Stairway to….Ohio’s Health Insurance Exchange

Was watching the Kennedy Center Honors last night. Led Zep was being honored. I realised that I’m old (Heart sang Stairway to Heaven) when bands from when I was in high school were honoring a band when they were in grade school. We’re all going to get old and fast. Probably why I have been asked by my colleagues and friends about the changes in healthcare insurance and the new exchanges that will be coming in to force soon. Many are worried about the changes. Somebody mentioned to me that that they don’t believe that pre-conditions will be overlooked from now on. There are a lot of ambiguities in the way the exchanges will operate. I feel that it comes with any major paradigm shift in thinking.

Change is not the most welcome thing individuals welcome, least of all something that affects their health care. Essentially, the exchanges are new organizations that will be set up to create an organized market for people to purchase health insurance. They are supposed to offer a choice of different health plans, as well as certifying plans that participate in the exchange and provide information to help consumers better understand their health insurance options.

From 2014 onwards, these exchanges will primarily serve individuals looking to buy insurance on their own and small businesses with up to 100 employees, though states can opt to include larger employers in the years to come. States are expected to establish Exchanges or can ask the Federal Government to do it for them and they can be a government agency or a non-profit organization. In addition, states can create more than one exchange, as long as only one serves each geographic area, and can collaborate to build regional exchanges. As it has been reported in the media, on November 16th, 2012, the Governor of Ohio told federal officials that Ohio would have a federally-managed health insurance exchange. The caveat is that the state would keep control over its insurance industry. Governor Kasich additionally indicated that Ohio would maintain control over eligibility for Medicaid.

Before the announcement, the Department of Insurance, working with other agencies solicited assistance for the first year of exchange planning and implementation. Qualified health plans purchased through an exchange in Ohio are prohibited from covering abortions, except in cases of rape, incest, or to avert death of the pregnant woman.

Essential Health Benefits (EHB): The Affordable Care Act (ACA) requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Ohio has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Community Insurance Company (Anthem Blue Cross Blue Shield)- Blue Access PPO. The funding for the exchange started in September of 2010 when the Ohio Department of Insurance received a federal exchange planning grant of one million dollars.

The Federal Government will be responsible for running the health insurance exchange in Ohio beginning in 2014. Ohio must submit a blue print of plan management functions if it wants to take over responsibility the exchange to the Department of Health and Human Services by the 15th of February, 2013. Additionally, much of the above information is available through the Kaiser Foundation website. A great source of information for everyone.

Martinis and email…

I was with a colleague traveling to a customer in Wisconsin and finished the day and were walking through the airport wondering how to find a place to eat, access email and debrief from the day’s activities when the need for, well, you guessed it…”martini’s and email came up” (we actually never got to the martini’s, just for the record). There is nothing more acute for busy, traveling executives than the loss of that connectedness we take for granted in our society these days.

I write this as I listen to my (second) favorite Dire Straits song, Money for Nothing (my favorite is Walk of Life, but that’s a whole other blog entry). A great song that exemplifies the 80s. A lot of people don’t realize that Sting had such a great impact on this song, singing the introduction and chorus in falsetto; most people only credit Dire Straits and Mark Knopfler for this. This was the work of a collaboration and that was what made the song great (plus everyone wanted money for nothing and MTV those days).

I bring up collaboration as I was priviliged to live up to my recent award as a Fellow of HIMSS by connecting the IT departments of two healthcare networks that make a significant impact on our community and having them collaborate and share information to make their initiatives better, faster and cheaper to execute. I truly believe that Ohio can be #1 in Healthcare and Healthcare Information Technology. We have been able to put men in space and on the moon. I’m sure we can collaborate our way to successful initiatives and make sure that we conserve and make use of our available resources appropriately in order to maintain lower costs of operations for our healthcare providers and hopefully pass those savings on to our patient population.

With aspects of the Affordable Care Act coming into force soon, true collaborative environment will be required and our communities will be tested soon. “Fiscal cliff” not withstanding,  our nation has it’s share of challenges ahead for it and I intend to find a way to bring our communities together to continue the great American adventure. Collaborate, collaborate, collaborate. On December 23rd, 1783, George Washington came back after defeating the British and voluntarily resigned his commission. This was a first in recorded human history. Don’t you want to be a part of that unselfishness? I know I do.