Organization and Planning Grant Requirements

Phase One National Press Release

The Brooklyn Borough President's Northern Brooklyn Health Consortium
Brooklyn, NY

April 2000

               Background

Many of the consortium members have been engaged for several years in building comprehensive and cohesive neighborhood healthcare alliance and examining community healthcare needs.  One very special effort is the Brooklyn Health Connection.  This alliance is made up of more than 130 community organizations.  Brookdale University Hospital and Medical Center with the assistance of The Brooklyn Hospital Center spearheads this effort.  The community needs assessment work undertaken through the Brooklyn Health Connection will serve as the springboard for expansion into this larger target area.

The Brooklyn Health Consortium is another partnership of community-based organizations, neighborhood groups and local businesses including SUNY Health Science Center in Brooklyn, Kings County Medical Center and Brooklyn College Center for Health Promotion of the City University of New York.  Projects and programs have been developed with the New York State Department of Health, the City Department of Health and the Centers for Disease Control and Prevention.

The Brooklyn Borough President's consortium members include:

  • The Brooklyn Chamber of Commerce

  • The Brooklyn College Center for Health Promotion

  • The Community District Planning Boards for the seven community districts representing Brooklyn

  • The free-standing primary care centers located throughout the region

  • The faith organizations, social service groups, and healthcare advocacy groups

Until the very recent passage of statewide legislation, there was no organized insurance coverage for uninsured adults.  In 1994, the state underwrote demonstration programs for the children that in 1996 were written into law.  The Child Health Plus Program provides a health benefit package to all children under the age of nineteen who are uninsured and do not qualify for Medicaid.  Participation is below expectations, with a total enrollment of over 292,000 statewide, 152,400 are enrolled in New York City.  In Brooklyn, 69,000 are enrolled.

In January 2000, the state passed new legislation to finance a similar program for adults that exists for children, called Family Health Plus.  This fully insured direct subsidy is to be targeted to families up to 150 percent of the Federal Poverty Level who meet Federal Medicaid residency requirements.  Federal approval is anticipated during 2000 with implementation to begin January 2001.

Historically, New York State has a longstanding commitment to funding healthcare services for the uninsured.  Among its various approaches is the bad debt and charity tax on commercial carriers that in 1998 generated $786 million in revenue, this is expected to grow to nearly $900 million in 2000.  Bad debt and charity care providers who treat the uninsured to compensate for previous levels of charity care.

With regard to small businesses, other state legislated insurance subsidies exist in the form of vouchers and small business partnerships.  In January 2000, the state legislature reconfigured its approach and added a stop loss fund for individuals and small group purchases of insurance to cover the cost of catastrophic care.  The availability of this pool will lower the cost of premiums and risk among insurance carriers to underwrite insurance products in this market.

While community-rated programs have increased access to small businesses, those most able to afford coverage have income above 200-250% of the FPL.  Therefore, despite New York's efforts to expand affordable insurance to the uninsured, significant gaps still exist in the affordability of health benefits for persons/families with income at or below the 200% of the Federal Poverty Level.

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       Guiding Principles

  • Typical of the small business insurance market, cost effiecieny is extremely attractive.  We will seek to tailor the benefits package and the delivery system to the needs of our targeted population.  We believe that price will be central to the successful design of our approach.

  • The uninsured population we seek to target will most likely to be found in the so-called small business group market.  Our product will likely utilize a similar healthcare benefit design as in prevalent in this market.  This design may exclude some of the benefits available under Medicaid fee-for-service and the Medicaid benefit design may prove to be too costly for this demonstration to succeed in the early years.

  • Conceptually, we will seek participation from our provider network with discounted fee schedules designed as part of this benefit package and a modest co-payment from the uninsured person using an agreed upon sliding scale approach.  The issue of participant contribution to the cost of the premium will also be examined.  Contributory plans are difficult to market and often confused by network design and choice features that require higher premiums.  Often these products are unaffordable for the lower income uninsured working families and individuals.

  • We will examine supplemental benefits, such as social services.  Prescription drug riders in today's marketplace are becoming quickly affordable for even the middle class.  Nevertheless, feasibility will be explored, as will all other aspects of a comprehensive health benefit package.

The above aspects of the benefit design will require concentrated analysis, market research and focus group studies.  This is also an area where the office of the Borough President will be utilized through its community development efforts, particularly among small businesses in the Borough.

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         Initial Project Objectives

The Brooklyn Borough President is leading an alliance of healthcare providers, academic institutions and community organizations to form the Brooklyn Borough President's Northern Brooklyn Health Consortium (NBHC).  The development of an insurance product for the uninsured product for the uninsured is a natural progression of the consortium's objectives.  Foremost among its objectives is the development of a financially sound and accessible healthcare delivery system for the uninsured that will have value to healthier uninsured individuals.  At the same time, it will be affordable to those with greater healthcare needs.

