Carlyle coo ps


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  • Neither Democrats nor Republicans embraceNot a cooperative
  • Creating an insurance entity is significant endeavor: marketing, enrollment, benefits, claims processing, client complaints
  • Chief aide for Senator Grassley was in room when idea was fleshed out.
  • Chair Allen Feezor-had serve on panels for NIH and Institute of Medicine. Vice-Chair of Health Practice Council of American Academy of Actuaries, Dr. David Buck of Houston, Dr. Michael Pramenko of Colorado, Also office for exchanges.
  • Lost money in this summer’s budget compromise
  • Carlyle coo ps

    1. 1. Section 1322 : CO-OPsConsumerOperated and Oriented PlansThe Middle Approach to Health Reform
    2. 2. Major Concepts• Health insurance entity-solvency• Non profit: profits used to reduce premiums or increased benefits• Premium holders elect Board of Directors• Government loans to provide start-up costs and to provide for reserves.• State, within State, Multi-State options• Required to have “integrated care”
    3. 3. Origin• Senator Kent Conrad of North Dakota• Based on concept of cooperatives found in rural America-grain, rural electric, credit union• Real life health cooperatives-GroupHealth of Seattle and Health Partners of Minneapolis• Opposition by Blue Cross/Blue Shields
    4. 4. Process• CO-Op Advisory Board-3 family physicians• Recommendations from AdvisoryBoard• Center for Consumer Information and Insurance Oversight,Center for Medicare/Medicaid Services, Department of Health and Human Services• Preliminary regulations• Applications: First deadline-October 17, 2011• Awardees notified in 75 days.
    5. 5. Finances• Initially-$6.2 billion• Now-$3.8 billion• Re-pay start-up loans in 5 years• Re-pay reserve loan in 15 years• Cannot use money formarketing• Need to show local financial support• Does not pay federal corporate income taxes
    6. 6. Restrictions• Cannot be a current insurance company or cooperative• Must show provider support• Must be sold on the Exchange• “substantially all” activity must be in either the individual andsmall group markets(either<50 or <100 employees)• Must meet local State Insurance regulations
    7. 7. Integrated Care “approach to care. . .includes apayment process that incentivizes a system of care coordination to provide safe and clinically based quality health care in the most efficient and evidence-based manner”
    8. 8. Integrated Care Examples• Medical Home• Accountable Care Organization
    9. 9. Iowa Example• 3rd Most Concentrated State Market• Wellmark raised rates for 2012 9.3%• Has said publicly will probably not sell policies in the Exchange• 1 in 4 Iowans belong to a cooperative• Dominance prevented care coordination efforts
    10. 10. Future• Grants announced-January, 2012• CO-OPs formed-2012• CO-OPs sell policies within and outside of Exchanges-2013• CO-OPs policies go into effect-2014• CO-OPs pay for “integrated care”-2014• CO-OP premium holders elect CO-OP Board of Directors-2014/2015