HFMA WEBINAR. Sponsored By: How Hospitals Can Get Involved in Health Insurance Exchanges

Transcription

1 HFMA WEBINAR Sponsored By: How Hospitals Can Get Involved in Health Insurance Exchanges Date: Wednesday, June 11, 2014 Time: 2:00 3:30 p.m. Central (12:00 1:30 pm Pacific/1:00 2:30 pm Mountain/3:00 4:30 pm Eastern) Follow this link (or paste it into a browser) to connect: Please log in 10 minutes early and test your computer connection: Enter platform where it says guest type in your full name first and last name only it is very important especially if you need CPE credit so that your attendance is accounted for You will Not be using your telephone, but will hear the audio via your computer speaker Online live seminars are broadcast over the web via Adobe Connect. You'll need a computer with a browser, Adobe Flash Player 11.2, and Internet connection. Test your connection to Adobe Connect: Login issues to check first: Are you connected to the Internet? Disable popup blocker software. Clear the browser's cache. Try connecting from another computer. Are you accessing the correct URL? Audio Issues: Close all Microsoft Applications, especially Outlook and Messenger. Having Outlook open absorbs almost 50% of the bandwidth which may cause intermittent audio interruptions. If you have questions regarding registration or connection please call HFMA Member Services at ( , ext 2). CPE Information: To receive CPE Credits for this webinar you must participate in online polling during the webinar and complete the online program evaluation within 2 working days. After 2 working days online programs will be inactive and you will not receive CPE Credit. The URL below will take you to our on-line evaluation form. You will need to enter your HFMA I.D. # (found in your confirmation ) You will also need to enter this Meeting Code: 14AT34 URL: You may also connect directly from the last slide of the live webinar Your comments are very important and enable us to bring you the highest quality Programs! To review your CPE information, please visit the HFMA web site at log into your profile, and retrieve all CPE information (by date) within your "CPE Center.

2 Sponsored By: How Hospitals Can Get Involved in Health Insurance Exchanges Wednesday, June 11, :00 3:30 pm Central (12:00 1:30 pm Pacific/1:00 2:30 pm Mountain/3:00 4:30 pm Eastern) Gwynne Mesimer Vice President of Operations, Chamberlin Edmonds Pat Riley Director of Insurance Operations, Forrest General Hospital

3 Introductions Gwynne Mesimer, Vice President of Operations, Chamberlin Edmonds Joined Chamberlin Edmonds in January of 2003 She is largely been responsible for the geographic extension of the company s operations into an additional fifteen states. This growth was accomplished by developing key relationships and processes with State Medicaid offices and hospital Prior to joining Chamberlin Edmonds, she began her career as a Registered Nurse. Gwynne managed the fund raising activities of the board of directors for VNA and Hospice for five years. 2

4 Introductions Pat Riley, Director of Insurance Operations, Forrest General Hospital An employee of Forrest General Hospital in Hattiesburg, Mississippi for 33 years Has served in various capacities during his career with Forrest General including: Patient accounts manager Business office manager Director of patient accounts Director of managed care operations 3

5 Expanding Medicaid & State Options What s New State option to expand Medicaid increases the # of eligible recipients AR model opened door for additional state expansion through 1115 Waivers Premium Assistance Model IN just submitted a waiver to expand Medicaid 5/2014 likely effective 1/2015 Private insurance instead of traditional Medicaid Some enrollees to pay modest premiums Some will pay into a health savings account Encouraging unemployed or underemployed to pursue work opportunities PA Governor awaiting CMS approval of expansion with the private insurance AR model IA Approved For population with FPL % Premium contribution of $20 / month VA Governor pro Medicaid Expansion 4

6 Medicaid Enrollment State New Medicaid Members Expanded Medicaid (?) California 1,448,000 Yes Washington 364,724 Yes New York 324,647 Yes Oregon 309,575 Yes Ohio 288,585 Yes Kentucky 265,091 Yes Colorado 263,452 Yes Maryland 254,179 Yes Illinois 222,477 Yes Florida 209,112 No Source: Medicaid & Chip: April 2014 Monthly Applications, Eligibility Determinations, and Enrollment Report: June 4,

7 Health Insurance Exchanges Patient Challenges Despite the assistance provided under the ACA, many patients continue to enter the healthcare system unable to pay their medical expenses The number of uninsured in 2014 will be 42 million people, according to the CBO It will fall to 36 million in 2015 and 30 million in 2016 Most of them will remain uninsured because they will have declined coverage: Source: Congressional Budge Office, Updated Estimates of the Effects of Insurance Coverage Provisions of the ACA: April 14,

8 Health Insurance Exchanges Patient Challenges Many patients shopping on an ACA Exchange will be encountering insurance concepts for the first time. They do not understand deductibles and co-pays. And thus may chose plans with high out of pocket costs. Lower-tier plans Catastrophic coverage Having made these choices some patients who receive coverage may not be able to cover their co-pays and deductibles 8

