ohio chats about healthcare · the work of ohio chats about healthcare could not have been...
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Voices of the Uninsured
Ohio CHATs About Healthcare
www.ohioinsurance.gov www.healthcarereform.ohio.gov April 2009
Acknowledgements
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The work of Ohio CHATs About Healthcare could not have been completed without the dedication, support and hard work of a number of individuals and organizations:
•The uninsured Ohioans who generously volunteered to share their time and thoughts with us around the State. Your insights, patience and humor were greatly appreciated by the CHAT Team.
•TheSCIteamandtheAdvisoryCommitteeforencouragingandsupportingtheCHATproject.
•Oursponsors:RonBridges(AARP),MaryJoHudsonandDougAnderson(OhioDepartmentofInsurance),JimCastle,MaryYost,CliffLehmanandDaveNichols(OhioHospitalAssociationandFoundationforHealthyCommunities),RichardStoff(OhioBusinessRoundtable),JohnBastuliandElayneBiddelstone(TheAcademyofMedicineofClevelandandNorthernOhio),andToddWardandDaveDornheggen(GoodSamaritanHospital).
•Thosewhoofferedsponsorship:SteveMillard(COSE).
•Ourpartnersandcoordinators:MarjorieFrazier(OhioAssociationofFreeClinics),DebMiller(HealthPartnersofMiamiCounty),LeeElmoreandMichelleBrzozowski(NorthCoastHealthMinistry),JohnMoritz(ViolaStarzmanFreeClinic),JulieGrassonandJanRuma(Toledo-LucasCountyCareNet),RickPetronis(TheToledoHospital),SharonSherlock(ReachOutofMontgomeryCounty),LindseyReynoldsandJulieDiRossi(OhioAssociationofCommunityHealthCenters),NancySinkandJennySmith(FamilyCaringClinic),ConnieWisner(CenterStreetCommunityClinic),KimTaflinger(AllenCountyHealthPartners),BobGallaghar(TheHealthcareConnection),MarkBridenbaugh(FamilyHealthcare,Inc.),KimDement(MuskingumValleyHealthCenter),BethSpriggs(HolzerMedicalCenter–Jackson),MichaelRobinson(St.ElizabethHealthCenter),JeffBiehlandIsiIkharebha(AccessHealthColumbus),KarenKrause(ToledoJobswithJustice),ToddWardandDaveDornheggen(GoodSamaritanHospital),AngieWellman(KaleidoscopeYouthCenter),SisterMaryanneMozserandLenaGrafton(St.VincentCharityHospital).
•Researchassistanceandanofferofsponsorship:BillHayesandTimSahr(HealthPolicyInstituteofOhio)
•Trainingandtechnicalassistance:MarjorieGinsbergandKathyGlasmire(CenterforHealthcareDecisions)
•StaffmembersfromtheOhioDepartmentofInsurance:AmyAndres,MalikaBartlett,EricBrewer,FelixChrappah,TinaChubb,SarahCurtin,RobertDenhard,AlanFuran,CarlyGlick,TeresaHannah,VirgilHughes,RayLacey,ConnieLodge,RonPokorny,PennyRickman,AdamRossbach,RaymondThimmesandJianmingXia.
•TheCHATTeam:MarjorieEllis,SuparnaBhaskaranandKevinTyler.
Table of Contents 1. Executive Summary
2. Background
A. History B.WhyCHAT? C.TheGame D.GoalsandObjectives E.TheParticipants
3. KeyValuesThatInfluencedParticipantDecisions
A. AffordabilityB.QualityC.PreventionD.CollectiveGoodE.ExcludeLow-ValueInterventions
4. CreatingaHealthPlanforOhio’sUninsured
A.MostImportantCategoriesB.LeastImportantCategoriesC.OtherRequired&ElectiveCategoriesD.IfYouHadMoreMarkersWhereWouldYouSpendYourMoney?E.WhatPlanDidTheyUltimatelySelect?
