Health Insurance Innovation Task Force...Sep 12, 2019 · agenda. welcome. minutes. demographics and target population. task force member presentations. presentation on idaho insurance

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/

https://healthinsurancetaskforce.mo.gov/

Agenda


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

https://ccf.georgetown.edu/wp-content/uploads/2018/09/FINALHealthInsuranceCoverage_Rural_2018.pdf

Agenda


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


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


• 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


• 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


• 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


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


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


• 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


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


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


$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


Overview of Reinsurance


• 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


• 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


• 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


• 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


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


• 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


2019 Ambetter Plan Offerings in Missouri

Agenda


65

Presentations on Idaho Insurance Innovations

DIRECTOR DEAN L. CAMERONIDAHO DEPARTMENT OF INSURANCE

66

Agenda


67

Presentation on the Colorado 1332 Waiver

COMMISSIONER MICHAEL CONWAYCOLORADO DIVISION OF INSURANCE

68

Agenda


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


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


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.


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.


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.


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


Conditions List (continued)

77


Adjusted Plan Options

• Actuarial Value

• Metal Level

78


High Deductible Health Plan Ideas

79

Pre-deductible

Primary Care

Behavioral Health

Virtual Visits

Rx

Agenda


80

Documents

Health Insurance Innovation Task Force...Sep 12, 2019 · agenda. welcome. minutes. demographics and target population. task force member presentations. presentation on idaho insurance