Ohio Health Plans. Maximizing best practices & leading reform efforts. Search. Ohio Association of Health Plans

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1 Ohio Association of Health Plans File Edit View History Bookmarks Tools Window Help Ohio Health Plans Search Maximizing best practices & leading reform efforts

2 HELPING OHIOANS GET NEEDED CARE Commercial Insurers: Provide coverage to more than 6.7 million Ohioans. (Source: Kaiser Family Foundation) Create health insurance products that meet Ohioans diverse needs. Foster new ways to improve quality of care, while streamlining administrative processes to keep costs down. Medicaid Care Coordination Plans: Coordinate the health care needs of 1.6 million Ohioans. Link consumers to other social and behavioral health services. Provide a holistic approach to care management. Medicare Advantage: Offer medical coverage and coordinate the care of nearly 576,000 Ohio seniors and others on Medicare. Add valuable extra benefits like vision, hearing, health and wellness programs and dental care. Offer predictable costs for services.

3 INSURING OHIOANS WITH HEALTH CARE COVERAGE There are many health care coverage options available to Ohioans and health insurers are working to ensure that they deliver quality services at the lowest possible cost. THE BIG PICTURE: MOST OHIOANS RELY ON EMPLOYER-BASED HEALTH INSURANCE Other Public (Ohio High Risk Pool, Tricare, VA):.7% Individual: 4.3% Uninsured: 12.8% Medicaid: 13.3% Medicare: 14% Private or employer-based: 54.9% Of those covered by private insurance, 54% self-funded and 46% are fully-insured health plans. Source: Kaiser Family Foundation THE VALUE OF A DOLLAR A breakdown of health care spending 2011 Milliman Index Components of Health Care Spending - Distribution of the $19,393 total medical costs for the typical American family of four 31% Inpatient ($6,068) 33% Physician ($6,329) 17% Outpatient ($3,404) 15% Pharmacy ($2,847) 4% Other ($745)

4 Ohio Association of Health Plans 230 East Town Street, Suite 200 Columbus, Ohio The Ohio Association of Health Plans (OAHP) represents 20 member health plans providing health insurance coverage to more than 7.5 million Ohioans. Ohio s health plans include commercial insurers, Medicaid Care Coordination Plans and Medicare Advantage Plans. As the statewide trade association for the health insurance industry, the OAHP is a leading organization that actively promotes and advocates for quality health care benefits for all consumers in Ohio. CREATING JOBS! 46,823 people are employed by Ohio s health insurance industry. (Source: Ohio Department of Development) Medicaid Care Coordination Plans are responsible for over 3,500 jobs in Ohio. Average health insurance job salary: $40,193 (Source: AHIP) Ohio payroll: more than $2.9 billion (Source: Ohio Department of Development) Ohio s health insurers pay more than $200 million in premium taxes to the state annually. (Source: Ohio Department of Insurance) According to the Ohio Department of Insurance, Ohio saw an increase by 1,000 jobs in health/medicalinsurance employment in Ohio is ranked 6th in the nation as a health insurance employer.

5 BUILDING A SUSTAINABLE FUTURE Health care costs are the nation s most urgent fiscal problem, and are driving the increases in health insurance premiums. To help build a health care system that works going forward, health plans are taking the lead with innovations to tackle costs and improve health. Reducing Costs Creating new payment systems so we pay for quality and not quantity. Engaging consumers to ask important questions before a service is provided. Tackling medical errors and patient safety with incentives. Improving Health Text alerts to those with chronic care. Health coaching to make lifestyle changes. Sponsoring wellness events, such as Runners and Walkers Clubs. Hosting fitness activities, such as a Radio Disney dance party, to help keep kids fit. Providing access to the Health Footprint calculator to help members determine the impact their behaviors have on their health and on the health of their social network. Promoting the Diabetes Detection Program with free community and office-based screenings. Offering online nutrition programs and health information to members.

