VERMONT HEALTH REFORM Green Mountain Care: Vermont’s Health Care Reform Mark Larson, Commissioner Department of Vermont Health Access April 19, 2012

VERMONT HEALTH REFORM

Green Mountain Care:Vermont’s Health Care Reform

Mark Larson, CommissionerDepartment of Vermont Health Access

April 19, 2012


Long history of coverage, quality, & cost control initiatives

Early efforts focused on expanding coverage – Children & pregnant women– Dental coverage for kids– Vermont Program for Quality in Health Care (VPQHC)

Mid-1990s– Universal access for kids

• Dr. Dynasaur– Coverage for low-income single adults

• Vermont Health Access Plan (VHAP)– Expanded pharmacy assistance program for seniors and

those with disabilities– Attempts at delivery system and payment reform largely

failed


Long history of coverage, quality, & cost control initiatives Late 90s - Early 2000

– Prescription Drug initiatives– Care Coordination

– Maximizes health outcomes for complex Medicaid beneficiaries

2004 to 2010– Efforts to maintain current access

• Part D wrap-around Rx coverage– Public-private partnerships, in lieu of gov’t

sponsored• Catamount Health

– Premium assistance• Employer-sponsored insurance subsidies• Rebranding as “Green Mountain Care”


Catamount Health & ESI Premium Subsidies for private insurance

– individual market (Catamount)– Employer markets – ESIA– 300% FPL

Provide a cost-sharing wrap so private coverage mirrors state-sponsored coverage in VHAP at lower incomes– 150% FPL adults w/o kids– 185% FPL parents

200,000 Vermonter are still uninsured or underinsured And the world changes in 2014….



Coverage options in 2014 Medicaid & the Exchange – a continuum

– Expand Medicaid up to 133% FPL• 70-80% of adults on VHAP will become eligible

– 2 options for 133-200%• Basic Health Plan• State premium & cost-sharing subsidies in addition to federal

subsidies & cost-sharing subsidies– 200% - 400%

• Federal premium subsidies (up to 400%) & cost-sharing subsidies (up to 250%)

• Considering state premium & cost-sharing subsidies, needs more analysis


Coverage options in 2014 Private market shifts– Catamount Health to Exchange plans– Association market employer plans to small group

Exchange plans– Existing small group to small group Exchange plans

Bottom line: lots of people changing coverage!


Green Mountain Care (single payer)

• Occurs after Affordable Care Act waiver and other requirements are met

• All Vermonters covered by virtue of residency• Legislative concerns re: in-migration of people for benefits• Penalties for falsifying residency• De-coupled from employment

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Exchange planning: Know your audience Report on uninsured & underinsured– http://dvha.vermont.gov/administration/hbe-uninsured-u

nderinsured-report-03032011.pdf– Slides with yellow are from the contractor, Market

Decisions

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Small Business Survey - FindingsCurrent Insurance Offerings

• 44% of businesses offer health insurance to full time employees and another 30% cover both full and part time workers. Of covering PT, 81% do not enroll.

• 28% offer employees a choice of plans while 72% only offer 1 plan from a single insurer.

• 51% describe their plan as comprehensive coverage while 46% offer high deductible plans and 3% offer catastrophic coverage only.

• 88% of businesses that offer insurance cover at least some of the cost of their employees’ premiums.

• Almost all businesses (94%) have seen premiums increase in the last 3 years and 72% covered some or all of the cost of this increase.


Small Business Survey - Findings

Communication

• 74% thought the state should be responsible for providing information about the Exchange to employers.

• 14% thought insurance brokers should be responsible for providing information.

– 54% use brokers ( 25% DK) for their current insurance, 26% thought brokers would be important for accessing insurance through the Exchange.

• The most popular ways to communicate information to businesses about the exchange were through direct mailings and a website.


Small Business Survey - Findings

Finding Not to be Ignored

Many of the uninsured and underinsured currently have access to employer sponsored health insurance or work at employers that provide health insurance to full-time employees.


Focus Groups of Uninsured Vermonters - Findings

•Cost of even subsidized insurance is not affordable, “its more than rent or mortgage”.

•Insurance not “worth the money”, health care expenses don’t come near amount that insurance would cost.

•Most skeptical that subsidies will make insurance affordable to them.

•Most do not want to be forced to buy what they cannot afford.

•Many don’t like implications of plan names, Platinum, Gold, etc. Richer get better plans.

•Will look to internet first for info, want personal assistance to choose.


Focus Groups of Uninsured Vermonters - Findings

Key Consumer Questions about Health Insurance

1.What will insurance cost me?

2.What will insurance cover? Interested in coverage for the expenses that would normally come out of their pockets.

3.What doctors can I use? Don’t want to be restricted.


Focus Groups of Underinsured Vermonters - Findings

•In financial trap – many must have insurance, expensive high deductible plans means some pay $10-20,000 a year.

•More heath insurance savvy.

•Know high cost of healthcare as they see and pay bills directly.

•Smart about buying to save.

•Some forgo necessary or recommended preventative care.

•Don’t see much new /benefit for them from the Healthcare Act.•Will look to internet first for info, want personal assistance to choose.


