In less than 90 days, on Oct. 1, open enrollment for government-run health care exchanges is scheduled to commence as part of the implementation of the Affordable Care Act.
It’s a day that the Common Ground Healthcare Cooperative has been building toward since its inception, as it will be the first day the cooperative will begin to enroll individuals and employers in its health insurance products.
The cooperative received a $56.4 million loan from the U.S. Department of Health and Human Services through the Affordable Care Act in February, 2012, to establish an organization to help southeastern Wisconsin small businesses and nonprofit organizations provide affordable health insurance for their employees. It uses a nonprofit, member-governed organizational model where any surplus achieved goes back into the company for the benefit of its members.
Progress has been made in the time since Common Ground Healthcare Cooperative received the loan. Key benchmarks have been met as it prepares to offer benefit plans to its future members.
“We’re in the red zone,” said Common Ground chief executive officer Robert DeVita, “We’re getting to the end zone. We’re working hard. Everybody’s working overtime, and it’s exciting.”
While the bulk of the loan – $48.9 million – is for solvency, $7.4 million of the $56.4 million loan is dedicated for the startup and operational costs involved with getting the cooperative off the ground, and is subject to 96 milestone deadlines.
“We’ve hit every one of our deadlines,” said Jim Wesp, vice president of the Common Ground board of directors.
“We’ll keep hitting them,” added DeVita. “That’s our trademark. We’re known for that.”
A major milestone for Common Ground Healthcare Cooperative came in early June, when an agreement with Milwaukee-based Aurora Health Care and Brookfield-based Trilogy Health Networks was announced.
“As a result of being able to get those two provider contracts, it has also allowed us to expand our territory,” said Wesp. “Where our original vision was the seven counties of southeastern Wisconsin, we’re now going to be into 19 counties. That gives us greater potential of people to work with.”
“Our members in our health plan will be their patients,” said DeVita, a former senior vice president and chief operating officer with Wheaton Franciscan Medical Group.
The cooperative has also obtained its crucial certificate of authority from the Wisconsin Office of the Commissioner of Insurance, which paves the way for Common Ground to reach its goal and begin selling health insurance plans at the planned timeline.
There will be a six-month sign-up period between Oct. 1, 2013, and March 31, 2014. The soonest the plans will be effective is Jan. 1, said DeVita.
The five-year goal for Common Ground Healthcare Cooperative is to get 50,000 people to sign up and become members. The first year goal is for 10,000 people, but “We’d take more in the first year if we could,” said DeVita.
State-level decisions have also had an impact on the number of people who may be signing up for the exchanges.
“With the governor’s decision to push more people onto the federal exchange – forget about any policy implications for the state – for people who are on the exchanges like us, there’s more people to sell to,” said DeVita.
Common Ground Healthcare Cooperative has also met some of the essential requirements of a new organization. It moved into an office in Brookfield in September and now has 12 employees on staff.
There are obstacles to overcome for the new organization, as well.
“The challenge continues to be the timeline, because it is a finite schedule,” said Wesp. “That has continued to be a challenge. But I think the direction that we’ve taken with it is that we take the most important things, we focus on them and whatever else is left, we put in the parking lot.”
There are also concerns about public knowledge regarding the implications of the health reform law in general.
“My biggest concern is the national lack of understanding about what problem we’re trying to solve,” said DeVita. “This is a national problem.”
That lack of understanding, however, is something Common Ground Healthcare Cooperative is working to combat on a local level.
“There’s been so much confusion out there in the marketplace regarding the implications of the law,” said Wesp. “So we said, what we’re going to do is put together a series of seminars, not emphasizing how great the Common Ground Healthcare Cooperative is, but talking about health care reform and what does it mean in the marketplace and how do you negotiate this as a small business owner or as an individual. We’ve done that and we’ve had 15 of them. We’ve had about 400 people who’ve attended those 15 seminars all over southeast Wisconsin.”
Another concern is the possibility that members may have to switch doctors if their current doctor is not in the Aurora or Trilogy networks, said Wesp.
“That may cause some people a certain amount of angst, but if there is enough savings and enough potential gained in health care and in quality of health care, it’s a good idea,” he said.
There are opportunities as reform approaches, as well, DeVita and Wesp said, as consumers will be able to make more of their own decisions regarding their own health care.
“One thing that is going to happen in health care in southeast Wisconsin is the consumer, the person using health care, is going to get a lot smarter,” said Wesp. “Our whole interest is in being member-governed and to be able to take care of the health of our members. The health of our members is No. 1. As the members become smarter consumers and would reduce the overall cost of health care, it’s going to be reflected directly in the premiums.”
“All the decisions are made by the people that own the policies or use the product,” said DeVita. “We’ll be listening to the local folks because they’re the voting board. People are now choosing their providers along with their health plans, and that’s way different for southeastern Wisconsin.”
Common Ground Healthcare Cooperative has also been in contact with other cooperatives around the country. When Common Ground received its loan, a total of $638 million was allocated to establish another six cooperatives around the country.
“We’re part of a national organization – National Alliance of State Healthcare Cooperatives (NASHCO) – and that’s been a really useful experience because we can share solutions to issues that we’ve run into in one state with everyone else,” said Wesp. “They’re all on the same schedule. They’re all going to be on the exchange on Oct. 1, and the policies go into effect on Jan. 1.”
DeVita noted that talks with the Minutemen Health co-op in Massachusetts have given them some insight into the potential success of exchanges.
“If you talk to people in Massachusetts where Gov. (Mitt) Romney signed a similar bill – for one state – in 2006, the people in Massachusetts that we know say to us, ‘You know, it was awful for the first couple years. People didn’t know what to do. Now, you can’t pry it out of their hands.'”