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        Financing & Outreach Strategy

Financing Strategy

How an insurance product is underwritten is a significant issue for the consortium. This requires the establishment of a dedicated fund or long-term funding approach for the uninsured.  The nature and form of a dedicated revenue stream will include, among others, using premiums, co-pays, and deductibles; accessing existing revenues to providers for bad debt and charity care; seeking waivers from insurer taxes that underwrite bad debt pools; and subsidies based on ability to pay.

Through the work of its technical committees, consortium members will be exposed to the factors that of into developing an insurance product.  Underwriting, risk factors and other insurance issues that will require resolution during the planning grant year.

As part of the Brooklyn Borough President's Northern Health Consortium's approach to building a community-based healthcare program for the uninsured, the consortium will apply for funding from these sources once we have developed the appropriate program and funding vehicle.

The consortium will actively pursue other funding sources and contracts with New York State such as through state sponsored health insurance partnerships and its grant funding mechanisms.  Once the product is designed, priced and readied for the marketplace we will seek formal recognition of it in our state legislature, the State Insurance Department and Health Department, the Federal Public Health Service, HCFA and other federal agencies that have a stake in finding permanent solutions for the uninsured.

Outreach Strategy

Based on their community assessments, the consortium will participate in the work of the Brooklyn Borough President's Northern Brooklyn Consortium regarding community assessment and consensus building processes, and the development of education, outreach, and marketing strategies in their respective communities.

Delivery System

Much work has been accomplished with regard to the network development and community needs assessments.  This network includes not only the hospitals, but also many of the social service agencies and community-based providers within our target area.

As managed care principles play such an important role in the healthcare delivery system, the consortium hospitals have been engaged in care management practices, network development and management information systems improvements for many years.  They sponsor Medicaid managed care plans, physician practice plans and engage in risk contracting.  Venturing into the development of an uninsured health plan and delivery system is a logical and natural progression.

With regard to participation in the service delivery network, financial feasibility will be a major factor.  The health benefit package for the uninsured must be affordable.  A decision by providers to accept discounted fee schedules is a matter of choice.  Pricing decisions will be a matter of consortium involvement and agreement.  Effective medical management policies and low administrative costs will also enhance our network service delivery.

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       Challenges

Affordability of healthcare coverage plays a significant part in the number of uninsured New Yorkers.  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.  We believe one of the more difficult challenges will be to determine 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.

Evaluations of the New York State's Child Health Plus Program show that complicated enrollment applications and lack of comprehensive marketing strategies have hampered the success of this program in reaching its target population.  We believe that our  consortium's outreach efforts are informed (and will benefit from) the problems experienced elsewhere.  As a strategic approach the consortium will explore the most sensible and direct ways to reach its audience more effectively through community-based organizations, faith organizations and through the Brooklyn Chamber of Commerce.

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       Demographics

The communities that make up the Northern Brooklyn area are characterized by either their poverty or near poverty profile.  Our targeted communities reflect a population of considerable economic, cultural and ethnic diversity.  Significant inequities in health status accompany this diversity.  Within Northern Brooklyn resides a substantial number of working poor.  Typically, they are employed in part time jobs, in small businesses, self-employed, non-unionized and in service industries, all of which are characterized by lack of insurance coverage.

The need for insurance products for the uninsured is indicated by the structure of business entities in our targeted area.  It is characterized by a preponderance of small businesses with fewer than four employees.  Nearly 11,500 businesses are located in our targeted area, constituting one-third of all establishments in Brooklyn.  Of that number 9,900 small businesses, or 86 percent, have fewer than 20 employees.

Nationally, less than half of firms with fewer than ten workers offered health benefits in 1998.  As part of a comprehensive survey of small businesses, over two-thirds cited that "premiums" were too expensive.  the seven communities that constitute our proposed targeted area are Williamsburg/Greenpoint, Fort Greene, Bedford Stuyvesant, and Ocean Hill, Bushwick, Crown Heights, Brownsville, and East New York.  the population of the targeted area is 835,000.

While the precise number of uninsured persons residing and/or working in Northern Brooklyn is unknown, we can estimated possible ranges based on socio-demographic characteristics.  Among New York City residents, an estimated 27.8 percent are without health insurance.  Applying this 27.8 percent to the total population of our targeted area yield an estimated 235,000 uninsured persons.  Children under the age of 19 would be channeled into Child Health Plus Program, several of which are operational in the Borough.  With a focus on adults between the ages of 19 and 64, we project 200,000 uninsured persons would qualify for this demonstration project.  Once fully operational, our goal would be to reach 25 percent of these individuals in year one, 35 percent in year two and 40 percent in year three.

 

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        Contact Us

Nancy Gaeta, M.S.  
Principal/Consultant  
Program Planners, Inc
230 West 41st Street  
New York, NY 10019
Phone:  212-840-2600  
Fax:  212-769-4094  
E-mail:  ppi@bway.net

 

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 Communities In Charge 2002 is a program of The Robert Wood Johnson Foundation.
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