5. Conclusion
6. Sponsors&Coordinators
7. Appendices
AppendixA:OhioCHATsAboutHealthcareCategoriesandTiers
AppendixB:OhioCHATsAboutHealthcareProjectPlan
AppendixC:OhioCHATsAboutHealthcareSessionPlanningPacket
AppendixD:OhioCHATsAboutHealthcarePre-andPostSurveyQuestions
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Chapter 1:Executive Summary
In 2007, Governor Strickland appointed a team of policymakers tothe State Coverage Initiative (SCI) team to provide his administrationrecommendationsoncovering1.3millionuninsuredOhioans.PolicymakersontheSCIteamidentifiedthechallengespresentedtosuchanexpansioneffort, namely the costs associated with healthcare coverage. To this end, theSCIteamrequestedinputdirectlyfromOhio’suninsuredpopulation.TheOhioDepartment of Insurance utilized a program calledCHAT (ChoosingHealthplansAllTogether) todeterminewhatuninsuredOhioans thoughta“basic” health plan must offer.
Policymakerswereinterestedindevelopingawaytoconstructahealth plan that was less expensive than an employer-sponsored plan yet onethat offered sufficient protections. In order to determine these adequateprotections, participants were asked through the CHAT process what was most needed and valued given a tight budget. Through individual and collectivedecision-makingprocesses,CHATparticipantsnegotiatedtrade-offs and developed a “basic” plan for all Ohioans, ages 18 through 64.
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MostCHATparticipantsagreeduponthefollowingprinciplesorvaluesfor a “basic” health plan:
Affordability:Theplanmustbefinanciallyaccessibletoindividualsatthelowertomiddle incomelevels;theyoung(18andolder)andthosenotyeteligibleforMedicare;andthosediagnosedwithchronichealthconditions.
Quality:Theplanmustemphasizequalitycaremuchmoresothansimplyhaving more choice of providers.
Prevention:Healthcarecoverageshouldbereasonablycomprehensive(i.e.,acutecareandpreventativecare)—andprovideforall levelsofprevention(meaningprimary,secondaryandtertiaryprevention).1 CollectiveGood: Ohioans would be healthier and more productive if all aspects of health, including mental/behavioral and dental/vision benefits,were coordinated and taken seriously in a basic health plan.
Exclude Low-Value Interventions: The plan must include high-valueandcost-efficient interventions.High-value interventionscompelprovidersto follow established clinical guidelines for treatment and care would still be patient-centered.
This report examines the results of 18 CHAT sessions conductedthroughoutthestateofOhiowith177participants.Asnapshotoftheplanchosencontrastingthebenefitssacrificedfollows.
1On the CHAT wheel primary prevention was referred to as prevention, secondary prevention was called maintenance, and tertiary prevention was calledcomplexchronic.
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BENEFITSSELECTEDANDSACRIFICEDBYTHEPARTICIPANTS
Healthcare Need BenefitsSelected BenefitsSacrificed
Prevention •Wellnesstreatmentthatmeets
national standards
•Screeningsthatofferlittlechanceof
findingproblems
Maintenance •Doctormustfollowexpert
guidelines for least costly treatment
•Thesetreatmentsworkwellfor90%
of patients
•Doctorcanorderanytreatmentor
drug
•DoctordoesNOTneedtofollow
expertguidelines
ComplexChronic •Doctorusesleastcostlywaysto
manage illness
•Coverscostlytreatmentslikeknee
replacement and heart transplant
EpisodicCare •Emergenciesandurgentcaredealt
withquickly
•MustwaitseveralweeksorLONGER
to see a doctor if not urgent
•Canseethedoctorearlier,waitis
severalweeksorLESSifnotan
emergency or urgent
Catastrophic •Treatmentsaregiventosavethe
patient’slife
•Paysforallmedicalcareknownto
be useful
•Paysfortreatmentsthathavelittlechance
of helping or may not work
Restorative •Coversnecessaryrehabilitation
services to improve function
•Basicequipmentfordailyliving
•Covers½costofcostlyequipment
End-of-Life •Hospicecareinhomeorhospital •Hightechcarethatpostponesdeath
Dental/Vision •$1,000maximumdentalbenefit
•Annualvisiontestingwithbiennial
glasses allowance
•NONE, participants selected the best
benefit
Maternity •Routinepre-natalcare,normal
childbirth and complications
•NONE, participants selected the best
benefit
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Healthcare Need BenefitsSelected BenefitsSacrificed
Mental/Behavioral •Treatmentforseverementalillness
