Hacia Salud Presentation At Ag Safe


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  • Please welcome participants. Introduce the session and yourself and speakers if applicable - including a brief background on yourself and your expertise on the topic being presented. Review emergency procedures and remind participants to fill out their evaluation and to put it in the evaluation box as they leave. Thank you and have a great session!!
  • Hacia Salud Presentation At Ag Safe

    1. 1. CO-OPs Work in Ag, Can They Work In Health Care Too?Presented February 23, 2012 by Ed McClements, CLU, ChFC
    2. 2.  Guaranteed Insurability Regardless of Health Individual Mandate to Buy Coverage Unlimited Benefits (no Annual or Lifetime Caps) Plans Must Meet/Exceed Essential Benefit Levels Large Employer (50+) Mandate to PLAY or PAY* *refers to a $2,000 per employee per yr. non-deductible tax penalty to the employer if they do not offer employees Essential Benefit plans with “Bronze Coverage” Level Do You Have a Plan to Deal With This? 2
    3. 3. Although many hope that these health care reforms will be eliminated before they go into full effect, it is looking less and less likely this will occur… U.S. Supreme Court is set to rule this Summer on the constitutionality of the Law ▪ Prediction* 1 – Individual Mandate Unconstitutional (5-4 vote) ▪ Prediction* 2 – The REST of the Reform STAYS Republicans Sweep Elections (unlikely but possible) ▪ Still questionable if Affordable Care Act is greatly altered * STRICTLY my best informed opinion – it carries NO legal force or effect! 3
    4. 4. It is estimated that California’s agriculturallabor pool is about 400,000 workers WGAT had 19,697 as of 6/30/2010 UABT had 12,789 as of 12/31/2010 Self Funded Employer Plans (unknown but unlikely to exceed 100,000 total participants) Bottom-Line: An estimated 2 out of 3 farmworkers have no employer provided health benefits 4
    5. 5.  In 2014, plans with Annual Benefit Caps will no longer be eligible for WAIVER status For example: instead of limiting losses at $25,000 per person per year, these plans will need to offer UNLIMITED benefits Ag Associations are working hard to extend that deadlineBottom-Line: Higher (possibly MUCH higher) costs for these programs 5
    6. 6. 6
    7. 7. • Time off from work only taken for medical emergencies• Location of medical services can be inconvenient• Office hours for appointments are inconvenient for most• Typical health plans have out-of pocket costs that are too high• Current public programs (MediCal, etc.) raise concerns over documentation issues (Deficit Reduction Act of 2005 requires proof of citizenship / immigration status)• County & State budget cuts make getting uninsured care harder• New health insurance EXCHANGES not available to undocumented workers 7
    8. 8. True INNOVATION inhealth care delivery to drive down costand drive up access 8
    9. 9.  Lowest Possible Cost High Quality Medical Clinics The New Essential Benefit Levels Easy Access to Medical Care Offer Low Cost Prescriptions Non-Profit and Member Run Structure HEAVILY Invest in Preventive Care No Requirement for Immigration Documentation 9
    10. 10.  Instead of LARGE (and expensive) PPO networks, we need to create a primary care network out of the top SAFETY-NET clinics around the state ▪ Federally Qualified Health Care Centers ▪ Many awarded Joint Commission Quality Awards ▪ Proven dedication to Latino population Roll Mobile Medical Clinics to worksites Provide access to the MediCal Rx discount program Make it free and easy to get preventive care Make the whole program non-profit and member run 10
    11. 11.  Provide each participant with a “Medical Home”  Link primary care with specialists & ancillary medical services  Work with HRSA – Health Resources Service Administration  Federally Qualified Health Centers  Rural Health Centers  Carefully selected regional hospitals  Use existing Mobile Medical Clinics / purchase if needed  Reliance on Promotores to encourage preventive health practices within the population* Exclusive Provider Organization • Like a PPO, but a lot smaller • Unlike an HMO, an EPO has no gatekeepers 11
    12. 12. This Network IS PROPOSED. None of the above clinics havecommitted to participate, since the CO-OP is still in its formation stage. 12
    13. 13. Make it easyfor workers tosee a provider Large groups create economic efficiencies 13
    14. 14. 14
    15. 15.  The ACA provides for Consumer Operated and Oriented Plans (CO-OPs) Dept. of Health & Human Services has $3.8 Billion to lend (with low interest rate loans) to non-profit groups for CO-OP formation (with a goal of at least one CO-OP in each state) CO-OPs are like Credit Unions for health insurance We intend to use the Federal CO-OP funding program to launch our new style of health plan According to multiple sources, we may be the ONLY one in Calif. 15
    16. 16.  New Non-Profit Mutual Benefit Corporation Ag focused formation board Eventually, a member run health insurance company Created for the ACA CO-OP funding opportunity Seeking start-up and solvency loans from HHS Target underserved hourly wage workforce Focused on Latino cultural needs California initially but seeking multi-state growth Dramatically different from current health plans in management, design and delivery10% of premiums dedicated to prevention 16
    17. 17. OperationalHealth Insurer by 1/1/2014 HHS/CMSFunding Award (mid 2012) 172/23/2012
    18. 18.  Obtained CA approval of Articles of Incorporation for non-profit Currently have 14 Board / 6 Advisory commitments Held 3 Board of Directors meetings Approved initial by-laws Opened bank accounts Named Chair/Vice Chair/Sec. Treasurer/ Exec. Dir. Hired Milliman as actuarial consulting firm Hired top law firm for DOI regulatory assistance Hired public health policy / grant writer Initiated discussions with select providers Have raised most initial funding needed for HHS application Filing formal application prior to April 2, 2012 18