Focus Groups of Underinsured Vermonters - Findings

Findings Not to be Ignored

1.Will readily consider alternatives to current insurance.

2.Informed and hard-nosed shoppers - will require high quality support.


Non-profit Interviews - Findings

• Experience demonstrates that cost coverage and eligibility of Govt. health plans are complicated and confusing to patients.

• One-on-one assistance is necessary to facilitate enrollment. For many-phone assistance OK, For others face-to-face.

• Navigator role is critical to success of insurance expansion.

• Navigator must be credible and neutral (no financial stake in what plan client chooses, brokers viewed as biased).

• Best Navigator would serve as an “advocate”, steering client to the best decision.

• Multiple sources of information are necessary , web, written and person-to-person. Web alone not sufficient.

VERMONT HEALTH REFORM18

Non-profit Interviews - Findings


Effective navigators need to be well trained and knowledgeable and have the time (and motivation?) to provide effective one-on-one consultation.


Insurance Agent Interviews - Findings

§Typically represent more than one, or all, insurers.

§Consider role as consultative - helping fit a plan to the employers needs and budget.

§Provide onsite enrollment and service ( acting as intermediary) between customer and insurance company.

§One-one-one assistance of individuals and small businesses is often required.

§Those that serve smaller of small business expect exchange to compete directly. Expect that larger customers may continue to want services of agent.


Insurance Agent Interviews - Findings


Agents serve the bulk of Vermont’s employed and employers, and are currently the primary mechanism for information about plan options, information about complying with regulations and for customer support if customer/insurer communications fail.


GREEN MOUNTAIN CARE - 2007


Green Mountain Care – 2007First 6 Months

Conducted focus groups, tested messages & brand names

Created an umbrella “Green Mountain Care” Created promotional materials Launched General Ad Campaign Launched website Measured brand recognition

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Advertisement Six weeks of ads over 3 months TV, Radio, Print & Web 45% recognized GMC 69% recalled TV “Horse” Ad Ad caused 1 in 5 to take action

http://www.vermont.gov/portal/media/index.php Choose “Green Mountain Care” from drop down

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College Senior Campaign

April 2008– Hosted a concert w/ The Buzz 99.9– 4 weeks / 120 radio promotions– Links on The Buzz, Seven Days, B-Scene and Higher Ground– Sponsored concert at Higher Ground– Church Street, Burlington merchant sponsorship

Spring 2009– 5,541 seniors @ 20 colleges– Emails & e-bulletin boards– Info w/ Career Planning– Info w/ Caps & Gowns

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Spring 2009 – Outreach to Facility & Staff

• 8778 facility & staff @ 20 colleges• HR Departments• COBRA letters

– Message to Parents via Business• LCRCC, 6,000 e-Newsletter • VABSR, 400 college interns• City of Burlington, 600 employees• VLCT, annual letter to subscribers

– Partnership w/ Chittenden Bank• Messaged on 64 ATM machines• Brochures & Flyers in 47 branches• 9,000 bank newsletters

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Summer 2009 – Marketing via State Agencies

• State Liquor Stores 74 sites– Messages on receipts– Brochures in stores

• State Lottery, Powerball & Megabucks– Messages on receipts– Brochures in stores

Spring 2010– Partnered with UVM and Champlain College Marketing Students

• Conducted peer to peer focus groups.• Peer outreach on campus• Video Production

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Other Outreach Company Lay Offs & Job Fairs– FY 10 Partnered with DOL at 14 layoffs and six job fairs to

reach 1100 people – From Oct. 2007 to today reached• 6660 laid off employee at worksite• 2210 at job fairs

Wal-Mart event in area with high uninsured rate– Radio remote– 78 pre-event promotionals– Partnered with CMS, BCBS and MVP

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Green Mountain Care Results (Launched October 2007)

2005 65,000 (9.8%) uninsured

2008 47,286 (7.6%) uninsured

2009 47,460 (7.6%) uninsured

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Lessons Learned Leverage multiple resources – money goes further Professional actors in the ads – too expensive; limited our use

– Just keeping it on the GMC site - $7,200 + actor fees– $450,000 for 6 weeks– BCBS spent $20,000

Celebrity spokesperson -with a lot of pre-planning price is significantly reduced Name recognition is the most difficult part! Bang at the beginning – 2007-2008 impacted on uninsured rates; after that, no

impact on uninsured rate


EXCHAGE


Exchange Planning: Outreach and Enrollment

Hot off the press survey results– 73% of Vermonters had not heard of the Exchange– After an one sentence explanation of an Exchange, 75%

said they would somewhat to very interested in using the Exchange

– After additional questions & explanations, this went up to 86%• Including information about the mandate & penalties


Exchange Planning: Outreach and Enrollment

Outreach and Education Plan– Assistance from GMMB to determine right level & types of

outreach– Also, assisting with the Navigator program– Hiring for an outreach and education coordinator in our

Exchange


Contact InformationRobin J. Lunge, Director of Health Care [email protected](802) 828-2316 (assistant: Marisa Melamed)

Documents

VERMONT HEALTH REFORM Green Mountain Care: Vermont’s Health Care Reform Mark Larson, Commissioner Department of Vermont Health Access April 19, 2012