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The first conference call for the multi-share series hosted by Communities Joined in Action took place on December 17. Judging from the number of participants (more than 40 lines connected to the call), there is considerable interest in the multi-share program. CJA will be hosting a series of calls throughout the balance of 2009. Interested parties can get a schedule of the calls and registration information on the CJA website, www. cjaonline.org. The first call of the series focused on the latest updates from the oldest multi-share program based in Muskegon, MI. Jeff Fortenbacher, Director of Access Health in Muskegon gave a presentation on the program, followed by an hour of question and answers with the participants. Below is a recap of the questions asked and Jeff’s responses.

Q: What has been the experience with enrollment and do you track any health outcomes? Jeff: The enrollment has stayed steady, even through the economic downturn. Muskegon has kept enrollment at between 350 to 400 businesses with a membership of about 1,300. Most of the losses in membership have resulted from the economy, but we continue to pick up new businesses too as more businesses look for affordrable health care. As for health outcomes, we are just now starting to measure behavioral changes that improve health. Our members come to us with unhealthy behaviors that we try to change as the first step in improving health outcomes. For example, our members smoke at 3 times the national average and we have seen a 30% - 40% quit rate - and 70% have reported reductions in their smoking. We are also now working with the Michigan Public Health Institute to track other health indicators and hope to have some reports on that in 2009.

Q: Can you explain the cost of the 3 three shares? Also what are your claims cost versus your administrative costs? And how much do you rely on health navigating? Jeff: The employer and employee shares are $46 per member-per month. The community share makes up the rest of the cost, totaling about $150. The claims cost is about 88%, versus the admin cost of 12%. We are able to keep this ratio consistent because we do reply heavily on health navigation to ensure that we use the appropriate coordinated care, and use safety-net services wherever appropriate. Q: How much of your expenditures are hospital costs?

Jeff: Hospital costs have varied between 56% to 63% since the start of the program. Q: What is the legal structure for Access Health? Jeff: We are a 501 (c) 3 charitable corporation. We are also not under the state’s insurance department for regulatory oversight. We do report to the Department of Human Services for oversight. We also have our hospital CFO and other community officials on the Board of Directors and Finance Committee to ensure internal oversight. Q: As a non-profit, do you receive philanthropic funding? Q: How do you market the product to businesses?

Jeff: We employ a full time sales person to begin with. In addition, we work through the Chamber of Commerce to identify prospective members looking for health insurance. We also experience considerable word of mouth advertising from both employers and employees. In some cases a business may be recruiting an employee from an Access Health business and learn that the employee will not relocate unless the business can provide Access Health. Word of mouth is one of our best marketing tools. Q: Are some of the businesses pushing back on the $46 monthly premium in this economy? Jeff: No. All of our businesses appreciate the value they have and the bargain it is at $46 PMPM.

Q: How many care coordinators are on staff, and are they able to handle the caseload effectively? Jeff: We have 2 care coordinators and they are able to handle the case load. Q: What is the rate for hospital charges you pay? Jeff: Access Health pays 80% of hospital charges, and 112% of Medicare for professional services. Q: Do you contract out for claims payment? Jeff: No. We began doing claims payment internally several years ago. Initially we did use a TPA for this, but switched to in-house claims in order to have a better handle on the data.

We manage to do this with . 5 FTE. Q: What is the health status of your membership? Jeff: As I mentioned earlier, we are just now starting to get a picture of the overall health status of the population through our work with the Michigan Public Health Institute. What we do know is what their health status has been when they first joined Access Health. We know that: 60% smoked; 24% had hypertension; 16% had Diabetes; and 14% had Asthma. When we shared these statistics with some HMOs in Michigan, their comment was that they’d flee from this population, given the choice. So we expect that our health status will show significant improvements, given the fact that we’ve been able to manage costs without significant increases over 9 years.

Q: What was the relationship to commercial insurance? Were commercial carriers concerned about your entry in the market? Jeff: Initially yes. Commercial carriers were concerned that we would be competing for their business. Today that concern no longer exist. We were able to show that the market segment we targeted was one that they could not attract, in large part due to price. In addition, commercial carriers began to understand that as our membership began to receive health care, they would become less costly for commercial plans as these members changed jobs and eventually received commercial health coverage. Today most commercial plans see Access Health as a nice fit that dovetails into the overall needs for health coverage.

Q: Is Access Health considered credible as tax deductible for business? Q: Does Michigan have an Adult Benefit program? and who decides who is eligible for which program? Jeff: Yes, Michigan has an Adult Benefit program for unemployed, low income persons. The state determines eligibility for the program and it is administered at the county level. Access Health Inc. manages the Muskegon County program, known as Muskegon Care. As for the small business plan, know as Access Health, the eligibility for that program is determined by the community Board of Directors. Since Access Health uses DSH funds, eligibility is restricted by Medicaid rules for eligibility - but it is limited to employees of small businesses who meet the income criteria.

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