30 April 2007

28 proposals to the 208 Commission

A smart healthcare provider in Boulder, Colorado, has summarized all 28 of the healthcare proposals that the Colorado Blue Ribbon Commission for Health Care Reform is considering.

The fact that there are 28 proposals is in itself amazing. At one of the early commission meetings a staff person reported on similar commissions in other states. Illinois got nine proposals, so did California. Washington got more, but they weren't calling for comprehensive proposals, as is the Colorado commission.

You can find the 28 proposals submitted to the 208 Commission here.

This woman works with one of the proposers, but notes that these are her own impressions — and she says that they may not be fair, since she's working from descriptions of the plans, rather than reading each and every plan. She shares her biases up front: "I think of 'premium assistance' to individuals or small businesses r the 'uninsurable').

"Many mentioned the desirability of “medical homes” of some sort, which would serve to coordinate care for patients.

"Many would increase reimbursements to Medicaid and/or Medicare providers to address the problems of inadequate access to providers. Also mentioned frequently were incentives for healthy choices, and some pay-for performance suggestions. A couple of proposals suggested limiting profits that insurance companies make."

So, cribbing from her notes, here are the 28, organized, as she organized them.

Types of Proposals

Predominately Single-Payer

Colorado Health Services, submitted by Health Care for All Colorado and signed on to by the Colorado Nurses Association, OWL, and the Physicians for a National Health Program. Publicly owned, not-for-profit insurance company, administered and governed as public utility. Negotiated provider fees, no co-pays to begin with. Private coverage will be a choice above standard benefits.

Comprehensive Health Advancement Plan for Colorado, submitted by retired University of Colorado professor Edwin McConkey. This is a modified single-payer with emphasis on health advancement rather than insurance. There are financial incentives for healthy lifestyles and training of professionals in high needs areas. It creates a new agency with state wide governance, public funds, set fees for providers.

Colorado Complete Healthcare Reform, submitted by PULSE. Expands Medicaid to all residents in a program called MediColo but allows insurance companies to operate in Colorado for up to five years. There would be a no-fault system that separates compensation from accountability which would reduce malpractice costs. Its medical home is a team of MD, nurse, social worker or counselor and advocate.

Colorado Comprehensive Care Coverage, submitted by Savant Solutions. Its state-run, paperless, profitless, models are Medicaid, VA, Kaiser and European countries. It would begin with a pilot project with four phases. An oversight group such as Savant, would serve as a procurement team requesting RFPs, getting bids, selecting them.

Colorado All Care, submitted by Nathan Wilkes. Healthcare delivery remains the same but funding would be through taxes. Reimbursement rates to providers would be set; there would be no co-pay or deductibles; all prescription, dental, vision, mental health, and long term care would be covered.

Universal Capitation Plan, submitted by Stuart Zisman. This single-payer plan is similar to HCAC proposal except that it's run by elected providers and consumers, with local assessments of needs and consumer choice of fee-for-service or a capitated-rate (recommended) plan.

Single-Payer with market component

Colorado Balanced Choice Health Care Reform, submitted by Balanced Choice Health Care, Inc. Ivan Miller's plan offers universal coverage, public funding, single-payer with a constant option of interchanging a two-plan system that allows for providers to set their own fees and for consumers to have cost conscious treatment choices. Spending on the two plans would be regulated by a mandatory funding split that adapts to market forces to ensure enough resources go to the standard plan to maintain quality care. There would be a focus on transparency, automatic enrollment (with opt-out possibilities if they have equivalent or better health insurance) so all residents are covered regardless of employment or income status, simplified paperwork and procedures, and relief for employers. Financial assistance for low income or catastrophic health expenses.

Predominately Subsidizing Private Insurance

A Comprehensive Health Care Plan for All Colorado Residents, submitted by Barry Bode. This comprehensive reform proposal would subsidize health, disability and life insurance.

Comprehensive Health Care Plan, submitted by Club 20. This plan mandates individual purchase of basic “Tier I” coverage as in Massachusetts. It uses value ranking procedures as in Oregon, which is a transparent way of limiting or rationing treatment. The plan states that the healthcare “...solution is less about need for new ideas and more about need to accept reality.”

A Plan for Covering Coloradans, submitted by the Committee for Colorado Health Care Solutions. This plan creates the Colorado Health Insurance Purchasing Authority, a quasi-governmental agency to standardize six to ten insurance benefit packages, assist with purchases of insurance, manage the insurance “pool” with community ratings and guarantee issue. The proposer believes that national policy is necessary. This plan has aspects of single-payer and expanding public coverage but remains a broker/ regulatory agency to oversee private insurance.

Solutions for Healthy Colorado, submitted by the Colorado State Association of Health Underwriters. This proposal would institute state-sponsored outreach for those eligible but not enrolled in public programs; insurance companies must guarantee issue “Core Limited Benefit Plan” with sliding scale premium subsidies; and mandated individual purchase to address the “voluntarily uninsured.” Plan lacks details.

