Miami-Dade Legislative Item
File Number: 081556
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File Number: 081556 File Type: Resolution Status: Amended
Version: 0 Reference: Control: Board of County Commissioners
File Name: BLUECROSS BLUESHIELD LOW COST COMPREHENSIVE HEALTH INS. Introduced: 5/19/2008
Requester: NONE Cost: Final Action:
Agenda Date: 5/20/2008 Agenda Item Number: 14A12
Notes: SEE 081793 FOR FINAL VERSION AS ADOPTED Title: RESOLUTION APPROVING THE MIAMI-DADE COUNTY - BLUECROSS BLUESHIELD OF FLORIDA, INC. CO-DESIGNED INSURANCE PRODUCT FOR THE UNINSURED RESIDENTS OF MIAMI-DADE COUNTY, AND AUTHORIZING THE COUNTY MAYOR OR DESIGNEE TO FINALIZE A NO-COST CONTRACT FOR A THREE-YEAR PILOT IMPLEMENTATION [SEE ORIGINAL ITEM UNDER FILE NO. 081462]
Indexes: BLUECROSS/BLUE SHIELD
  INSURANCE
  PILOT PROJECT
Sponsors: Joe A. Martinez, Prime Sponsor
  Carlos A. Gimenez, Co-Sponsor
  Rebeca Sosa, Co-Sponsor
  Jose "Pepe" Diaz, Co-Sponsor
  Barbara J. Jordan, Co-Sponsor
  Dennis C. Moss, Co-Sponsor
  Sally A. Heyman, Co-Sponsor
  Audrey M. Edmonson, Co-Sponsor
  Dorrin D. Rolle, Co-Sponsor
Sunset Provision: No Effective Date: Expiration Date:
Registered Lobbyist: None Listed


Legislative History

Acting Body Date Agenda Item Action Sent To Due Date Returned Pass/Fail

Board of County Commissioners 5/20/2008 14A12 Amended
REPORT: See Report Under Agenda Item 14A12 AMENDED, Legislative File No. 081793.

County Manager 5/19/2008 Additions 5/20/2008

County Attorney 5/19/2008 Assigned Hugo Benitez 5/19/2008

Health and Public Safety Committee 5/15/2008 2B AMENDED Forwarded to the BCC by the BCC Chairperson with favorable recommendation with committee amendments P
REPORT: During consideration of changes to today’s agenda, Assistant County Attorney Valda Clark Christian requested a scrivener’s error reflecting this resolution as Agenda Item 3G, should be corrected to reflect Agenda Item 2B. Assistant Count Attorney Clark Christian read the foregoing proposed resolution into the record. Assistant County Manager Alina Hudak noted the Board approved a unique partnership between the County and Blue Cross/Blue Shield (BC/BS), to develop a pilot program tthat provided insurance to uninsured residents of this community. She noted the item before the Board today defined the plan, and advised the actual contract would be brought back before this Board once this item was approved. Ms. Hudak advised that Commissioner Martinez requested that this item be waived to the May 20th County Commission meeting, if approved today. Ms. Janet Perkins, Executive Director, Countywide Healthcare Planning Department, noted this proposed plan would be of no cost or risk to the County. She also noted the County’s investment included the roll of OSHA (Occupational Safety and Health Act) and the County’s technical staff to follow the plan’s implementation and monitor the utilization and health outcomes. Ms. Perkins said the County was fortunate to have BC/BS as its partner in this program and commented that this partnership enhanced two existing products. Assistant County Manager Alina Hudak directed attention to “Attachment B” of this agenda package, which she noted provided a synopsis of the benefits. Ms. Lisa Matthews, Blue Cross Blue Shield of Florida Representative, and Ms. Penny Schaefer, Local Market President, Blue Cross and Blue Shield, appeared before the Board in connection with the foregoing resolution. In response to Commissioner Gimenez’ question of whether the reflected price points were the actual prices, Ms. Perkins explained that BC/BS could not finalize contracts with providers until they had specific price points. She noted the reflected price points had not been finalized. Ms. Matthews advised that a rate structure for the plan’s design had been prepared and would be filed with the Office of Insurance Regulation (OIR) for approval, depending on contract negotiations with the providers. Pointing out that negotiations had begun with the key hospital systems, as well as the provider community, Ms. Matthews stated she expected the plan and rates, as reflected in “Attachment C,” to be filed with the OIR in time to begin selling the program in May 2009, and implementing it in July 2009. Commissioner Gimenez asked Ms. Janet Perkins, Director, Countywide Healthcare Planning Department, to provide him with a report identifying how much this program would cost, retail versus wholesale. He asked that representatives from Jackson Health Systems be involved in the marketing component of this proposed Blue Cross Blue Shield program. Commissioner Gimenez also asked to be added as a co-sponsor of this resolution Commissioner Sosa asked Ms. Perkins to explore the possibility of marketing this product to the community through advertisements in the County’s Newsletter. She also asked that staff ensure there was no significant increase in the monthly costs of this product over the next 12 months and that costs remained as low as possible. There being no further questions or comments, the Committee proceeded to vote. The Committee forwarded the foregoing proposed resolution to the full Commission with a favorable recommendation, with committee amendments to include the language “…and directs the Public Health Trust, through its Jackson Health System, to participate in the outreach and education efforts related to the new product…” in the “NOW THEREFORE…” paragraph. Chairman Moss requested staff to prepare the appropriate memorandum to the Board of County Commissioners (BCC) Chairman Bruno A. Barreiro requesting a waiver of the Board’s Rules and Procedures to hear the foregoing proposed resolution at the May 20, 2008, Board meeting.