9 The Opportunity for Hospitals Provider organizations continue to struggle with high rates of uncompensated care Source: Health Affairs: ACA Payment Cuts Could Challenge Providers May

10 The Opportunity for Hospitals To combat this, hospitals can provide expert marketplace enrollment assistance Public health insurance exchanges (HIXs) are the portals through which the uninsured are able to gain coverage Hospitals can focus on enrolling more patients into these programs to ensure they are reducing uncompensated care, and increasing reimbursements 10

11 MarketPlace Activity (as of 4/2014) While it is difficult to determine the status fully of the Marketplaces / State Exchanges, some information was publicly available this week Eligible to Enroll in a Marketplace Plan Key numbers Overall Federally Facilitated Exchanges and State Marketplaces 8M selected plans from state and federal Marketplaces (HHS) 4.4M have had a Medicaid determination or assessment 28% between years old 85% were eligible for financial assistance Metal levels selections Eligible to Enroll in a Marketplace Plan w/ Financial Assistance 65% selected a Silver Plan 20% selected a Bronze Plan Eligible for Medicaid/CHIP by the Marketplace Have Selected a Marketplace Plan Mississippi 117,518 72,219 13,779 61,494 Alabama 195, ,059 22,564 97,870 Louisiana 184, ,337 14, ,778 Source: ASPE Issue Brief, 5/1/

12 The Enrollment Process 12

13 The Enrollment Process Individuals apply for premium tax credit/cost-sharing reductions during exchange open enrollment periods Applicants must elect to receive the premium tax credit in advance Credit paid monthly to the health plan Payment amounts based on income Special enrollment periods are available in the event of life changes loss of job & employer based insurance, marriage, divorce, birth of child, etc. Enrollment periods are annual open enrollment (November 15, 2014 February 15, 2015) 13

14 Challenges for Hospitals Enrollment is not a simple process to undertake Has no retroactive component Current episodes of care are unlikely to be covered Doesn t ensure a patient will return to the hospital providing assistance Patients may be inconsistent with premium payments 14

15 Benefits for Hospitals However, many hospital executives see HIXs as a community benefit For a non-profit hospital, may be included in the overall Community Benefit Plan Having coverage may encourage individuals to utilize lower cost medical settings 15

16 Benefits for Hospitals Hospitals will likely be able to: Increase patient engagement scores Convert specific patient populations from self-pay to insurance Provide a community service i.e. required Community Service plans for non-profit status with IRS Fulfill their overall mission to serve patients Increase market share in their communities 16

17 Premium Tax Credits in Insurance Marketplaces There are no pre-existing clauses with the QHP: these health plans are guaranteed issue Eligibility for premium assistance: Must be a part of a tax-filing unit (individual or family - must file) Must enroll in a marketplace plan With MAGI household income at or above 100% of FPL, but not more than 400% of the FPL Must be lawfully residing in the US and not be incarcerated Must NOT be eligible Medicaid, Medicare Part A, CHIP, Tricare, employer sponsored plans Employer coverage cannot exceed 9.5% income in cost and much meet minimum coverage standards If employer coverage is not affordable (would exceed 9.5% of household income) or does not provide minimum value (covers less than 60% of total allowed costs), then individual or family can access the marketplace and receive premium subsidies The amount of the premium tax credit depends on household income and family size The premium is based on enrollee s age and whether they are a smoker also traditional Managed Care data Premium will also be based on geographic area where the applicant lives The total expense is capped as a percent of household income The premium is calculated off second lowest silver plan in the relevant marketplace 17

18 Maximum % of Income for Premium Contributions Maximum Percentage of Income Measured by FPL to go toward premium contributions Patients are also eligible for cost-sharing assistance if their MAGI income is from % FPL Federal Poverty Line (%) Source: Congressional Research Service Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA) March 12,

19 Monthly Required Premium Contributions Contributions based upon family size, and if premium credits were available in 2013 Federal Poverty Line (FPL) Maximum Premium Contribution as a % of Income* Monthly Required Premium Contribution (2013) by Family Size % 2% $20 $27 $34 $ % 2% $26 $35 $44 $53 133% 3% $39 $53 $66 $79 150% 4% $58 $79 $99 $ % 6.3% $122 $164 $206 $ % 8.05% $194 $261 $329 $ % 9.5% $274 $369 $465 $ % 9.5% $319 $431 $542 $ % 9.5% $365 $492 $619 $747 *Applicable percentages SOURCE: Congressional Research Service Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA) March 12,

20 So, What Now? 21

21 We can all relax now right? Just when we all thought we could take a breath the ACA is implemented; Open Enrollment is over (for now) and we can get back to the million things on our desk that have been pushed aside. How many of your eligible patients completed their QHP enrollment process? Effectuated How many of your patients with QHP insurance will pay each and every payment? How will you know if they don t? Grace Period Key Points to consider How many of your patients will be able to afford their deductible and coinsurance? How many of your patients know about the penalty? And the hardship case for not obtaining insurance 22