•Counselingandmedicationfordrug
and alcohol addiction
•Long-termcounselingforlesssevere
mental problems
•In-hospitaldrugandalcoholaddiction
treatment
Obesity •Covers,medication,counselingandif
necessary stomach surgery
•NONE, participants selected the best
benefit
QualityofLife •NONE,nobenefitselected •Drugs,medicalandsurgicaltreatmentto
correctnon-disablingproblems
Co-Payments •Mid-rangeco-paymentsof$20/doctor
visit,$10genericdrugand$20brand-
name drug
•$100/ERvisitand$250/hospitalvisit
•Lowestco-paymentsof$10/doctorvisit,
$5genericdrugand$15brand-namedrug
•$25/ERvisitand$100/in-patienthospital
visit
Premium •Mid-rangehealthpremiumof4%of
salary($66/mofor$20,000/yrsalary)
•Lowesthealthpremiumof2%ofsalary
($33/mofor$20,000/yrsalary)
Providers •Limitedchoiceofdoctorsandhospitals
•Referralsneededforspecialists
•Extensivechoiceofdoctorsandhospitals
•Referralsnotneededforspecialists
Care Management •Healthreviewformsandcare
managementclassesarerequired
•Patientchoicetoparticipateinhealth
review forms and care management classes
2CoveringOhio’sUninsured:TheSCITeam’sFinalReporttoGovernorTedStrickland,ExecutiveSummary,2008
Chapter 2:Background A. History
GovernorTedStrickland identifiedhealthcarereformasoneofOhio’surgent issuesandestablished the followinggoals to aidOhio’suninsuredpopulation:
1.Provideaccesstoquality,affordablehealthinsuranceforeveryOhiochild and reduce the number of uninsured Ohioans.
2. Increasethenumberofsmallemployersthatareabletooffercoverage to their workers.
To accomplish these goals, the State of Ohio applied for and was awardedaRobertWoodJohnsonFoundation(RWJF)granttojointhe“StateCoverageInitiative”(SCI).TheSCIprogramisdesignedtohelpstatesdevelopandimplementstrategiestoexpandaccesstoaffordablehealth insurancecoverage and thereby reduce the number of uninsured citizens.2
GovernorStricklandselectedfourmembersofhisadministration,fourmembersoftheOhioGeneralAssemblyandfourkeystakeholderstoformthe SCI team that worked with RWJF, AcademyHealth and health policyexperts to develop comprehensive, effective strategies to cover Ohio’suninsured residents. The SCI team received input from the HealthcareCoverage Advisory Committee, a large group of stakeholders appointed by the Governor to advise the SCI team throughout their exploration ofpolicyoptionstoexpandcoverage.Thecommitteerepresentedconsumeradvocates, providers, labor, employers, insurance companies, free clinics, community health centers, hospitals and associations. The recommendations ofthisyear-longprojectwerereportedtoGovernorStricklandin“CoveringOhio’sUninsured:TheSCITeam’sReporttoGovernorTedStrickland”.Tosupplement the report, theSCITeamandAdvisoryCommittee requestedinputdirectlyfromOhio’suninsuredpopulation.
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B. Why CHAT?
TheSCIteam’ssupportstaffattheOhioDepartmentofInsurance(ODI)were introduced to CHAT in late 2007. CHAT, also known as ChoosingHealthplans All Together, is a proprietary and educational game and research tool developed by the University ofMichigan and The National InstitutesofHealthwith support from theRobertWood JohnsonFoundation. Thiscomputer-based program examines consumer healthcare choices in thecontext of limited resources. The software has been used in the UnitedStates and overseas.
ThroughajointventurewithAARP;MarjorieGinsburg,MPH,ExecutiveDirectorof theCenter forHealthcareDecisions introducedCHAT toOhio.WithsixyearsexperienceusingCHAT,theCenterforHealthcareDecisionsoffers consulting services to interested states. Services include game design assistance, facilitator training and technical support. Ohio secured theservicesofCenterforHealthcareDecisionstocreatetheproject,OhioCHATsAboutHealthcare.
TheoriginalCHATgamewastailoredtoreflectOhio’scurrenthealthcarecoverage environment. We decided to utilize a needs-basedmodel overthe more standard services-based model. In the needs-based model,participantschooselevelsofcoverageforsuchneedsasComplexChronic,RestorativeandPrevention.AcompletedescriptionoftheOhioCHATsAboutHealthcareCategoriesandTierscanbefoundinAppendixA.Pre-andpost-CHATquestionsweredeveloped to collect participantdemographics andqualitativedataandcanbefoundinAppendixD.Allinformationiscollectedanonymously to encourage open dialogue and protect the identity of the participants.