Better Health Care for Colorado, submitted by the Service Employees Union (SEIU) and the Colorado Association of Public Employees. This plan would bring Medicaid-funded premium subsidies to purchase insurance; establish a clearinghouse to help small business purchase health insurance and offer private insurance products rather than mandating insurance. It would create a “culture of insurance” and extend coverage to 96 percent of residents. Recipients would have choice of managed care plans. It does provide long-term care plans and urges improved access to affordable housing so long-term care consumers can live independently.

Individual Based Insurance System Combining Free market Principles with Appropriate Role for Government, submitted by the South Metro Denver Chamber of Commerce. This plan mandates individual purchase of “maintenance tier” insurance not tied to employer. There would be a Massachusetts-style health connector portal and search engine that provides healthcare purchasing consultants. There would be group pools for catastrophic insurance that is re-insurance funded by contributions from the maintenance policies. The free market moves responsibility from managed care to the individual and eliminates inefficiencies. There is a heavy emphasis on HIT and incentives. A statewide system of clinics funded by the state, business gifts, and non-profit donations would serve the uninsured/minimally insured.

Universal Colorado Health Insurance Plan, submitted by Joseph Roddy and William Yancey. This plan would “fine tune the industry with regulation to... serve the entire population...” It puts people into groups of 10,000 with identical demographics so that the premium price is the same for everyone. Insurance companies decide how many groups to compete in. Providers are exempt from malpractice claims.

Combination of Expanded Public and Subsidizing Private

Uninsured Action Plan, submitted by Anthem BC/BS (Wellpoint). This plan expands CHP+ and Medicaid; subsidizes private insurance; increases managed-care; and “minimizes administrative costs by building on existing systems.”

Connecting Care and Health for Colorado, submitted by Colorado Consumer Health Initiative (CCHI), also signed by Health Care Policy and Finance, Division of Insurance, Department of Public Health and Dept. of Human Services. This government-run plan limits the profits insurance companies can make. It standardize benefit packages in both public and private markets and mandates individual purchase with limits of 5 percent of income for out-of-pocket costs. It builds on employer-sponsored plans with subsidies and/or reinsurance and consumer protections.

Healthy Colorado Now, submitted by the Coalition for the Medically Underserved. CCMU builds on our existing system but develops a new insurance plan for the working uninsured, funded by employer-paid payroll fees, which does provide premium assistance if necessary. This may be private insurance.

Community of Caring, submitted by the Colorado Community Health Network, Colorado Children’s Campaign, Colorado Access, and Colorado Behavioral Health Council. This plan calls for mandated individual insurance purchase with subsidies for individual and small business insurance purchases. A “quasi-governmental” entity creates a public-private partnership to purchase coverage for all Coloradans (except ERISA) and it expands public programs. They propose a “Safety Net Stabilization Program” which provides enhanced reimbursements to providers certified to meet needs of distinct populations.

Phased Approach to Universal Coverage, submitted by Kaiser Permanente. This plan expands public programs as funds permit, and creates policy and administrative infrastructures.

Additional but not Comprehensive Proposals

Improving Our Health Care and Condition, submitted by the Colorado Foundation for Medical Care. This plan would provides foundational elements essential to quality and functioning of health care systems.

System to Ensure Medical Home—Health Outcomes Measurement and Evaluation Consortium, submitted by Health TransPharmacy Care Fund. This proposal provides information on available resources, access to pharmacy savings program and subsidies.

Neighborhood Nurse Practitioner Clinics Mandating private health insurance “is absolutely the wrong approach [it] is the problem, not the solution” so neighborhood groups of 500 households would join a clinic for $25/month and receive unlimited free office visits with nurse practitioners. The $25/month would pay for a NP, part-time office staff and overhead, which is low because it operates out of a residence. Insurance would cover catastrophic care.

Free-market, Affordability and Individual Rights, submitted by Brian Schwartz. The fault for unaffordable healthcare lies in third party payments that delete personal responsibility

A Simple Health Care Solution, submitted by Monte Uyemura, MD. This proposal would make it illegal to sue providers and would eliminate physician shortage. In exchange providers could not refuse to see patients for inability to pay. It calls for major medical and HSAs to reduce paperwork.

Colorado Health Coverage and Jobs Solution, has no name on the submission. It requires insurance firms having government contracts to offer a plan comparable in price and benefits to Federal Employees Health Benefit Plan.

Telemedicine and Data management Systems for Improvement of HC Coverage Costs, submitted byEnigami Systems. This patent-pending protocol is a plan in which consumers' symptoms are telephonically assessed on a daily basis using interactive voice response system that can be viewed graphically on the web-site by the consumer. This addresses inadequate accountability; allows provider to change treatment plan and allows insurer to do utilization reviews and provider rating scales

The Option to Die in Peace, submitted by Bart Windrum. This proposes expanded hospice-type education and care for at-home deaths.

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