Roundtable Discussion: Findings from the Florida Health Insurance Study, Phase II, Strategic Plan Discussion

Agency for Health Care AdministrationUniversity of FloridaHealth Management AssociatesWinter Park Health FoundationMarch 3, 2006

Focus Groups

A third in the series of focus groups with uninsured individuals, three groups of uninsured in north, central and south Florida revealed again that:

Uninsured have access problems—especially preventive care and specialists

Uninsured use the emergency room and health centers

They are not willing to pay for current limited services in a plan—want more comprehensive and unaffordable coverage—unrealistic view of costs

Focus Groups (cont.)

Education of providers and consumers needed for health literacy

Special access challenges in rural areas More support, eligibility and referral help may

be needed at clinics Transportation for health services a

challenge

Focus Groups (cont).

Safety-net providers are concerned with: Capacity Inappropriate ER use Maintaining rates Access to specialists when needed Skeptical that limited benefit or insurance

type product will work.

Literature Review

Coverage options and plan designs implemented in other states relevant to Florida:

Small group purchasing pools Premium assistance programs Three-share plans High deductible plans and savings accounts Limited or flexible benefit plans

Literature Review (cont.)

Review of plans in other states reveal that the design is structured to meet the particular needs of the population identified and include several design characteristics. Generally, the plans offer limited benefits for affordability and include funding mechanisms tailored to the community, i.e. tax structure.

Literature Review (cont.)

SCI, Issue Brief, State and Community Collaboration…..(April 2005) committed communities are capable of leveraging significant dollars (including state level investments), brokering public/private partnerships, institutionalizing coalitions, responding to local needs, accessing local resources and building and sustaining new safety-net infrastructures.

Literature Review: Successful Plans

Well designed and successful plans include: A thorough understanding of the populations

targeted An identified vehicle for coverage A knowledgeable champion to lead the project A source of sustainable finding A well coordinated system, comprehensive An aggressive marketing approach

Questions

Is there a key person who will lead the effort in the community—able to bring individuals to participate?

Do you have staff or resources to support them? Are the right organizations available as partners? Will the fiscal environment in your area support the

project in the short and long term? Do leaders agree on what they want to accomplish? What vision do we have for the current and future?

Questions (cont).

Do you know what it is going to take to get a program up and running, and do you have the funding to carry out the planning and implementation?

Do we have the right resources to get started, or do the plan?

Necessary activities

Ensure enrollment in current programs, Medicaid, Medicare (Part D), SCHIP—first priority to make resources go further.

Understand consumer attitude Actuarial soundness Care, clinic services vs health insurance Financing