Countywide Healthcare Planning

Blueprint

Miami-Dade County (MDC) has undertaken the challenge in meeting our 600,000 uninsured residents’ needs.  The Office of Countywide Healthcare Planning (OCHP), leads a two-part approach: Part I – the low-cost, comprehensive health insurance product, Miami-Dade Blue*, co-designed with Blue Cross and Blue Shield of Florida for those currently uninsured residents (under age 65) and the work force (entities with up to 50 employees); and  Part II – OCHP’s analysis and management of 4 core efforts: (1) transparency – data at community level, (2) chronic disease management within FQHCs, (3) work force value-added analysis of insurance, and (4) premium assistance program.
top

History

Miami-Dade Blue is a 3-year Pilot (7/09 to 7/12) between Blue Cross and Blue Shield of Florida (BCBSF) and Miami-Dade County. After a competitive bid process, the County collaborated with BCBSF to design and implement a specific product which would meet the needs of uninsured individuals and the workforce struggling with the high cost of health care. Over 29% of Miami-Dade County residents live without health care coverage (Small Area Health Insurance Estimates, 2008).
top

Part I - The Product

A community-based Preferred Provider Organization (PPO) plan with a $5 million lifetime maximum (benefits as of 8/1/09):

• Affordable Premium for Individuals – example: $101 a month for 35 yr old male/$111 a month for 35 yr old female
• Unlimited Office-Based Services and Wellness (up to $5 million lifetime Plan maximum) – Plan pays up to $50 for each covered physician or dental visit and members pay the balance up to the pre-negotiated lower provider fee when a participating provider is used (PPO-provided mammograms and labs are fully covered).
• Generic Prescription Drugs for a low $10 co-payment, plus a discount card for brand medications
• Inpatient and Outpatient Hospital-Based Services – 10 percent co-insurance up to maximum annual out-of pocket of $2,500 (negotiated rates) 
• Broad Provider Network – 7 hospitals and 1,600+physicians plus Community Health Centers (including 6 FQHCs); hospice and durable medical equipment providers
• Point of Service Plan – member can choose their doctors; referrals not required
• Disease Management and ER Alternatives Included – 24/7 nurse line, case management and urgent care centers
• Plans to cover groups or Individuals:
  •  Work Force Plan – Up to 50/work force members (employees); “Guaranteed Issuance” no refusal for pre-existing conditions
  • Individual Plan – Medically underwritten not guaranteed issuance; some individuals with pre-
    existing may not be eligible for coverage (those individuals will be offered other products).

top

Part II- County Role

County’s added public health strategies that enhance the Pilot’s ability to achieve our shared goals. 

Miami-Dade County’s role is focused on Four Key Efforts:

• Transparency of Outcomes – increase Miami-Dade Blue’s outcomes transparency through analysis and reporting of enrollment and utilization results at the community level (while also safeguarding individual’s privacy);
• Chronic Disease Management – increase the Plan’s performance by working with providers to implement nationally-proven, clinic-based models of provider and patient driven chronic disease management;
• Work Force Value-Added – coordinate with work force to capture the value-added benefits of providing heath coverage (e.g.; measure skilled labor retention, decrease absenteeism and increase productivity); 
• Premium Assistance Program – develop the Program and source funds for the premium assistance (starting from the $250K in seed money received from our State’s Medicaid Waiver) which will enable more of our County’s lowest income residents to participate in Miami-Dade Blue

Core Shared Goals

• Increase the number of insured individuals;
• Reduce the amount of charity care and ER use for primary care;
• Increase the viability of our safety net providers; and
• Ultimately, Improve the health of our community

top

For more information

Contact Janet Perkins, Director, Miami-Dade County Office of Countywide Healthcare Planning: 305/375-5444; jperkin@miamidade.gov. Or visit: http://www.Exploremdb.com

*Miami-Dade Blue is insured by Blue Cross and Blue Shield of Florida. Miami-Dade County is not responsible for the operations or liabilities of this product.

At the December 15, 2009 Board of County Commissioners (Board) meeting, the Board approved Resolution No. 1450-09 directing the Office of Countywide Healthcare Planning and the Office of Intergovernmental Affairs to monitor and report on national health care reform to the Board through the Health, Public Safety and Intergovernmental Committee (HPSIC). Subsequently, a report was distributed to the Board.

Please click on the following link below to see an overview of the national health reform law which passed in March.

• Health Reform Summary and Analysis

If you need assistance, please or call 305-375-5444, Office of Countywide Healthcare Planning.