Managed Healthcare Executive - November 2008 - (Page 18)

{EX EC U T I V E PROFIL E} two physician networks rose to 9,237, up chronic condition or a serious disease, 62.6% from 5,681 since June (providers such as cancer, could easily exceed this are counted twice if in two networks). maximum,” she says. Gov. Rell recently announced that all 13 Charter Oak, according to Starof the state’s community health centers kowski, is one of the few coverage ophave agreed to partions on the market ticipate in Charter that welcomes apOak, resulting in an plicants with preextensive network existing medical of providers across conditions—the ° $25 copay for primary care visit the state. Out-ofbest evidence that ° $35 copay for specialist visit network authorizaCharter Oak is a ° $35 copay for behavioral health or tions are permitted viable option for outpatient rehabilitation service to accommodate people with chronic ° 100% maternity coverage enrollees as the illness. “One of our networks continue rst covered hospi° 100% preventive coverage to build. A hospitalizations, in fact, ° 100% emergency room coverage talization for John, was for an enrollee ° 90% inpatient hospitalization coverage the member from with chronic illness,” after maximum $900 deductible met Torrington, was he says. ° 80% outpatient procedure coverage after covered through With diabetes, deductible met an out-of-network for example, Char° 80% skilled nursing coverage 14 days/ Provider network authorization. ter Oak excludes year after deductible met Another criticism of Charter Oak, acAetna’s Kelly says diabetic supplies cording to Families USA’s Hushagen is he expects HUSKY from the pharma° 3-tier drug formulary, starting at $10 copay that it appears as if it’s struggling to build network participaceutical cap and the a provider network, and some individuals tion at the same durable medical ° $100,000 annual maximum for medical are less likely to enroll if their doctor is level as achieved by equipment cap. ° $7,500 annual maximum program not part of the network, she says. prior plans and the To date, the state bulk cost for drugs, with exclusions DSS reports state’s interim FFS has elded tens of ° No vision or dental that HUSKY program, but that thousands of phone and Charter the Charter Oak calls from the public Oak net- network will be slower to develop. about Charter Oak. The plan is projected works are “Providers will likely be cautious in to serve an average of 19,200 adults in sg r o w - contracting unless and until they agree that cal 2009; 24,800 adults in scal 2010; and ing. As of Charter Oak is e ectively targeted to the 47,000 adults in scal 2011. Three-plus last month, uninsured, and not commercially insured months after program launch, over 1,600 the size of persons looking for a less-expensive alter- Connecticut residents were enrolled in with the native,” he says. a Charter Oak MCO, with another 1,300 As with any individual market product, eligible to enroll. those enrolling in Charter Oak should ex“Without creative approaches like Charamine the bene t package carefully to make ter Oak, the real cost of meeting the healthsure it meets their needs, says Hushagen. care needs of uninsured individuals would “Charter Oak has some bene t limita- be a continued strain on hospital emergency tions including an annual maximum departments, community health centers for medical and clinics, and most of all, medical proservices and fessionals,” Starkowski says. “Connecticut pre sc r ip - has become an incubator for a new kind tion drugs,” of publicly sponsored and subsidized model she says. that utilizes private insurers and reinforces “People diag- personal responsibility through cost-sharing nosed with a by enrolled adults.” MHE vidual market premiums for a good policy remarkably high,” she says. Charter Oak is making every e ort to achieve a reasonable mix in the population in order to sustain, says Starkowski, emphasizing that one of the goals of Charter Oak is to attract the younger population. “We had a lot of discussions with the university system and community colleges in Connecticut,” he says. “We want to attract those individuals who are healthy and willing to pay that lower premium. If they are just starting out in the workplace after high school or college, they probably aren’t making a signi cant amount of money.” Starkowski says that the department has received inquiries from parents interested in picking up Charter Oak coverage for their young adult children. Charter Oak beneﬁt design 18 NOVEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Healthcare Executive - November 2008

Managed Healthcare Executive - November 2008 For Your Benefit Editorial Advisors Contents News Analysis State Report Politics &�Policy Letter of the Law Affordable Access Economic Ripple Effect Hospitals &�Providers Technology Managed Care Outlook Desktop Resource Ad/Edit Index

Managed Healthcare Executive - November 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.