health CCHP is currently offered plan offered through a to small businesses health alliance pool through a purchasing pool Proposes consumers can CCHP plan offers cover- choose their own health age certified to meet fed- coverage erally qualified Knox- Keene licensed require ments Proposes choice of doctor Members can choose from a staff of more than 120 physicians 2.12 1 coCHOIC A O 9 ® O I thought the Clinton Plan gave me the right to choose which doctor, not a witch doctor! 2.13 I decided to only With CCHP I had buy coverage just a choice of.1 Medi- for my child Kr. , care plans SENIOR I could choose between 2 plans for young adult_~ o FOR ~IDS ONLY We all choose our own �i doctors from Contra �••� Costa County's Staff O%VN Y )UR OWN I could choose be- tween 4 CCHP plans d �f for small businesses 1 / I i I i © i SNIALL BUS : ESS 2.14 Clinton's Plan CONiM PL" Quality Quality Proposes explicit quality CCHP has extensive goals and standards Quality Assurance and Peer Review systems an nually audited by State and Federal regulatory agencies Proposes health plans be CCHP has continuous held accountable for Quality Management quality improvement Systems in place Proposes regular publica- CCHP conducts regular tion of accessible inform- member satisfaction ation about quality and surveys and hospital exit cost surveys I Member Satisfaction Survey Satisfaction with Health Centers 91% of members expressed overall satisfaction 94% of members are satisfied with medical care j Satisfaction with Merrithew Inpatient 90% of members are satisfied Satisfaction with Staff i 97% of members are satisfied with nursing staff 96% are satisfied with nurse practitioners 95% are satisfied with M.D.s 95% are satisfied with reception/clerical Overall Satisfaction with Health Plan 95% of members are satisfied and are planning to stay i 2.16 I CONTRA COSTA Clintons Plan HEALTH PLAN Responsibility Responsibility ' Proposes making available to members CCHP currently provides members information on cost, qualifications and with complete and accurate informa- availability of providers,rights and tion on cost, qualifications and avail- responsibilities of patients ability of providers,rights and respon- sibilities of patients Proposes a grievance procedure CCHP grievance procedures already in place Proposes having an Advisory CCHP's HMO Advisory Board advises Board in place the governing body, the Board of Supervisors Proposes members help control CCHP members encouraged to share utilization in partnership with the plan responsibility through copayments, lifestyle adjustments. Primary care providers and Advice Nurses help members control utilization Proposes using primary care In CCHP family practice-based physicians primary care providers direct members'care Proposes that consumers take First HMO in nation to use smoking as responsibility for protecting and a risk factor for groups promoting health Lifestyle factors such as smoking, seat belts, weight and exercise are currently used in adjusting small group rates Proposes all consumers contribute SeniorHealth, individuals, small and to cost of care large group members all contribute to the cost of their care 2.17 -A- T-aking Our Own Health ----------------------------------- NO SMOKING -------------------------------= JYr"f� ..•rr �'� jam- i l +- r, t � f� .1 CG 2.18 .y - O -0 � end .co w � cz c �= = 0 V C 0Cld ay0co 3cz0w 1, ' p 0 0 44 o VCldu y o •° Jaz 8 8 r « �y a ,°c.cd� Eco- Q+% uC o M j a G E y C C oC_ O O" �': 8i y •«C�•:,rq „r 'C s ,QO c� � � � � �� W���� ��a � ��:c�a.�... �'amu-" � ''-• �' c av9uu a_ ae' c .c2o o �w .r� s$ a �3ae E�-'` '� 3t u $ E'&ao c cr o' _ , « m ; L « «. uo ° w ' Ecn .. �' bco� o = cc cv, cOi Pi �' � � oaNs '3 Ea,"'�cm °yEoL J « g'" y ar c.� 3 E a 3 E c « uc « o= _ E �Fi u r O_+A u= E �E a W m ` S u, o c itl 3 � �E u= �" u 3 a6' a� E s X1 £ _ a E u y u o °� r u °D c =3 -' u 3 = B W u4 Q `3 � � ey�'S--ar, .. 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It, «Usr u « $$' o a r>�'x Grc E m v� 2.19 Health Reform Changes From Unmanaged Care m=T�9> To Managed Care � Acute Inpatient Care System Of Care Treating Illness Maintaining Wellness Caring For Individual Accountable For Patients Health Status of Defined Populations FFS mm Capitated Specialty-Oriented Primary Care 2.20 ealth C yare Model Ssterr� USA Today Canada CCHI' Good ✓ ✓ Cheap ✓ ✓ Fast ✓ d Universal ✓ ✓ 2.21 BE Y� .. 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I am also aware of at least some help for residents of Contra Costa County. It is I am well aware of the health insurance crisis in the united States. I am also aware of at least some help for resi- dents of Contra Costa County. It is the Contra Costa Health Plan. Kerpos- for everyone, but it certainly does answer the problems for many. Bob Holden Sr. San Pablo �jecti��eOtoC , (\ �c1� \ � Nor " . Graph" Ba n (\ 6AIg�on V'iaeO �