    19. 19. Name Title Company Ed McClements Sr. Vice President Barkley Insurance & Risk Management Al Barkley CEO Barkley Insurance & Risk ManagementHacia Salud Roger Boman CEO Transwestern Ins. Administrators George Ekizian President Ekizian & Associates Ins. ServicesBy-Laws call Rudy Avila HR Director Jaguar Farm Labor Contracting Lynn Grayson CFO Boskovich Farmsfor 15 Board Ron Hayduk President Coastal States Insurance Services Lori LeSuer CFO Villa Park OrchardsMembers Santiago Martin, Jr. President Cal Ag Resources Glen Michael Managing Partner Benefits Administartion & Insurance Servicecs, LLC Roy Nishomori President San Miguel Produce, Inc. Juan Uranga Executive Director Center for Community Advocacy Jerry Van Winderden President Westland Floral Mark Weighall Agribusiness Controller Pandol Bros., Inc. Matt Conroy President Conroy Farms Henry Vega President Coastal Harvesting Keith Ford President Ocean Breeze Ag Management Rene Van Wingerden President Ocean Breeze International Lenny Villagomez President All Ag Tim Finster President CAPAX Executive Director Board Members Advisory Members 19
    20. 20. • CO-OP rules require that the majority of the Operational Board be comprised of members in the CO-OP• Transition from Formation Board to Operational Board must be completed within 2 years of first membership• Each “Care Area” will elect a regional representative• Care Area with greatest membership will be able to seat the 8th regional representative 20
    21. 21.  Medical Provider Legal Insurance Management Insurance Distribution Labor Advocate Employer At Large 21
    22. 22. • Each Care Area will have a Care Committee (9 elected plan participants + a Hacia Salud representative + a local provider representative)• Care Committees meet monthly• Care Committees will oversee the coordination of the preventive care expenditures in their region• Care Committees will oversee development and funding of PROMOTORES programs locally• Care Committees will also oversee community outreach funding “life-changing-grants”, and other health-focused programs 22
    23. 23. Preventive Care Budget Care Area 1 - San Diego/Riv/SanBer/Imp $2,328,663 These Care Area 2 - LA and OC $7,594,162 figures Care Area 3 - Ventura and Santa Barbara $2,482,750 are Care Area 4 - SLO and Monterey $5,692,454 expected Care Area 5 - South San Joaquin Valley $3,381,014 to Care Area 6 - Northern Cal $1,141,689 DOUBLE Care Area 7 - Bay Area $2,282,125 in 2015 TOTAL First Year Preventive Care Budget $24,902,858 Participating clinics will be directly involved with theplanning for the use of these funds in their regions of operation 23
    24. 24.  October 15, 2011 – Letter of Intent to HHS November 1, 2011 – Selection of grant writer November 15, 2011 – Selection of actuary for feasibility study December 31, 2011 – CA certification of Articles of Inc. February 15, 2012 – First draft of feasibility study March 15, 2012 – Final application draft complete March 20, 2012 – Submission of application (deadline is 4/2/2012) June 15, 2012 – Notification of approval or denial of application August 1, 2012 – If approved, start-up funding begins: hiring of core staff, begin contracting provider network, etc. December 1, 2012 – Ins. Co. application to CADOI June 1, 2013 – License approved August 1, 2013 – Launch public awareness / marketing campaign September 1, 2013 – Issue initial rates January 1, 2014 – First plan participants 24
    25. 25.  All Hacia Salud Plans will be fully compliant with ESSENTIAL BENEFIT LEVELS (not yet defined for California) Target pricing for Bronze Level Benefits is <$200 per month per individual (up to age 39) in most areas of California 25
    26. 26.  Hacia Salud will be operational January 1, 2014 Hacia Salud will offer Bronze /Silver / Gold / Platinum benefit levels to both the Individual and Small Employer (SHOP) Exchange Hacia Salud will also offer the general public access to the same plans that are available in the exchanges 26
    27. 27.  Our Estimate for total enrollment statewide:  141,000 total participants by the end of 2014  226,000 total participants by the end of 2015 Our initial target for enrollment was within 5% of the growth target established by our independent actuary
    28. 28. In addition to farmworkers… Restaurant workers Hotel workers Janitorial Service employees Manufacturing workers Garment Industry workers Construction workers Landscapers Small business employees Individuals in need of low cost & high value coverage 28
    29. 29. State Organization Name Award TotalIA & NE Midwest Members Health $112,612,100 MT Montana Health Cooperative $58,138,300 NJ Freelancers CO-OP of New Jersey $107,213,300 NM New Mexico Health Connections $70,364,500 NY Freelancers Health Service Corporation $174,445,000 OR Freelancers CO-OP of Oregon $59,487,500 WI Common Ground Healthcare Cooperative $56,416,600 Total Awarded So Far $638,677,300Earmarked Funding for Entire CO-OP Formation Program $3,800,000,000 Percentage Awarded So Far 16.807% Potentail Funding Still Available $3,161,322,700 29
    30. 30.  Can Hacia Salud help you: ▪ Understand how employer Play or Pay rules are likely to impact your company? ▪ Create a strategy to deal with the expected changes to health care in 2014? Can you help Hacia Salud: ▪ Submit a letter of support? ▪ Connect with a Community Clinic you use and can recommend? ▪ Contribute financially to the formation effort? 30
    31. 31. For more information, contact: Ed McClements, CLU, ChFC Sr. VP – Benefits for Barkley Ins.Exec. Director – Hacia Salud CO-OP (949) 232-9178 emcclements@haciasalud.org 31