6 IMPROVING QUALITY OF CARE IN OHIO As the cost of medical services continues to rise, the Ohio Association of Health Plans and its member plans are committed to working with medical professionals to explore new payment structures and improving quality of care. SUCCESS 415 Ohio health plans were listed is U.S. News and World Report s Top Health Plans rankings for Commercial, Medicare and Medicaid plans in % of OAHP s member plans offer products accredited by either the National Committee for Quality Assurance or URAC. 4In 2011, J.D Power and Associates reported that Ohio s health plans rank three points above the national average in consumer satisfaction. RESULTS 4According to an Ohio Medicaid survey, over 85% of Ohio s Medicaid Care Coordination Plan members were satisfied with their health plan in 2010, up from 83% in 2009 and 82% in According to the Ohio Department of Insurance, Ohio saw a 30% increase in the number of health insurance carriers offering health insurance benefits in According to AHIP, 92% of commercial plans implement measures to improve quality among physicians. RIGHT CARE IN THE RIGHT SETTING 4Medicare advantage enrollees spent less time in hospitals and reduced emergency room visits by 29% in Health plans help to save up to $3.5 billion nationally in avoidable medical costs each year. 4Medicaid plans for access to preventive health care services exceed the national average.

7 By investing in technology and forging new partnerships, health insurers are connecting patients with new sources of care while containing costs. TECHNOLOGY 4Ohio insurers launched the Availity project, which provides physicians access to multiple insurers through a web portal for the purpose of conducting key office tasks. Potential for savings of $29 billion annually when fully implemented. (Source: AHIP) 4Insurers are connecting with consumers anytime, anywhere with the use of apps that can be used on smart phones. 4Insurers are investing in texting services to remind members about upcoming appointments with providers. MEDICAL HOME Columbus Organizing Entity: Access Health Columbus Participating Health Plans: Anthem BC/BS, Humana, Medical Mutual of Ohio, The Ohio State University Health Plan, UnitedHealthCare Cincinnati Organizing Entity: Aligning Forces for Quality Participating Health Plans: Anthem BC/BS, Humana, UnitedHealthCare Cleveland Organizing Entity: Better Health Greater Cleveland Participating Health Plans: TBD Dayton Organizing Entity: CareSource Participating Health Plans: CareSource Ohio s health plans are leading efforts to support development of patient-centered medical homes - pioneering new provider payment systems, electronic medical records, incentive programs, quality improvement goals and other innovations to help providers create new best practice operations. Southeast Ohio (6 Counties) Organizing Entity: CareSource Participating Health Plans: CareSource Emerging Projects Booneshoft School of Medicine at Wright State University University of Toledo College of Medicine Northeastern Ohio Universities Colleges of Medicine and Pharmacy Ohio University College of Osteopathic Medicine

8 PROVIDING VALUE IN OHIO In total, Ohio s health plans cover more than 9 million Ohioans through a variety of insurance products that provide consumers with value and peace of mind. (Source: Kaiser Family Foundation) COMMERCIAL Most Ohioans are insured through their employers or the individual market. 4More than 6.7 million covered lives. (Source: Kaiser Family Foundation) 4Ohioans pay 5% less the national average when it comes to employer-based coverage. 4The cost of individual coverage in Ohio is 5% less the national average. 4Ohio s health plans pay providers $12 billion annually for medical care. 4The Department of Insurance reports that 97 percent of electronically filed claims in 2010 were paid within 30 days. 4Nearly 75% of insured Ohioans have access to providers outside of the preferred network of providers. 4Access to 24-hour nurse hotlines to help consumers with questions any time, day or night. 4For every dollar our nation spends on health care, less than one penny goes towards health plan profits. (American Health Solution) 4In 2009, the percentage of premiums that went towards administrative costs and profits declined for the sixth year in a row. (AHIP) MEDICARE ADVANTAGE Seniors and others who qualify for Medicare can receive their coverage through a Medicare Advantage Plan. 4Medicare Advantage plans provide extra services to members, such as dental, vision, smoking cessation, and health and wellness offerings. 414 of OAHP s member plans offer Medicare Advantage Plans. 432% of Ohio s Medicare beneficiaries, or 576,000 Ohioans, are enrolled in Medicare Advantage Plans. (Source: Ohio Department of Insurance) 4Ohioans enrolled in a Medicare Advantage Plan pay less than the national monthly average for Medicare Advantage plans. 490% of plans have no co-payment for preventive services and screenings. 484% member satisfaction reported. (HHS) 4Ohio s health plans offer Special Needs Plans (SNPs) for those eligible for both Medicare and Medicaid and have specific chronic or disabling conditions like diabetes, congestive heart failure, mental illness or HIV/AIDS.

