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Health: A Cure for Big Health

Health Care

Could it be that Nevada is starting to get a few things right when it comes to health care? Consider: While many Republican governors rejected Medicaid expansion and balked at setting up state health exchanges as laid out in the Affordable Care Act, Gov. Sandoval has both approved Medicaid extension and led the effort to set up what some are calling a model exchange. And when the Silver State Health Insurance Exchange’s online marketplace, Nevada Health Link, opens Oct. 1, consumers will find an option that is only available in 24 states — a health insurance CO-OP. It stands for “consumer-operated and -oriented plan.” Think of it as a credit union for health insurance — a novel idea in a market crowded by behemoths such as UnitedHealthCare and Anthem BlueCross BlueShield. A CO-OP is locally grown, locally staffed and is as much about consumer advocacy as it is about customer service.

“Our goal is to have a welcoming, high-tech center that customers can visit much like their local AT&T store,” says Nevada Health CO-OP CEO Tom Zumtobel, former president of the Culinary Health Fund.

In Nevada, CO-OPs are nothing new. They’ve long existed as member-owned enterprises to provide everything from electricity to telephone service, and like Nevada Health CO-OP, they’re often non-profit. In fact, Nevada CO-OP’s three-minute introductory video makes comparisons with the Churchill County Telephone and Telegraph System, which was founded in 1889 and still operates today.

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[HEAR MORE: Does a new clinic downtown have the answer to our health care woes? Hear a discussion on "KNPR’s State of Nevada."]

As part of the Affordable Care Act, Congress set aside $6 billion for health CO-OP funding, hoping they’d provide viable competition to insurance corporations, but the bulk of the funding was cut during fiscal cliff negotiations, leaving only 24 states with approved loans. Receiving nearly $66 million, Nevada Health CO-OP (nevadahealthcoop.org) is one of them.

“There have really been no new insurance carriers established in the past 30 years,” says Janice VanRiper, CEO of the The National Alliance of State Health Cooperatives. Even among existing companies, regional entrenchment has created markets dominated by limited offerings. For example, in Nevada, big players such as Aetna and Humana have proven unworthy opponents for United’s Sierra Health. “I left my position in academia to become the CEO of (the alliance) because I am excited about what CO-OPs have to offer. By law, they have to be non-profit, seriously non-profit, and a substantial majority of their board must be people who purchase insurance from the CO-OP, so it assures the products are consumer-oriented,” says VanRiper.

A brief session of comparison shopping reveals the prices are competitive with private insurers — generally, Nevada Health CO-OP’s platinum plans are the priciest in its class, while its bronze plans are the cheapest of the bunch. The real advantage Nevada Health CO-OP hopes to offer is that it is 100 percent in and of Nevada, providing in-the-flesh advocates and a customer service center at 3900 Meadows Lane.

But, because the CO-OP’s target demographic is the one in five uninsured Nevadans who are expected to earn subsidies by purchasing their policy through the exchange, it hopes to compete on perks other than cost. Other features: nurse advocates on-site at network hospitals, neighborhood networks that link primary care docs and specialists by proximity, and — perhaps its secret sauce — an advocacy model as opposed to a typical customer service model adopted by an insurance corporation.

Zumtobel uses a lost insurance ID card as an example: “Insurance carriers count it as successful customer service if they get a replacement to you in 48 hours. In an advocacy model, the card goes out, but the question is asked, ‘Why did you need your card?’” Then, an advocate works to meet the needs of the person, which in many cases may be to get much-needed care before their new card arrives.

“The ACA was a necessary law because health care has become about money and process, and it is complicated,” he says. “The CO-OP is like the Wizard Of Oz, (but) with a consumer advocate in front of the curtain so the consumer doesn’t have to deal with the complexity. The goal is to make health care about health care again.”

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