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).
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
For more information contact: Janet Perkins, Director, Miami-Dade County Office of Countywide Healthcare Planning: 305/375-5444; jperkin@miamidade.gov.
*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.
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