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Houston/Harris County Initiatives

Houston/Harris County Initiatives. Healthy Vision 2010 Health Care Summit II Texas Medical Association August 30, 2006. The Emerging Alliance. Save Our ERs Greater Houston Partnership Public Health Task Force Harris County Public Health Care System Council

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Houston/Harris County Initiatives

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  1. Houston/Harris County Initiatives Healthy Vision 2010 Health Care Summit II Texas Medical Association August 30, 2006

  2. The Emerging Alliance • Save Our ERs • Greater Houston Partnership Public Health Task Force • Harris County Public Health Care System Council HARRIS COUNTY HEALTHCARE ALLIANCE

  3. Increasing the # of Insured • 1.1 million uninsured in Harris County ~ 31.4% • No Single Silver Bullet • What’s a County to Do? • Common Eligibility System • 3-Share Demonstration Project • Texas Dept. of Insurance Small Employer Product • BCBS Foundation Hospital Care

  4. Sustainability Affordability Accountability Evidence-based Collaboration Stakeholder benefits Accessibility Additive value Cultural competence Defined parameters of success 3-Share Demo Principles

  5. 3-Share Demo • Three year pilot project to enroll 100,000 employees with incomes below $50,000 • Targeting a $150 PMPM premium • $600 PMPY subsidy needed for one-third • Preventive and primary care service focus • Locally managed • Aimed at employers who have not offered insurance in past 12 months

  6. 3-Share Benefits & Features • Low co-payments; BH service parity • All preventive screenings covered • $25,000 annual max • Closed network • out of network for emergencies only • Includes FQHCs • Medicare reimbursement rates • Chronic disease management protocol participation incentives

  7. 3-Share Benefits & Features(cont.) • 85+% spent on medical care • Traditional and non-traditional marketing • Greater Houston Partnership • ACORN, TMO, Catholic Charities • Consumer & Employer Education

  8. TDI Insure Houston Project • TDI’s 3rd State Planning Grant from HRSA • Develop a low-cost product for small employers in Houston area • Council’s Insurance & Finance Committee expanded as grant Steering Committee • Actuarial support • Marketing and consulting support

  9. TDI Insure Houston Project • Aiming for $150 or less PMPM product • Available to small (<50 ees) employers only • Eliminates all but age and gender as rate-impacting factors • Hoping to negotiate lower than 75% required participation rates

  10. TDI Insure Houston Project • July - focus groups • September - product design finalized • October – RFP • November – Marketing/Education campaign finalized • Early 2007 – product available in market

  11. Foundation Hospital Care • Offered by BC/BS – began January 2006 • Developed by Houston Uninsured Task Force • Aimed at fastest growing segment of uninsured – individuals earning more than $50,000

  12. Foundation Hospital Care • Covers inpatient care only • $5k individual/$15k family deductible (annual max) • 80% coverage after deductible • No outpatient drug coverage • No maternity coverage • $2 million lifetime max

  13. For further information contact: Karen Love Harris County Healthcare Alliance karen_love@hctx.net

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