C. The Game
Ohio CHATs About Healthcare seeks to answer: Whatismostimportantto provide for Ohioans if we cannot afford healthcare coverage foreverything? Ingroupsof12to18,participantsmustdecidewhethertocovercommonorexpensivemedicalneeds;torestrictaccesstocostlyspecialists;ortorequireindividualstocompleteaHealthReviewformandattendCareManagement classes. CHAT allows participants to examine a variety ofhealthcare coverage needs and set priorities on the relative importance of those needs.
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The Ohio CHATs About Healthcare wheel consists of 16 categories of needs representing different aspects of healthcare coverage. They are:
1.Catastrophic-Treatmentofsudden,seriousinjuryorillness such as car accident injuries or deadly cancer.
2.ComplexChronicCare-Treatmentofserious,long-term chronic illness like a heart condition or diabetes.
3.Dental/Vision-Preventingandtreatingdentalproblemsand, if selected, testing for and correcting problems with eyesight.
4.End-of-LifeCare-Palliativecarethatcannotprovideacureforpersonsexpectedtolivelessthansixmonths.
5.EpisodicCare-Treatmentofcommonproblemssuchas ear infections and strep throat; includes emergencies like appendicitis.
6. Maintenance-Regularcheck-upsandtreatmentforearly chronic conditions that are not yet serious such as high blood pressure and asthma.
7. Maternity-Medicalcareofwomenduringpregnancyand childbirth.
8.Mental/Behavioral-Detectionandtreatmentofmentalillness(schizophrenia,depression,etc.)includingtreatmentfor smoking and substance addictions.
9.Obesity-Treatmentforpatientswhoareseverelyoverweight.
10.Prevention-Teststofindmedicalproblemsasearlyas possible and to help prevent disease.
11.QualityofLife-Treatmentforproblemsoffunction,appearance or comfort, like hair loss and infertility.
12.Restorative-Repairingtheabilitytodotheactivitiesofdailyliving(walking,dressing,etc.)neededafterbrokenbones, surgery or stroke.
13. Care Management-ArequiredcategoryofprogramstohelppeoplestayhealthyincludesaHealthReviewFormandCareManagementclasses.
14.Co-Payments-Arequiredcategoryofamountsindividuals pay to utilize healthcare services.
15.Premium-Arequiredcategoryofamountsindividualsmust pay monthly for healthcare coverage.
16.Providers-Arequiredcategoryofprofessionalswhoprovide all medical care including doctors, specialists, clinics, labs and hospitals.
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Participantsmayselectasmanyasfourdifferentlevelsofcoverageforeachcategory.NoCoverageisanoptionformostalongwithTier1,Tier2andTier3benefits.Tier1benefitsrepresentbasic,minimalcoverageatthelowestcost.Tier2benefitsofferbettercoveragethanTier1atamoderateprice.Tier3benefitsarethebestavailableatthehighestcost.Asdetailed,asthetierincreases,thelevelofbenefitsandcostofcoverageincreasesaswell.CoverageinallcategoriesisoptionalexceptfortheCareManagement,Co-Payments, Premium and Providers choices. Participantsmust selectsome level of coverage in each of those categories.
EachCHAT game consists of four rounds. In Round 1, participantswork independently to design a plan of coverage to suit their own individual needs.Participantsmustconsidertheirhealthcareneedsforthenextthreeyears. Potential illnesses and health events are introduced at the endofthe round to demonstrate how well the plan chosen covers medical needs. Participantssharetheseexperienceswiththeentiregroup.Thisfirstroundallows participants to become familiar with the game and, if necessary, the computer.
In Round 2, participants work together in small groups of 3 or 4 tocreate a plan for all Ohioans ages 18 through 64. The second round affords
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participantstheexperienceofworkingwithotherstobuildaconsensusplanand to reconcile their personal healthcare needs with at least two others. Again, potential illnesses and health events are introduced, however, they are shared only in the small groups.
Round3bringsallparticipantstogethertodevelopabenefitplanforallOhioans,ages18through64. Participantsaregivenachancetoexpresstheir views on healthcare coverage needs in a roundtable discussion format. A trained facilitator leads this round, in which participants are encouraged to offer their opinion even if it means disagreeing with other participants.
