Southeastern Actuaries Conference CO-OP s - Where are they now? Lynda Johnson, ASA, MAAA (423)
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1 1 Southeastern Actuaries Conference CO-OP s - Where are they now? Lynda Johnson, ASA, MAAA Lynda.Johnson@Wakely.com (423)
2 2 CO-OP s Where are they Now? CO-OPs - State of the Union Background Start Up Challenges CO-OPs Today Risk Adjustment Current CO-OP Experience What s Next
3 3 Status of Healthcare CO-OP s ME OH Commonwealthhfund.org December 2015 Ohio Failed May 2016 Maine/NH enrollment freeze as of 12/2015
4 4 Formation of CO-OPs under ACA Not for Profit & Member Owned and Operated(Member Board governance) Increase Competition Low interest loans Startup Debt Solvency - Surplus Original ACA allotment - 6 Billion ACA created level playing field CMS preference for integrated care models Goals for Statewide coverage
5 5 Early Policy/Regulation Challenges Marketing could not use startup loan Community Relations Diversification limited Substantially all business must be from individual or small group markets (became 2/3) Budget agreements cut funds to 2.4 billion 23 CO-OPS in 25 states Transitional plan rule changes late 2013 If you like your plan you can keep it Limited private capital opportunity
6 6 Pricing and Enrollment Dynamics Place your bet - All in Feast or Famine Enrollment Controlled Growth very difficult Pressure for immediate membership 2014 and 2015 rate set before Risk Corridor budget neutrality requirement Group markets slower to adopt new plans Broker confidence in operations Monthly renewing Networks for individual vs group
7 7 Operational Challenges Startup timeline Networks Claim systems Clinical Ops Regulations IT/Edge Server Dependence on vendors Vendors in high demand
8 8 Financial Challenges Pent up demand, illness burden, specialty Rx Financial Projections IBNR (no history, TPA s, newly insured, exchange eligibility, 90 day grace) Temporary Reinsurance Waiting for reimbursement Risk Adjustment Wide variability with large potential payouts
9 9 Financial Challenges Risk Corridor Stability mechanism for pricing risk Budget neutral deal December % payment announced October remainder paid with future collections? 2015 uncollectable completely?
10 10 Remaining CO-OP s as of today Connecticut Illinois Maine/NH enrollment frozen Dec 2015 Maryland Massachusetts Montana & Utah New Mexico New Jersey Oregon Wisconsin
11 11 Risk Adjustment Challenges Anticipate wide range of risk adjustment payments with 2015 report due June 30 th CO-OP s and other smaller or rapidly growing new carriers No historical data that can used for targeting Established technology and data, coding processes CMS updates with some fixes in process Partial year enrollment some pharmacy data Detailed Analysis, Risk Score Optimization (targeted) and Edge Server data management
12 12 Risk Adjustment Transfer as % of Premium by Market Share
13 13 One CO-OP s Experience - Maryland 37,500 members as of March , up from 11,700 at the close of 2014 Focused on small group when Individual exchange had issues in 2014 Evergreen Health s CEO 3 strategies: Diversification individual(30%), small group(55%),large group 15% Priced Appropriately not aggressively Focus on Wellness, Value Based Benefit Design
14 14 One CO-OP s Experience - Maryland Next Step. Risk Adjustment? Anticipate 2015 payment of 26% of Premium Lawsuit filed last week Maryland DOI support Referencing 2017/2018 CMS changes as acknowledgement of issues 2017 rate filing assumes 3% of premium maximum risk adjustment transfer payment
15 15 Upcoming Items to Watch June 30 th Risk Adjustment Report 2017 Rate Review Continued release of 2016 financials CO-OP recent flexibility for private capital and board of directors Law Suits And of course.
16 16
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