By Richard Asinof
Christine Ferguson, the executive director of HealthSourceRI, freely admits that she is not surprised by the skepticism some have voiced regarding the launch of the stateâs new marketplace for health insurance. The state is doing things it has not done before: selling health insurance products, launching a startup business, and offering full employee choice in the health insurance, Ferguson said.
At the same time, Ferguson believes that the new marketplace â which will allow individuals and employees from small businesses with fewer than 50 employers to shop, compare and buy health plans â will lead to the development of a more affordable, accessible health care delivery system.
Further, she sees it as a critical economic development issue for Rhode Islandâs future.
Providence Business News sat down to talk with Ferguson a few days before the public outreach efforts on behalf of the new exchange got underway.
PBN: Does the new health insurance marketplace need to be defined in changing economic terms, as the definition of workforce changes?
FERGUSON: Yes, I think thatâs true. No question. Many books have been written about this, the shift of risk to the individual for health benefits and pensions.
The shift is happening. Weâre in the throes of it. Part of the reason itâs happening because of the bump of Baby Boomers.
Thereâs a negative side to that, one that frightens people: âWhatâs going to me? Oh my God, what if I canât afford it, what if I canât find somethingâŚâ
Thereâs also a positive side to it. Basically, if I can get my health insurance benefit â and nobodyâs going to give me a pension anyway â then if I want to work for two companies, and I have the skill set that they want, now companies donât have any golden handcuffs on me.
The downside is that there is no coasting in that world; you always have to perform and deliver.
The new [marketplace for health insurance] may open up opportunities we never had for our kids. The workforce may be a very different place. It seems like it is moving in that direction.
I want to make sure that in Rhode Island â if you come here as a small business, as an entrepreneur, as a family â that you know youâre going to be able to get good quality health care at a good price that is really designed around your quality of work and quality of life. And not just end up with [a plan decided by] some actuary making decisions about what you should and shouldnât want.
PBN: How will competition in the individual market for health plans between Blue Cross & Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island, which is a new entrant into the commercial insurance market?
FERGUSON: With Neighborhood Health Plan, we want to make sure we do this is a graduated way. We are slowly entering them into the market. Theyâre going to focus on individuals who are at 250 percent of the federal poverty level or below [$27,925].
If youâre above that amount, your only choice is going to be Blue Cross, but if youâre below that, you will have a choice of Neighborhood.
My hope is that next year, when we will have [the experience of] a full year of operation, weâll know what the take-up rates are for Neighborhood.
Neighborhood will know if theyâre capable of managing a new chunk of people.
In addition, Tufts Health Plan has agreed that they will come in the Rhode Island beginning on Jan. 1, 2015.
PBN: In 2015, will we also see the introduction of new kinds of innovative health plans that offer limited, tiered collaborative networks between hospitals, medical groups and health insurers? Will they feature lower deductibles as a result?
FERGUSON: One problem with the way the Affordable Care Act was written, it [allows for] high deductibles. Thatâs a big problem. I donât like the idea of this range of large deductibles.
We have spent the last 15 or 20 years designing whatâs available in health plans based on co-payments and deductibles. You didnât want an employer to make a choice to have an integrated limited network that all of their employees have to participate in, regardless of where they live in varying geographic areas.
But once the employees can make choices, the ability to use networks will increase, and thatâs what weâre planning to do next year, offering a tiered, limited network package on the exchange, moving people toward a primary care focus.
Next year, which we will start negotiating in November and December this year, the focus will be on exactly that â limited tiered networks.
[Thereâs been some back and forth on this already.] The providers say they are ready to go. The insurers say, âOh, no, itâs the providersâ fault, theyâre not willing.â And the providers say, âWeâve been going to the insurers, and the insurers say, âWe donât have time for you now,â or âItâs the insurers who arenât ready.ââ
What weâre going to be saying is: âLook guys, you both say that youâre ready, here are four or five examples. Letâs sit down and figure out how weâre going to do that, offer it on the exchange,â and let people make decisions about whether they want a higher deductible, or whether they want a different kind of network.
PBN: Will dental plans be inclusive to health insurance plans offered, or will they be separate?
FERGUSON: Itâs somewhat awkward because of the way the Affordable Care Act was written, but weâve dealt with that in Rhode Island.
It will be a separate product, bought separately, and weâre ironing out our systems issues now.
There will be at least one dental plan offered and probably at least two more dental plans. But I canât share any more information until the details are worked out.
PBN: Rhode Island is one of 17 states that have chosen to run its own exchange. It is one of the few states to be offering full employee choice. It has a new health IT infrastructure being built to determine eligibility and enrollment for Medicaid. Do you see Rhode Island as a national leader on implementing health care reform? Have you experienced pushback?
FERGUSON: I think thereâs a lot of stuff swirling around. What weâre doing is so conceptual. Weâre asking people to understand something, again, for which there is no precedence in government: to be selling products, and to be doing a startup of this magnitude. There are a lot of moving pieces. Itâs not surprising that there might be skepticism. But we just have to keep moving forward, and do the best that is possible, and then continue to improve.
A fourth [element of what Rhode Island is doing], weâre going to looking at the results, at what the outcomes are for productivity, for hospital readmissions, for a whole series of data analyses.
We got a couple of people contracted to start building the basic analytics, looking cross sector at workplace and performance.