Healthcare Exchange Webinar


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Healthcare Exchange Webinar

  1. 1. A Legislative Update:Implications of Healthcare Reform<br />Reid Rasmussen <br />& Guest Contributors<br />
  2. 2. Agenda<br />The New Issue: Cooperatives<br />The Kennedy Factor<br />The Future of Healthcare <br />The Legislative Process: A Reminder & What We’ll See<br />Resources For Staying Engaged<br />
  3. 3. Cooperatives<br />“If not a Public Plan, then let’s build Cooperatives”<br />Version 1: Senator Kent Conrad’s Description<br />Version 2: House Bill Language<br />Version 3: Real-World Examples<br />The Growing Discussion<br />
  4. 4. Cooperatives: Senator Kent Conrad’s Description<br />Cooperative Plan<br />An insurance option sold within Exchange(s)<br />Democratically controlled by members; governed by an elected Board.<br />Surpluses retuned to members or reinvested <br />Non-profit<br />Funding<br />Initial seed $: Government & Others<br />Then self-sustaining<br />Considerations?<br />Individuals? Groups?<br />State Law <br />Conversion of existing Insurance Plan?<br />Elected Board<br />Exchange<br />$<br />$<br />$<br />$6B<br />?<br />?<br />
  5. 5. Cooperatives: House Bill Language<br />Cooperative Plan<br />Not for profit, member-run<br />Sold through Exchange(s)<br />Once established, Co-op is at risk<br />Can be regional; state has acceptance authority<br />Funding<br />$5 Billion, for 36 mo. disbursement<br />Gov’t: Gift $ for Reserves<br />Gov’t: Loan $ for startup Administration<br />Priority for Funds: Integrated, Statewide & Non-Gov’t support<br />Qualifications for Funds<br />Has to be a new entity<br />Can’t be a Carrier or Gov’t subsidiary<br />Elected Board<br />Exchange<br />$<br />$<br />$5B<br />
  6. 6. Cooperatives: Real-World Examples<br />Most Applicable Existing Models<br />Group Health Cooperative & HealthPartners<br />Sell through Brokers<br />GHC: 2/3 in-house Drs/Facilities<br />HP: 1/3 in-house Drs/Facilities<br />Act just like other Insurance Companies<br />Large HMOs<br />Members identify more with HMO philosophy than with membership<br />Tremendous information<br />Efficiency? Yes & No<br />Decisions of members often very similar to decisions of owners<br />Elected Board<br />$<br />Broker<br />
  7. 7. Cooperatives: The Growing Discussion<br />Examples That Don’t Apply<br />Health Insurance Purchasing Cooperatives (HIPCs)<br />Population-Specific Business Cooperatives<br />Market Implications<br />More Insurance Companies<br />Will Brokers be Able to Sell Cooperative Products?<br />How Can We Drive the Discussion?<br />How will they improve competition?<br />Why will they be more honest than Insurance Carriers?<br />Where is proof they’re more efficient?<br />
  8. 8. Future of Healthcare Forum<br />Highlights From New World of Healthcare Forum<br />Future of Products?<br />Future of Carriers?<br />Future of Brokers?<br />Future of Broker Commissions?<br />How Can We Affect Change?<br />
  9. 9. Future of Products?<br />Transparency<br />Individualized by Patient<br />Rankings by Price / Quality<br />Behavior Change: Fun<br />Horse Power Challenge<br />Incentives & Rewards Work<br />New Approaches <br />Virtual Health Records<br />Social Networks by Disease<br />Make it Fun<br />Mike McCallister<br />President & CEO, Humana<br />
  10. 10. Future of Carriers?<br />Merge Small Group / Individual<br />New Pricing<br />In-Migration of High Risk Members?<br />COBRA Members <br />Uninsured (Mixed)<br />Multi-Line Products by Carriers<br />Bigger Market for Specialty <br />Carrier Consolidation<br />Growth of Individual<br />Brian Sassi<br />President & CEO , WellPoint Consumer Business<br />
  11. 11. Future of Brokers?<br />What Makes a Top Firm?<br />Engaged Leadership<br />Clearly Articulate Differentiator<br />A Plan<br />Best Players<br />Training & Performance Mgmt<br />Sell Themselves, Not a Product<br />Value Added Differentiation<br />Protect Relationships!<br />Ken Fasola<br />Former CEO, Secure Horizons<br />
  12. 12. Future of Brokers, In Light of Exchanges?<br />Limit the Exchange<br />A Regulatory Agency<br />Defining the Plans<br />Monitoring Body<br />Set to Replace Brokers<br />Explaining Role of Broker<br />Exchange Would Cost Billions<br />Use Infrastructure in Place<br />BenefitMall Lobbyists at Work<br />Launching Online Community <br />For Brokers / Carriers to Communicate & Participate <br />Bernie DiFiore<br />CEO, BenefitMall<br />
  13. 13. Future of Broker Commissions?<br />Not Fundamentally Change<br />Probably Not Always Tied to Medical Inflation<br />Work Still Needs to be Done<br />Work Needs to be Paid For<br />Will Still Vary By Carrier<br />Mike McCallister<br />
  14. 14. Future of Broker Commissions?<br />Physician/Hospital Comp Will Change<br />Brokers’ Probably Will, Too<br />If Comp Reduced, Doesn’t Mean We Can’t Generate Income <br />Time Is Not Our Ally<br />Have Your Voice Heard<br />Ken Fasola<br />
  15. 15. How Can We Affect Change?<br />Media Usage?<br />Best: “Un-Earned Media”<br />TV<br />Radio Talk Shows<br />Op-Eds<br />Letter to Editor<br />Quoted in Articles<br />Value: Volume of Hits<br />Read Local Editorials <br />Respond: Short Letter to Editor<br />Member of Congress Reads Daily<br />Janet Trautwein<br />CEO, National Association of Health Underwriters<br />
  16. 16. The Legislative Process<br />A Reminder of the Process<br />Road Map to a Health Reform Law<br />What We’ll See This Fall<br />Building Blocks of 2009 Reforms<br />
  17. 17. Road Map to a Health Reform Law<br />Senate<br />House<br />Harry<br />Reid<br />Nancy<br />Pelosi<br />Finance <br />Committee<br />Health Education<br />Labor & Pension (HELP)<br />Committee<br />Education <br />& Labor<br />Committee<br />Energy & <br />Commerce<br />Committee<br />Ways & <br />Means<br /> Committee<br />Henry<br />Waxman<br />George<br />Miller<br />Charles<br />Rangel<br />Max<br />Baucus<br />Ted<br />Kennedy<br />Finance <br />Bill<br />HELP<br />Bill<br /> Senate Passes House Passes Bill <br /> Combined Bill via Rules Committee<br />House<br />Bill<br />Senate<br />Bill<br />Bipartisan Work to Combine Bills <br />Conference Committee Sets Rules for Debate & Votes<br />Combined<br />Bill<br />Debate & Passage Debate & Passage<br />In Senate In House<br />Final<br />Bill<br />
  18. 18. Building Blocks of 2009 Reforms<br />Employer<br />Mandate<br />Large Fund-Raising<br />Mechanisms<br />Public <br />Insurance<br />Plan <br />Cost <br />Containment<br />Strategies <br />Cooperative<br />Individuals<br />Employers<br />Connector /<br />Exchange<br />Government <br />Subsidies<br />Individual Mandate<br />
  19. 19. Staying Engaged On Reform<br /> <br />Subscribe to the Site<br />Register For NAHU Membership<br />Cooperative Report<br />Q&A: Follow Up Answers<br />Blog: Give Your Input!<br />