120505 Universal- Multi Payer PowerPoint Universal Means for Everyone! It’s the promise of this grant. Michicare? Better for people: better for business

120505 Universal- Multi Payer PowerPoint120505 Universal- Multi Payer PowerPoint

Universal Means for Universal Means for Everyone!Everyone!

It’s the promise of this grant.It’s the promise of this grant.

Michicare?Michicare?

Better for people: better for businessBetter for people: better for business


CoverageCoverage

Everybody in!Everybody in! Phase in uninsured first.Phase in uninsured first. No means testNo means test Insurance not related to employmentInsurance not related to employment All are automatically in the planAll are automatically in the plan Present HMO’s; Blue Cross; HAP and Present HMO’s; Blue Cross; HAP and

selected others to bid on covering the selected others to bid on covering the uninsured and on everyone within 5 years.uninsured and on everyone within 5 years.


SummarySummary

Early phases focus on primary and Early phases focus on primary and preventive care.preventive care.

Multiple payers but substantially fewer Multiple payers but substantially fewer than at present.than at present.

State to collect funds and contract with State to collect funds and contract with health insurance carriers as we do in health insurance carriers as we do in Medicaid.Medicaid.

Capitation rate to insurers in either case.Capitation rate to insurers in either case.


Funding SummaryFunding Summary

Integrate workers’ disability [WC], motor vehicle Integrate workers’ disability [WC], motor vehicle medical coverage [PIP], and other medical medical coverage [PIP], and other medical coverage to lessen administrative and claims coverage to lessen administrative and claims overhead.overhead.

Legislate that there can be no exclusions for Legislate that there can be no exclusions for WC, PIP or other categorical coverage – WC, PIP or other categorical coverage – one one policy/one person.policy/one person.

Assess a fee to motor vehicle owners, Assess a fee to motor vehicle owners, individuals, and employers at a rate lower than individuals, and employers at a rate lower than present WC, PIP, administrative costs and present WC, PIP, administrative costs and capture funds for coverage.capture funds for coverage.


Timeline – Year One and TwoTimeline – Year One and Two

Year One – make changes to WC; PIP etc Year One – make changes to WC; PIP etc and begin collecting funds.and begin collecting funds.

Give DCH authority over all medical Give DCH authority over all medical programs and discretion over use of funds.programs and discretion over use of funds.

Use funds to cover the uninsured in year Use funds to cover the uninsured in year one or two, as funds needed are collected.one or two, as funds needed are collected.

Begin debate over a fair financing system Begin debate over a fair financing system needed to make system permanent, needed to make system permanent, universal, and comprehensiveuniversal, and comprehensive


Time Line – Year Two and ThreeTime Line – Year Two and Three

Cover everyone!Cover everyone! Assess and implement benefits based on Assess and implement benefits based on

financesfinances Focus on chronic diseases Focus on chronic diseases State to establish price limits for procedures and State to establish price limits for procedures and

care such as WC’s cost containmentcare such as WC’s cost containment Age tiering – people on Medicare would need Age tiering – people on Medicare would need

less coverage from Michicare.less coverage from Michicare. Establish savings based on quality measures Establish savings based on quality measures

and mechanism to collect portion of savingsand mechanism to collect portion of savings


Time Line – Year Four and FiveTime Line – Year Four and Five

Assure comprehensive benefits as in Assure comprehensive benefits as in Michicare legislation.Michicare legislation.

Implement general fair financing Implement general fair financing mechanism to take the burden of mechanism to take the burden of health insurance off of employers.health insurance off of employers.

System unique to Michigan would System unique to Michigan would draw business to the state.draw business to the state.


Benefit PackageBenefit Package

Phase One – Collecting funds and Phase One – Collecting funds and programs under DCH.programs under DCH.

Phase Two – Covering the Uninsured – Phase Two – Covering the Uninsured – Medicaid benefit package.Medicaid benefit package.

Phase Three – Covering All – depending Phase Three – Covering All – depending on funds – comprehensive benefit on funds – comprehensive benefit package. Take burden off of employers!package. Take burden off of employers!


