|
Brooklyn
HEALTH WORKS
Brooklyn,
NY
§
Objectives
Our
goal is to develop and implement a low-cost, comprehensive health insurance
product available to small businesses.
In
order to "corporatize" our program's leadership, our operating
structure is evolving from a group of interested parties, heretofore called a
consortium, into a not-for-profit organization. The office of the Brooklyn
Borough President as lead agency and convener is changing. The original
consortium remains in place and is comprised of the private and public hospitals
in Northern Brooklyn, the freestanding primary care centers, the Brooklyn
Chamber of Commerce, and numerous other community-based organizations.
Many members of the consortium will not take their place on the governing board
of the not-for-profit called the North Brooklyn Consortium. The Brooklyn
Chamber of Commerce will replace the Office of the Borough President as lead
agency. Collectively, the entity represents the communities of
Williamsburg/Greenpoint, Fort Greene, Bedford Stuyvesant, Ocean
Hills-Brownsville, Bushwick, Crown Heights and East New York.
The
Consortium's health insurance product, called Brooklyn Health Works, is designed
for working low-income families (and individuals) with income between 150-250
percent of the Federal Poverty Level, i.e., $25,000-35,000 for a family of
three. Our goal is to enroll between 10,000-15,000 participants.
This consortium is a true public-private partnership designed to substantially
reduce the cost of healthcare insurance premiums so that small business owners
can afford insurance for their employees. We have been able to accomplish
this through our grants and subsidies that will reduce administrative
costs. Provider reimbursement rates are well below commercial rates, but
they are greater than what bad debt and charity pools can provide to hospitals
and free-standing clinics.
→Back to Top
§
Program Design
The
Consortium is seeking legislation to operate a demonstration program
-
Through
this demonstration, a low-cost plan will be made available to the
communities that use these facilities. The Northern Brooklyn Health
Consortium has sought administration assistance from the Commissioners of
health Insurance to help reduce the cost of premiums for the uninsured
population in our targeted demonstration area in Northern Brooklyn.
The
Consortium sought waivers from the Department of Health
The
Consortium sought access to Healthy New York Stop Loss Pools
In
both instances, administrative waivers were not pushed, although the
encouragement and support for a legislative wavier was offered. These
activities were undertaken during the planning grant year. During 2001, we
moved into the legislative cycle. The state is to play a central role in
developing and implementing a low-cost health insurance plan for the
uninsured. Getting legislative waivers is a critical aspect of our program
and one for which considerable political support exists. Therefore,
Northern Brooklyn Health Consortium members and staff expanded considerable time
and effort seeking legislation to create a demonstration area within Northern
Brooklyn. With these waivers, premium costs, can be reduced by nearly 20
percent for the uninsured population in our targeted demonstration area in
Northern Brooklyn.
The
Details of our Legislation
We
seek special access to these stop-loss funds even though both the Brooklyn
Health Works benefit package and target audience differs from the requirement of
a state statue called Healthy New York. Our program differs in important
ways that require approval if we want to access stop loss funds.
-
The
income levels for participation would extend beyond the 200% of poverty to
between 250-300% of poverty.
-
We
are seeking to place the product in the community without co-pays and
deductibles. Modest co-pays may be required for office visits.
-
The
employer contributions will not be uniformly mandated at 50 percent, but
rather subject to individuals employer's determination. Employers
would be required to offer coverage to all eligible employees.
-
The
health delivery system includes our provider sponsors, their affiliates and
all other providers in the demonstration area who will accept the
reimbursement rates established by our consortium network. An
out-of-network benefit if being considered as a separate rider that would be
excluded from access to the stop loss pools.
-
The
benefit package includes home healthcare and substance abuse treatment,
which are excluded from Healthy New York.
While
the Healthy New York program expands coverage options, considerable gaps
remain. The following ideas have been suggested to reduce these gaps.
-
An
insurance plan designed for employed families with income slightly over the
level contemplated by Healthy New York. This would help a greater
number of modest earning uninsured working families afford healthcare
insurance.
-
A
low cost, comprehensive health insurance plan that does not require
significant out of pocket costs and deductibles.
-
A
plan that does not result in high premiums for their employees.
Even
with the inroads that HRSA 2000 will make toward more accessible health
insurance coverage, there will remain a large segment of New Yorkers who will
not qualify for these programs because their income is between 200-300% of
poverty.
Healthy
New York insurance programs will include co-pays and deductibles that our
research indicates are still to costly for modest earners to afford. Our
provider sponsors have sought to cope with the cost factor by agreeing to
reimbursement levels that will require minimal and/or no-pays and still keep the
premium within an affordable range. Over-utilization will be monitored
through our care management programs and will serve as a subject for observation
as part of this demonstration.
The
community has expressed a strong preference for an open network. In
response, our demonstration area is inclusive of all providers and will seek to
keep all enrollees in network.