Legislative Text


TITLE
RESOLUTION APPROVING THE MIAMI-DADE COUNTY - BLUECROSS BLUESHIELD OF FLORIDA, INC. CO-DESIGNED INSURANCE PRODUCT FOR THE UNINSURED RESIDENTS OF MIAMI-DADE COUNTY, AND AUTHORIZING THE COUNTY MAYOR OR DESIGNEE TO FINALIZE A NO-COST CONTRACT FOR A THREE-YEAR PILOT IMPLEMENTATION

BODY
WHEREAS, this Board desires to accomplish the purposes outlined in the accompanying memorandum, a copy of which is incorporated herein by reference,
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MIAMI-DADE COUNTY, FLORIDA, that this Board approves the Miami-Dade County - BlueCross BlueShield of Florida, Inc. co-designed insurance product for uninsured residents of Miami-Dade County including specified benefits, premiums, co-payments, coinsurance, and deductibles; [[and]]1 authorizes the County Mayor or designee to finalize a contract with BlueCross BlueShield of Florida, Inc. for a three-year pilot implementation of the co-designed product in substantially the form attached hereto and made a part hereof, and to submit the same for approval by this Board>>, and directs the Public Health Trust, through its Jackson Health System, to participate in the outreach and education efforts related to the new product<<.
1 Committee amendments are indicated as follows: words within double brackets are deleted, words within double arrows are added.

HEADER
Date:
To: Honorable Chairman Bruno A. Barreiro
and Members, Board of County Commissioners

From: George M. Burgess
County Manager

Subject: Resolution recommending approval of the Miami-Dade County -
BlueCross BlueShield of Florida, Inc. co-designed low cost
comprehensive health insurance product for the uninsured
residents of Miami-Dade County, and authorization to
finalize a no-cost contract for a three-year pilot implementation

STAFF RECOMMENDATION
RECOMMENDATION
It is recommended that the Board of County Commissioners (Board) approve the attached Miami-Dade County - BlueCross BlueShield of Florida, Inc. (BCBSF) co-designed low cost comprehensive health insurance product (Product) for uninsured residents of Miami-Dade County; approve a three-year pilot implementation of the co-designed Product, and that the Board authorize the County Mayor or designee to finalize a no-cost contract with BCBSF for a three-year implementation.

SCOPE
The pilot implementation of the Product would be made available to uninsured residents Countywide.

FISCAL IMPACT/FUNDING SOURCE
The no cost contract with BCBSF protects Miami-Dade County government from being responsible for financing the Product through general revenue. The Office of Countywide Healthcare Planning (OCHP) has been charged with the successful design of the Product, and upon Board approval, will work with BCBSF to refine the design during the pilot and will monitor and evaluate the outcomes. OCHP will perform these responsibilities within its existing staff. BCBSF will bear the cost of obtaining regulatory approval of the Product, preparing the marketing plan and marketing materials, obtaining media purchases and member enrollment, as well as taking all claims risk.

TRACK RECORD/MONITOR
BCBSF has more than 60 years of health care experience in Florida with a demonstrated commitment to providing affordable health care solutions to Floridians. BCBSF has a proven track record of financial stability, strong reserves, quality provider networks, value-added services and high customer satisfaction. BCBSF also has extensive experience in developing both limited benefit health insurance products as well as innovative health insurance products and with obtaining the required regulatory approval to deploy such products. OCHP staff will closely monitor enrollment and service utilization as reported by BCBSF, and will work with BCBSF to engage in continuous quality improvements throughout the three-year pilot. BCBSF has agreed to contract with the safety-net providers at market rates, thus providing new points of access to enrolled members and a new source of income to the safety-net providers. OCHP will closely monitor the impact on these providers. Staff will provide updates after the first six months, and quarterly oral reports to the Health and Public Safety Committee for the duration of the pilot.

MANAGER'S BACKGROUND
BACKGROUND
BCC Healthcare Task Force, established by Ordinance (No. 05-169) through County Commissioner Joe A. Martinez’ leadership, recommended that the County develop a low cost health insurance product to help decrease the significant number of County residents who lack health insurance and the growing demand for charity care. Sponsored by Commissioner Martinez and approved by the Board on December 4, 2007, Contract No. 8347: Limited Benefits Insurance Product, directed staff to work collaboratively with BCBSF to co-design a comprehensive insurance product with very low premiums and cost-sharing (deductibles and co-pays). The proposed Product was to be brought back to the Board for its approval to initiate a pilot implementation by BCBSF, in collaboration with OCHP, for three (3) years.

