Even before the first member is enrolled, consumer operated and oriented plans (CO-OPs) will invest thousands of hours in developing the operational infrastructure that will provide healthcare coverage for their members. Conventional approaches to managing cost such as contract negotiations with network providers for competitive unit costs and implementing medical management models to curb excessive utilization are important starting points for controlling the cost of claims. However, recent changes to the nation’s healthcare system have created a few additional items for CO-OPs to consider as they prepare for October 2013 and enrolling their first members.
Read more in the latest issue of CO-OP Point of View.
Consumer operated and oriented plans (CO-OPs) share many similar values with the community health centers (CHCs) that are supported by the Health Resources and Services Administration (HRSA). Both are nonprofit with consumer-majority governing boards, and the population that currently obtains care through CHCs will likely account for many of the members that CO-OPs enroll. This edition of Milliman’s CO-OP Point of View newsletter discusses how CO-OPs and CHCs are currently in alignment and may be poised for mutual success. Click here to view the newsletter.
The U.S. Department of Health and Human Services (HHS) yesterday announced two new consumer operated and oriented plan (CO-OP) loans. Here is more information:
Kentucky Health Care Cooperative
Service Area: Kentucky
Award Amount: $58,831,500
Award Date: June 22, 2012
Kentucky Health Care Cooperative is sponsored by a coalition of business leaders, providers and community organizations who plan to improve health outcomes throughout the Commonwealth of Kentucky by providing better access to high quality care at an affordable cost. The Cooperative will participate in Kentucky’s Health Insurance Exchange, as well as in the individual and small group marketplace.
The Vermont Health CO-OP (Incorporated as the Consumer Health Coalition of Vermont)
Service Area: Vermont
Award Amount: $33,837,800
Award Date: June 22, 2012
The Vermont Health CO-OP (incorporated as the Consumer Health Coalition of Vermont) was founded by Vermonters with extensive experience in health insurance and regulation, State health reform efforts, health care delivery, and successful corporate start-ups, with the support of providers, employers, and consumers. The CO-OP will work with Vermont Managed Care, the network affiliated with Vermont’s academic medical center, to coordinate the delivery of health services statewide through its growing network of hospitals, physicians, primary care medical homes and other health care providers.
For the full announcement, click here.
Given their not-for-profit nature, it may not seem obvious that the consumer operated and oriented (CO-OP) health plans enabled by the Patient Protection and Affordable Care Act (PPACA) need to market themselves. But, argues Shyam Knolli in the latest issue of CO-OP Point of View, CO-OPs still need to differentiate their products and gain market share. Recommended strategies include using data to drive strategy and creating innovative yet easy-to-understand products.
Consumer Operated and Oriented Plans (CO-OPs), the not-for-profit health plans envisioned in the PPACA, have been gaining traction, with CMS announcing hundreds of millions of dollars in loans to help establish such plans in Maine, Oregon, South Carolina, Iowa, Nebraska, Montana, New Jersey, New Mexico, Wisconsin and New York.
Milliman recently started a newsletter on CO-OPs. The first issue encouraged CO-OPs to learn from history and avoid pitfalls common to all new insurance plans. Milliman produced a briefing on CO-OPs back in July of 2011. For quick access to all the Health Care Town Hall posts on CO-OPs, use this link.
The consumer operated and oriented plans (CO-OPs) created by the Patient Protection and Affordable Care Act (PPACA) will soon be the newest entrants in the health insurance marketplace. However, they are the next in a long history of entities aiming to sustain competition and innovation in the provision of prepaid healthcare. A careful review of the successes and failures of HMOs and health insurers that have come before can provide key insights into the challenges that CO-OPs face in creating, growing, and sustaining a plan. CO-OP managers can learn from this history and gain valuable insights that will help them formulate strategies on what to do—and what not to do—to build a viable, thriving, and competitive health plan. Learn more in the first issue of “CO-OP Point of View.”