Quality of Care/Effect on Delivery Quality of Care/Effect on Delivery SystemSystem

Use incentives to promote evidence-based Use incentives to promote evidence-based medicine medicine

Use pay-for-performance model to save on Use pay-for-performance model to save on qualityquality

Use disease-based protocolsUse disease-based protocols Use incentives to patients to promote healthy Use incentives to patients to promote healthy

behaviorbehavior Use incentives to providers to promote the use Use incentives to providers to promote the use

of electronic records, or simply require thisof electronic records, or simply require this Use incentive plans for geographic accessUse incentive plans for geographic access


Quality ControlQuality Control

Establish mechanism to measure Establish mechanism to measure savings because of quality controlsavings because of quality control

Establish savings goals (savings Establish savings goals (savings in Maine were $43 million in a in Maine were $43 million in a system 1/10system 1/10thth the size of the size of Michigan)Michigan)


Cost ConsiderationsCost Considerations

Anticipate greater cost when uninsured first get Anticipate greater cost when uninsured first get covered; with lessening thereafter.covered; with lessening thereafter.

Cost containment by negotiating of Cost containment by negotiating of pharmaceutical prices; evidence based pharmaceutical prices; evidence based medicine; e-record keeping; disease based medicine; e-record keeping; disease based protocolsprotocols

Decreasing number of insurers decreases Decreasing number of insurers decreases overheadoverhead

Ending WC, PIP and other medical coverage Ending WC, PIP and other medical coverage lessens claims systems and disputes.lessens claims systems and disputes.


Capturing the Money - ExampleCapturing the Money - Example

PIP and Catastrophic Claims premiums to PIP and Catastrophic Claims premiums to go to DCH.go to DCH.

As costs brought under control drop these As costs brought under control drop these rates.rates.

Eventually end the premium system and Eventually end the premium system and create a fee per motor vehicle at a rate create a fee per motor vehicle at a rate less than present day premiums to go to less than present day premiums to go to DCH to provide health insuranceDCH to provide health insurance


Medicaid??Medicaid??

Use funds to expand Medicaid Use funds to expand Medicaid program capturing federal matchprogram capturing federal match

Allows expansion of Medicaid Allows expansion of Medicaid through present HMO driven through present HMO driven systemsystem


FairnessFairness

Everyone is covered!!.Everyone is covered!!. Problems of ‘over-insurance’ lessened.Problems of ‘over-insurance’ lessened. Decreasing administrative cost for all.Decreasing administrative cost for all. Quick access for uninsured to Quick access for uninsured to

primary/preventive care decreases use of primary/preventive care decreases use of ER in near future.ER in near future.

Care management and disease based Care management and disease based treatment lessen costs.treatment lessen costs.


EquityEquity

All have set benefits for medically All have set benefits for medically necessary services.necessary services.

Allowed to buy policy covering more.Allowed to buy policy covering more. No coverage issues with claims of No coverage issues with claims of

categorical coverage.categorical coverage. No loss of health insurance if job is lost.No loss of health insurance if job is lost. Increased regulation, and increased Increased regulation, and increased

incentives.incentives.


Consumer ChoiceConsumer Choice

Consumer given list of insurance Consumer given list of insurance companies or HMO’s to choose from.companies or HMO’s to choose from.

May choose any company.May choose any company. Providers not limited.Providers not limited.


TradeoffsTradeoffs

End some programs to increase funds End some programs to increase funds used for general health insurance.used for general health insurance.

Greater regulation of provider pricing.Greater regulation of provider pricing. Employers lose ‘control’ of HI industry.Employers lose ‘control’ of HI industry. Medical malpractice premiums should Medical malpractice premiums should

drop.drop. Universal system would draw business Universal system would draw business

into the state.into the state.


TradeoffsTradeoffs

Health insurance off the collective Health insurance off the collective bargaining tablebargaining table

Greater regulation of pharmaceutical Greater regulation of pharmaceutical pricing through negotiationpricing through negotiation

Note: System would not affect Note: System would not affect technological innovationtechnological innovation

Documents

120505 Universal- Multi Payer PowerPoint Universal Means for Everyone! It’s the promise of this grant. Michicare? Better for people: better for business