The rocky roll out of the Obamacare medical insurance exchanges is big news. In Colorado, there are several exchanges, including the official state-run Connect for Health Colorado, offering plans from a variety of insurance providers. New to the insurance mix is Colorado HealthOP, a medical insurance co-op. It’s Colorado’s first medical insurance cooperative, sponsored by the Rocky Mountain Farmers Union Educational and Charitable Foundation. The co-op’s focus is on affordable choice and prevention, while encouraging co-op members to take responsibility for their own health.
To achieve those goals, Colorado HealthOP is partnering with doctors who believe in the mission. Using providers in the co-op network can help members save on medical costs. They can also save, or earn monetary rewards, by taking specified actions, such as getting certain medical tests.
Julia Hutchins is the CEO of Colorado HealthOP, and she spoke recently about how this system will work.
Examiner: How did the idea for Colorado HealthOP get started?
Hutchins: There is a provision in the ACA regarding co-ops. People at the Rocky Mountain Farmers Union thought this might be a good fit and started talking to officials in Colorado. They wanted to know whether Coloradans thought there was a need for a consumer-run medical plan, and how it could be organized.
Examiner: Your brochure mentions preventive care, as well as network pricing as key aspects of the co-op mission. How does this work?
Hutchins: One of the key tenets of the co-op business model is a sense of shared responsibility to the larger group. Members who sign up will have a personal responsibility for their own health. We’ve developed different ways to start having that conversation with people, so they have a sense of how their actions and spending impact the whole co-op membership.
It’s important that we provide the tools they will need to be good consumers. We have a pricing tool called The Health Care Blue Book. It’s a service to members, who can search it to find out the costs of specific procedures from providers in their service area. It gives consumers a feel for the range of costs, so they know what costs to expect going into a procedure. It’s also a way to weed out providers whose costs are off the charts.
There are explicit rewards built in to the system to encourage people to take care of themselves, such as getting blood work done or filling out a health questionnaire. These help to identify any emerging conditions the member isn’t aware of.
Examiner: So is the preventive care more about assessment and testing?
Hutchins: In most of Colorado HealthOP's plans, when members do three health actions once a year (the health survey, a biometrics screening and a preventive check-up with their primary physician), their health plan gets upgraded to an "enhanced" plan, which means that they pay less out of pocket when they see the doctor and they get money deposited to a debit card which can be used to pay for medical expenses. The co-op will support members for the conditions they already have. For example, we have a program to give people blood pressure monitors to use at home. This will help someone manage a chronic condition they’re living with.
Examiner: Does the co-op reward people financially for being healthy?
Hutchins: We’re constrained by the rules of the insurance industry,* and can’t price based on health. Because of the investment we’re making, it’s important the people maintain their health. Our aim is to communicate to people their responsibilities for their health, as co-op members.
Examiner: Can you outline what that means – “their responsibilities”?
Hutchins: The members need to improve or maintain their own health, and engage in the health of the co-op community. We’ve mapped out patient engagement with a set of evidence-based tools. We’ll implement a staged approach of how we communicate these messages to members. The co-op should be seen as a trusted entity that’s supporting them to improve their health and the health of the community. The first thing they see on our website is a statement asking them to commit to improving their own health. The welcome packet and introductory phone call give us another opportunity to talk about their responsibility as a member. They can connect to other co-op members to support each other to improve health. We’re using evidence-based questions to measure how successful we are in engaging people in their own health.
Examiner: Who is the ideal candidate for your insurance?
Hutchins: People should have a philosophical alignment with the co-op and a commitment to their own health. We have a lot of programming for people with chronic diseases. We have engagement tools; people can track their activity in the health system. We are developing a partnership with Map My Fitness. The goal is to create a continuum so we become a one-stop-shop for people to share activities around their health.
Examiner: Can you talk about how you will assess a person’s health status?
Hutchins: When people create their profile, we ask a lot of things about lifestyle. We want to target our message specifically to where members are on the health continuum. We look at it as a way to engage and provide a way to connect to other people. The members will get some benefit out of giving that information. It’s about creating an online profile, not just putting information into a black box. It’s a different way to engage people. Members are directly invested in our success. The way our benefits are structured, unless they really are engaging with us, people are not going to get as much out of it as they could.
We like to think of ourselves as a community-based organization that happens to provide health insurance. Cost transparency advocacy are one of the goals. The products are designed to keep people sustainably healthy. The co-op is run by a volunteer board for the first 2 years, and then the board is elected. The majority will be members. They’ll decide who to reinvest savings and what kinds of things people are willing to pay for. One of our biggest challenges is that people have a lot of questions and need to understand how a consumer-run insurance system will be different from conventional insurance. People are hungry for a way to make healthcare better. We expect the co-op will be attractive to individual consumers and employers.
*NOTE: The ACA prohibits charging unhealthy people more, unlike other types of insurance, where higher risks lead to higher premium costs, such as drunk drivers.