22 Health Insurance Exchange Grace Period The Grace Period applies to individuals who have purchased a Qualified Health Plan (QHP) on the Exchange and that plan is subsidized by the Federal government Insurance company responsible for healthcare charges Patient responsible for healthcare charges 30 days 60 days Grace Period Patient is reinstated on QHP 90 Days Patient pays at least 1 premium Patient doesn t pay premium Questions for Providers How will hospital determine where the patient is in this cycle? Will hospital pay premiums Will patient be able to pay premiums? Will patient be able to pay deductible and co-pays? Patient pays premium 23

23 ACA Outreach A Hospital s Experience Pat Riley, Director of Insurance Operations, Forrest General Hospital

24 Forrest General Hospital Forrest General is a county owned government entity 512 inpatient beds Level II regional trauma center Located in Southeastern Mississippi Forrest General Hospital in Hattiesburg Highland Community Hospital in Picayune Jefferson Davis Community Hospital in Prentiss Marion General Hospital in Columbia Walthall General Hospital in Tylertown The Orthopedic Institute 26

25 Uninsured Five states will have the largest % of uninsured in the US two of those are in the Southeast: Louisiana (167.8 in every 1,000 residents); Georgia (155.3 in every 1,000 residents); MS will have / 1,000 27

26 Forrest General Hospital ACA Strategies Outreach Activities Health Fairs Town Hall Meetings Flyers Public Service Announcements Website information Visiting local churches Listed on healthcare.gov as Certified Application Counselor organization Numerous calls and enrollment activity due to this listing Mailer sent to former Forrest General patients uninsured Onsite Enrollment Activities Staff person onsite Screening Self Pay patients Very little enrollments due to patients primary need for healthcare; insurance planning would be considered secondary to this need Patients express sticker shock even with premium assistance Hospital Insurance Brokers Newly retired persons under 65 years of age Concentrated on educating prospective patients to encourage enrollment Better enrollment experience no perceived sticker shock after the applicant understood premium subsidy and cost sharing subsidy Applicants came to CAC s after an educational session 28

27 Forrest General Samples of Materials Forrest General utilized flyers like these when they held town hall meetings and other events in the community 29

28 Forrest General Experience to date Forrest General offers their services of enrollment assistance free to those who call and there is no obligation on the patient s part Hospital insurance brokers have helped over 100 area residents Some patient examples: 58 year old female: Excellent health plan with prescription drug coverage - $21.25/month 57 year old male: excellent health plan with prescription drug coverage - $56.25/month 64 year old male and 63 year old female: excellent health plan with prescription drug coverage for both - $196.59/month 57 year old female: excellent health plan with prescription drug coverage - $.50 / month Too early to share absolute results 80 claims recently sent to QHP s for billing 30

29 Outreach Program Strategy is now the time? Forrest General implemented a proactive outreach program in the community. Such a program like this would consist of the follow elements OUTREACH ENROLL Proactive Outreach Enrollment in a QHP Tactics Include Mailers Public Service Announcements Town hall meetings Health fairs Marketing materials Website content Staff education sessions Pre-registration screening Face to face enrollment Healthcare.gov Call Center Paper Generally takes more than one discussion with patients Results seemed better with a scenario such as: Patient received flyer or other communication Patient had time to assimilate information 31

30 What happens after the application is complete? It is important when helping patients on the fringes of the economy to let them know the premium they first see is oftentimes not the actual amount they will be paying after a subsidy is applied Application is completed Patient found eligible for Insurance Plan (QHP) Follow up activities Application determines citizenship Application validates income Application validates residence Patient found to be over income for Medicaid Patient will be expected to: Pay monthly premiums Pay annual deductible Pay co-pays at point of service Patient will need to: Decide which metal level of plan Gold, Silver, Bronze If eligible for cost sharing, must select a Silver Plan Decide which insurance company only one QHP / county in MS Pay 1 st month premium Understand premiums are monthly make arrangements for payments Factors patients will consider Amount of deductible Prescription drug coverage (formulary) Co-Pays Network Providers 32

31 Conclusion Hospitals may use the launch of public exchanges to help uninsured individuals navigate HIXs The ACA presents new opportunities to serve patients while also reducing the burden of uncompensated care With the assistance of knowledgeable partners who understand marketplace enrollment, hospitals can create a win-win situation for both themselves and their patients 34

32 Questions?????????? 35

33 To Complete the Program Evaluation The URL below will take you to HFMA on-line evaluation form. You will need to enter your member I.D. # (can be found in your confirmation when you registered) Enter this Meeting Code: 14AT34 URL: Your comments are very important and enables us to bring you the highest quality programs! 36