����������

���������� Note: The article below highlights the unexpected success that MetroPlus, NYC’s public hospital-run insurance company, has had in recruiting members of different socio-economic classes within its new product lines offered under the ACA. It’s difficult to generalize this case study, but it does indicate initial success with one of the policy’s major goals: with an open, transparent marketplace and price standardization, consumers can make choices based on cost and outcomes. If value is prioritized by insurance companies and more communities of consumers (such as the 700,000 ����������ers who will have their behavioral health benefits newly managed by insurance companies in 2015) are able to make informed choices about the managed care company they use, it may level the playing field for companies with excellent outcomes but without the big name. In NY, the state is preparing a new set of outcome measures around the social determinants of health for managed care companies offering specialty behavioral health management that could change the way consumers view, and choose, insurance providers.

Public Hospitals Hope to Attract More Upscale Patients Under Affordable Care Act

���������� Times; Anemona Hartocollis, 1/15/2014

��

Todd Obolsky lives in a studio apartment in Manhattan, drives a leased Toyota Corolla and occasionally splurges on experimental cuisine in the East Village. When the��Affordable Care Actallowed him to buy insurance for the first time in years, he was so price-sensitive that $30 a month made a difference in which plan he picked.

So the obvious choice was��. It offered the best deal at the coverage level he was looking for — about $400 a month for a gold plan, the second-highest of the four levels. “That’s like as high as I can possibly go without living on rice,” he said.

He never noticed that it was the insurance company of ���������� City’s public hospital system; to a typical shopper on ����������’s health exchange, it looks no different from big-name companies, like Empire or United.

But to the��Health and Hospitals Corporation, the city’s public hospital agency, it is not merely another insurance plan. The corporation created MetroPlus, and sees it as a powerful opportunity to attract a different class of patients — somewhat higher-income, more educated and more stable — to a system whose historic mission has been to serve the poor, and whose finances have been straining.

Robyn Chapman, an artist, signed up with MetroPlus as well. The hospital system is hoping to attract more affluent patients.��Nicole Bengiveno/The ���������� Times

“It’s a potential significant source of additional revenue,” said Alan Aviles, the corporation’s president. While “we won’t necessarily have concierge services; there won’t be a piano in the atrium,” he said he hoped the new customers would find that his hospitals were underrated.

Around the country, a number of public health systems and charity hospitals serving large numbers of poor patients see the health exchanges, created by the states under the act, as a way to widen their customer base. In Los Angeles,��L.A. Care, a publicly run health plan, has enrolled about 8,000 people so far via the California exchange. The��Henry Ford Health System��in Detroit, which has roots in organized labor and the auto industry, has signed up about 4,000 people in its exchange plans.

The��University of Arizona Health��Plans have attracted only 250 people, said James Stover, their chief executive. But he said they were still trying to sign up young people who were part of the university system, as well as uninsured people on the cusp of Medicaid eligibility, who are partly responsible for the system’s $100 million a year in uncompensated care. “It makes a lot of sense from a mission standpoint to go into the marketplace and try to find coverage for these individuals,” Mr. Stover said.

By Dec. 24, the deadline for receiving coverage on Jan. 1, MetroPlus, one of 10 companies selling exchange plans in ���������� City, had enrolled 18,397 members, about 32 percent of all those who signed up citywide. Enrollment hit 22,000 last week, the corporation said, and it hopes to reach 40,000 by the end of 2014.

Currently, only 7 percent of the 1.4 million people treated by the city’s public hospitals each year have private insurance, according to the Greater ���������� Hospital Association. Another 58 percent are on Medicaid or Medicare, and 35 percent are uninsured; half of those are illegal immigrants, who cannot get coverage under the new law.

That patient mix fosters a common belief that the public hospitals are a last resort, or as one��Yelp��reviewer described Woodhull Medical and Mental Health Center in Brooklyn: “If you were writing for a TV drama about the downtrodden castoffs of society, you could not have conceived of a more appropriate place.”

In the Medicare system’s��Hospital Compare��ratings, the city’s public hospitals typically score lower in patient satisfaction than private ones. But they compare well on medical measures, like whether they follow protocols for heart attack, pneumonia and surgery patients.

For years, the hospitals corporation has tried to polish its image by contracting with private hospitals and medical schools to staff the public hospitals; for example, many Bellevue doctors come from NYU Langone Medical Center next door. And by attracting more affluent and choosy customers, the corporation hopes, it can also attract doctors into the MetroPlus networks who would not normally associate with public hospitals.

MetroPlus was created in 1985 as a managed-care plan for Medicaid recipients. While there is no guarantee that offering MetroPlus on the health exchange will be profitable, the corporation projects that the exchange plans will bring $120 million a year in revenue to a system now running a $250 million annual deficit.

By this week, 66 percent of its customers were enrolled in the silver plan, suggesting that they had low to moderate incomes and expected to qualify for subsidies. But 10 percent enrolled in gold and 18 percent in platinum, suggesting higher incomes, which surprised MetroPlus officials.

As Mr. Obolsky discovered, MetroPlus offers the lowest premiums on the ���������� exchange for the top three standardized plans: $359 a month for silver, $396 a month for gold and $443 a month for platinum.

One major reason for the low prices is that MetroPlus will cover patients only at the city’s 11 public hospitals and four private ones — Beth Israel’s two campuses in Manhattan and Brooklyn, St. Luke’s-Roosevelt in Manhattan, and Lutheran in Brooklyn. Except in an emergency, plan members will not be covered at some of the more prestigious hospitals like Mount Sinai and NYU Langone.

Mr. Aviles said that to keep its premiums down, MetroPlus had to offer relatively low reimbursement rates for hospitals. Several hospitals said they were still negotiating with MetroPlus and might join the network.

Mr. Obolsky, 48, a consultant, said he was happy to hear that St. Luke’s-Roosevelt was on the plan, because its campuses were near him on the Upper West Side.

Robyn Chapman, an artist who pieces together a living making and selling comic books, working as a legal assistant and cat sitting, signed up for a silver MetroPlus plan. Her first bill was for $119.42 a month after tax credits.

She had not realized that MetroPlus was run by the city hospital system. But that would not have stopped her, she said, because she was looking mainly for price. She was familiar with one city hospital — Woodhull in Brooklyn — because she had used its clinics for routine medical care at $20 a visit. She said the waiting times there were very long, many patients seemed desperate and some nurses and doctors were “a bit cold, maybe even a little rude.”

She might try a different hospital, but otherwise she said: “I can’t complain. I’m honestly very grateful.”

Mark P. Scherzer, a consumer lawyer and counsel to ����������ers for Accessible Health Coverage, said he expected MetroPlus would “still be sort of a poorer person’s plan,” with lower prices and lower quality.

Mr. Aviles conceded that for some people, public hospitals would never be acceptable, regardless of how well they delivered care.

“There’s always a headwind in terms of how many hospitals there are in ���������� City and how many have designer labels,” he said. “In the same way that if you’re affluent and buying a pair of jeans, you may be willing to spend $200 for those jeans because they have a designer label.”

��