Target Population & Goals – This Product is targeted to the estimated 600,000 uninsured County residents under age 65, many of who are unable to afford existing private health insurance and who do not qualify for public programs (such as Medicaid and KidCare). Small group employers who employ less than fifty employees and have been unable to purchase cost effective health insurance, will be targeted for the group coverage product. It is staff’s intention that eligibility for the Product shall not be contingent upon immigration status and citizenship.

The measurable goals of this pilot implementation and post-pilot full implementation are to (1) increase the number of insured; (2) achieve increased sustainability for safety net providers, including Jackson Memorial Hospital, its broader Jackson Health System and Federally Qualified Health Centers; (3) reduce avoidable visits to the ER and avoidable hospital admissions; (4) establish a "Medical Home" for enrollees who will have access to a full spectrum of services from primary to inpatient care; and ultimately, over time, (5) a healthier Miami-Dade County resident population. It is projected that in the first 12 months of enrollment, there will be approximately 4,000 to 6,000 new enrollees in the Product.

Design Features – A unique Product has resulted from this collaboratively designed effort between the County (through OCHP) and BCBSF. No known similar product exists locally, statewide, or nationally. This new type of product combines features of indemnity insurance and the more common coinsurance model in a way that maximizes benefits while offering an affordable premium and member out-of-pocket structure. Attachment A, “Key Points,” provides a summary of the unique features of this co-designed product.

This co-designed Product includes comprehensive benefits including primary and specialty care, inpatient (hospital) services, diagnostic services, and pharmacy benefits. This Product will incorporate Chronic Disease Management and Emergency Room alternatives to increase healthcare efficiencies, decrease cost of charity care and improve health outcomes. Refer to attachment B, “Benefits Overview Matrix,” for a list of benefits for individual and group plans and their corresponding deductibles, coinsurance and co-payments.

Swipe card technology will be used to facilitate eligibility, benefits, and payment to providers, thereby lowering administrative costs. The significant elements of BCBSF’s commercial network will be combined with local safety-net providers, including participating Federally Qualified Health Centers and the Jackson Health System. This will ensure a broad provider network with community based access to primary care.

As a result of the co-design process, persons will be able to purchase this Product for a planned monthly premium as low as $69 for a 19-year-old male with the premium for the uninsured population approximate median age of 35 being $110 per month for a male (these monthly premium rates are subject to review and approval by the Florida Office of Insurance Regulation and are based on a low cost provider network which must be developed with negotiations currently underway). Attachment C, “Proposed Rates,” provides individual and group planned monthly premiums by gender and age cells. During the implementation process, BCBSF, in collaboration with OCHP, will continue to improve the cost effectiveness of the Product. Enrollees will have unlimited visits to both primary and specialty physicians with little or no co-payments after an insurance paid allowance of $50 per visit and the certainty, that if a catastrophic hospitalization occurs, the most they will pay in a year is $2,500. The benefits would continue up to a Lifetime Maximum of $5,000,000.

The Product will be offered to both individuals and small businesses. The group product is what is a ‘guaranteed issue’ product and will be provided regardless of health status to all employees being enrolled though it will have some pre-existing condition exclusions. The individual product will be ‘medically underwritten’ which means that some individuals with certain health conditions may not be eligible for enrollment. Individuals who are not eligible for enrollment will be offered a lower cost product on a guaranteed issue basis that covers primary and specialty physician office visits and that provides a pharmacy benefit. This guaranteed issue product will provide the same local access to physician services and will have the goal of aiding individuals in transition into an underwritten, broader spectrum product. OCHP and BCBSF will collaboratively monitor the progress of these individuals, assist them in better managing their conditions and re-offer, as appropriate, the more comprehensive Product. OCHP will report, by Commission District, on the progress of this parallel program with the goal of continuously increasing the number of individuals eligible for enrollment in the comprehensive co-designed MDC/BCBSF product.

Next Steps – Upon Board approval of Staff’s proposal (with or without any added options outlined in Attachment D, “Additional Benefit Options”) BCBSF will prepare the application to the Florida Office of Insurance Regulation for approval including the Product description, pricing and marketing materials. Additionally, BCBSF will develop a comprehensive marketing plan to reach the target population. To the extent permitted by State statute and regulation, the marketing and enrollment process will utilize community-based resources such as community-based providers and social service agencies to assist individuals in applying to BCBSF for this Product. Neighborhood events may be used to both enroll and educate members to help ensure that enrolled members understand how to utilize their benefits.

Over the next several months the County, through OCHP, will continue to work collaboratively with BCBSF to ensure that the Product and the implementation processes are completed in a way that meets the objectives of the County. BCBSF will negotiate with providers to develop agreements, apply for Florida Office of Insurance Regulation approval for the plan and rate filings, develop marketing materials and outreach plan, commence sales, implement marketing campaign during March-April 2009, and begin enrollment in May for an effective date of July 1, 2009.


____________________________
Assistant County Manager



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