9 MEDICAID Medicaid Care Coordination Plans serve as a health care home for 1.6 million Ohioans. 47 OAHP member companies serve enrollees throughout Ohio. 4Adding value for consumers and the state by serving as the health care home for members, coordinating the medical, behavioral and social service needs to keep people s lives on track. 4$1 billion fiscal benefit to the state in the current biennium. 4Access to advice from nursing staff via a toll-free hotline, anytime, any place. How an Ohio Medicaid Premium Dollar is spent 4Expanded provider networks. 4No co-pays. 4Transportation services to appointments. 4Incentives for members to maintain good health. 497% of claims paid within 30 days and 99.8% of clean claims paid within 90 days according to the most recent ODJFS Managed Care Prompt Pay Semi-Annual Report for % of children age 12 months to 11 years in the Medicaid Care Coordination Program had a primary care visit; 86% of children ages had a primary care visit during the same period; and Ohio exceeded the national average during that same time period with 85 percent of adults ages 20 and over receiving a preventative health visit. 497% of Medicaid Care Coordination Plans interact with schools, 89% with volunteer organizations, such as local branches of the American Cancer Society, and 87% with faith-based organizations. 46 Hospital care 19 Physician/ Professional care 16 Prescription drugs 10 Dental, vision, and other medical services 9 Value-added managed care services* *Such as transportation, provider incentives, chronic disease management, wellness promotion and other care coordination services

10 INFORMING POLICYMAKERS With passage of federal healthcare reform, Ohio s health plans have begun implementation of the new provisions. While most of the changes are really just beginning in Ohio, the Ohio Association of Health Plans continues to engage with policymakers at the state and federal levels to ensure reforms are implemented as efficiently and effectively as possible while minimizing disruptions to current enrollees. LOOKING BACK In 2010, several reforms were quickly implemented in Ohio. These include: 4Federal dollars subsidized the Ohio High Risk Pool: currently insures 1,100 Ohioans with pre-existing conditions. 4Dependent care: coverage of dependents now through age 26, if dependent care is offered. 4Small business tax credits effective. 4Temporary early retiree reinsurance program established. 4No cost sharing for preventive services. 4Web portal developed for information on available coverage and programs. UPCOMING CHANGES Starting in Health Plan Medical loss ratio must be 80% for individual and small group policies and 85% for large groups. 4Creation of uniform descriptions of policy coverage. 4The cost of brand-name drugs for Medicare recipients will be cut by 50%. The doughnut hole will be closed by Subsidies for Medicare Advantage programs will be cut significantly to match traditional Medicare more closely. 4Free preventive services, such as annual wellness visits and personalized prevention plans for seniors on Medicare. 4Bonus payments to Medicare Advantage plans that provide high quality care. 4Prohibits Medicaid payments for health care acquired conditions. 4New Medicaid waste, fraud and abuse programs.

11 Annual Reports on quality-of-care activities. 4Medicaid demonstration projects New Health Insurance Tax to fund Comparative Effectiveness. 4Increase payments for primary care providers for Medicaid patients. 4Increase in federal assistance for preventive services in Medicaid New taxes on health insurance companies that increased each year from $8 billion to $14.3 billion in Individual mandate to purchase health insurance. 4Guaranteed issue to anyone that applies for health insurance regardless of their medical history and no pre-existing condition exclusions. 4Guaranteed renewability of coverage. 4No lifetime or annual dollar limits on essential benefits. 4State insurance exchanges established to allow consumers to shop for health insurance, receive government subsidies and sign up for state services. 4Rating differences of premiums for health insurance only vary due to age, location and tobacco use. 4Employers that do not offer health insurance coverage may incur penalties. 4Essential benefit package is required for all health insurance policies. 4Multi-state qualified health plans created and allowed for purchase in exchange. 4Temporary state reinsurance program for individual market. 4Co-ops created. 4Coverage for approved clinical trials. 4Cannot impose waiting periods for group coverage beyond 90-days. 4Individual and small business tax credits. 4Expand Medicaid to all non-medicare individuals under age 65 with incomes up to 133% Federal Poverty Level. 4Establishes Medicaid coverage for children under age 26 who were in foster care when they turned 18. 4New basic benefit plan for low-income Ohioans. 4Allows enrollment in Medicaid through internet. Hospitals and doctors to make eligibility determinations High cost health insurance tax.

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