→Back to Top
§
Financing & Outreach Strategies
Outreach Strategy
Our consortium has created
a marketing and advertising strategy that will be used to separate from other
health plans. Brooklyn Health Works is Brooklyn's own health plan that is
locally accountable, affordable, and accessible. Our message will stress
our concern for the economic health of the community as well as the physical
health of members who subscribe to the plan.
The Consortium, through
its partnership with the Brooklyn Chamber of Commerce and other smaller, ethnic
chambers, trade groups, creating several important distribution and marketing
alliances. Our co-promotion efforts and community outreach alliance with
our consortium hospitals and health center providers are expected to expand
reach to smaller businesses. The Chamber membership alone represents
nearly 20% of the targeted business prospects.
The Consortium has sought
provider participation using discounted fee schedules designed as part of this
benefit package. Modest co-payments will be instituted without
legislation. The issue of participant contribution to the cost of the
premium will also be examined. Contributory plans are difficult to market,
often confused by network design and choice features that require higher
premiums. Often these products are unaffordable for the low-income
uninsured working families and individuals.
One of the more difficult
challenges is the nature and extent to which uninsured persons can or will
contribute to the cost of care, be it a co-payment a deductible and/or premium
contribution. Affordability of healthcare coverage plays a significant
part in the number of uninsured New Yorkers particularly in Brooklyn. the
portion of the poor and working poor in our Northern Brooklyn targeted
communities make it difficult, if not impossible for our residents to either
afford healthcare premiums or to contribute to employer sponsored
programs.
→Back to Top
§
Accomplishments to Date
The
Northern Brooklyn Health Consortium has identified multiple ways in which to
bring premium prices within more affordable ranges. This
provider-sponsored collaboration has created an insurance approach that crosses
institutional boundaries united in its single purpose to make comprehensive
insurance available using whatever methods and means available. The
Consortium is also calling on private philanthropies to participate in the
public-private partnership to demonstrate that healthcare can be made affordable
and accessible to those who cannot afford to buy it on their own.
The
hospitals and freestanding providers in our demonstration area are united in
their respect to the Department of Health to waive the covered lives assessment
and surcharges on enrollees in the Brooklyn Health Works Plan.
Daily, these healthcare providers in Brooklyn provide uncompensated care to one
out of five patients who access their care and from whom the covered lives
assessment and surcharges will not be collected. Consortium members
believe this is more important that some level of reimbursement be provided to
providers through Brooklyn Health Works than to continue to see a large
and growing segment of the community remain uninsured because of unaffordable
health insurance premiums.
Prescription
drug riders in today's marketplace are becoming quickly affordable for even the
middle class. Brooklyn residents without prescription drug benefits have
difficulty affording medications. Therefore the consortium has developed a
unique approach to funding the pharmaceutical components of its health benefit
design. "Carve-outs" are plans in which the employer offers a
prescription to drug benefit separate from the rest of the plan in order to
control costs. This program has been approved by the Department of Health
and Human Services and is not to be offered along side The Robert Wood Johnson
Foundation - sponsored comprehensive health benefit plan designed for small
businesses and others who qualify on the basis or lack of coverage
options. Using the various approaches described therein it is our goal to
bring the cost of pharmaceutical benefits from $30 to $40 per member per month
to under $20 per member per month.
→Back to Top
§
Challenges
Brooklyn
Health Works must now become an insurance program to be underwritten by an
insurer called GHI. Transitioning our program from an alliance of
healthcare providers, academic institutions and community organizations to a
fully operational insurance program has occupied a significant amount of time
and energy.
No
Go in 2001
Legislation
was drafted and was introduced. This legislation was introduced in June as
a budget bill and positive action on it was likely if the State would have
passed a budget bill during the normal legislative session.
Never
in the history of the State of New York has the Governor and the Legislature
been so delinquent in passing a budget. It never did. After the
World Trade Center Disaster, the legislature quickly convened and adopted last
year's budget. No new items were passed, except appropriations to the
Trade Towers. Most notably Brooklyn, our demonstration legislation was not
acted upon. We will pass our legislation again when the legislature
convenes in January 2002.
We
are also moving forward with legislation. We have re-priced our products
and have introduced modest co-pays and slightly higher premiums. Even with
these adjustments, our premiums will be 50-60 percent lower than commercially
available insurance products in the market today.
→Back to Top
§
Contact
Us
Mark
Kessler
Vice President, Program Development
Brooklyn Chamber of Commerce
25 Elm Place, Suite 200
Brooklyn, NY 11201
Phone: (718) 875-1000 ext 121
Fax: (718) 237-4274
E-mail: mkessler@brooklynchamber.com Brooklyn
HealthWorks Marketing pages:
http://www.ibrooklyn.com/site/brooklynbusiness/businessservices/brooklyn_healthworks/
Nancy
Gaeta M.S.
Principal/Consultant
Program Planners, Inc.
230 West 41st St.
New York, NY 10019
Phone: (212) 840-2600
Fax: (212) 769-4094
E-mail: ppi@bway.net
→Back to Top
|