In Round 4, participants return to their computers to independentlydesign what they believe is the best plan for all Ohioans, ages 18 through 64.Participantswillhavetheinsightofthepriorroundstocreateaplanthatis fair for all. The conversations in the prior rounds give most participants a newappreciationforothers’choicesandneeds.
Ineachround,participantsaregiven50markerstospendonahealthcarecoverage plan. Themarkers represent the price of an affordable benefitpackage for Ohioans. However, the Ohio CHAT wheel has more options to choosefromthanmarkerstospend.Participantsmustdecidehowtogetthemostvaluefromthe50markers.Participantsmustalsounderstandthecoverage theydesign isall that isavailable. In thesescenarios, therearenopublicorprivateprogramstoprovideadditionalcoverage.Participantswouldhavetopayoutoftheirownpocketforanybenefitsnotincludedinthe plans created.
AcompleteCHATsessionlastsapproximatelythreehours.Participantsareaskedtoarriveatleast30minutesearlytoassureanon-timestart.
D. Goals and Objectives
WithinformationcollectedfromtwostatesinvariousstagesofaCHATprogramaswellasCenterforHealthcareDecisionsinput,webegantolaythegroundworkforaProjectPlanandSessionPlanningPacket.
TheOhioCHATteamestablishedspecificprojectgoalsandobjectivesfortheuninsuredsessions.Projectgoalsare:
1.TosolicitinputfromOhio’suninsuredpopulationaboutwhatabasichealth plan should cover;
2. To educate Ohioans about healthcare coverage choices; and
3.ToprovidefeedbacktoOhio’sSCIteamregardinguninsuredchoices.
WeconsultedwithUniversalHealthcareActionNetworkofOhio,(UHCANOhio)theOhioAssociationofFreeClinics(OAFC),theOhioAssociationofCommunityHealthCenters (OACHC) andAccessHealthColumbus (AHC). Theseorganizationsofferedvaluableinsightintowhattoexpectduringthe
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project, how to encourage participation of the target individuals, possible funding needs and how to locate the uninsured throughout the state.
We then consultedwith theHealth Policy Institute ofOhio (HPIO) todetermineour targetaudience for theproject. Itwasunderstoodthat theproject would be a “convenient” sampling; only the data of those who chose to attend a session could be collected. Wewanted to ensure adequateparticipation of a diverse population with regard to the following:
• Ageandgender;
• Race/ethnicity;
• Incomeandemploymentstatus;and
• Geographicalarea.
WeutilizedtheHPIO2004OhioFamilyHealthSurveytodeterminethecounties to survey. The following factors of each county were reviewed:
• Uninsuredrate;
• Povertyrate;
• Unemploymentrate;and
• Race/ethnicity.
WeselectednineofOhio’slargestMetropolitanareas,fiveAppalachian,fourruralandtwoSuburbancountiestotarget. Wehadhopedtoholdatleast twodifferent sessions ineachMetropolitanareaandonesession ineachoftheremainingcounties.AProjectPlanwaswrittentosolicitfundingforstipendsandrefreshments.ASessionPlanningPacketwasdevelopedtoguidecoordinatorsthroughplanningasuccessfulsession.ThefinalplanandpackethavebeenincludedinAppendixBandCrespectively.
As an original partner, AARP agreed to expand its role and sponsorstipends for at least ten uninsured sessions. Additionally, Foundation forHealthy Communities of the Ohio Hospital Association, Ohio BusinessRoundtable, The Academy of Medicine of Cleveland and Northern Ohio(AMCNO),GoodSamaritanHospital,Council ofSmall Enterprises (COSE)andHPIOofferedtofundstipends.Acompletelistofsponsorscanbefoundin Chapter 6.
TheOhioAssociationofFreeClinics(OAFC)wasthefirstorganizationtocoordinate uninsured sessions. Additionally, Ohio Association of Community Health Centers (OACHC), Access HealthColumbus (AHC), Toledo AreaJobsWithJusticeCoalition,KaleidoscopeYouthCenterandvariousOhiohospitals agreed to plan uninsured sessions. A complete list of coordinators is included in Chapter 6.
We successfully secured sufficient funding to complete the project.Some of our partner organizations employed enough resources to coordinate a session and had access to a large pool of uninsured. Others, while willing to participate, lacked the staffing or interested uninsured to successfullyorganize a meeting. Therefore, locating participants willing to devote the time necessarytocompleteasessionprovedtobemoredifficultthanexpected.Of the 29 sessions planned, we successfully completed 18.
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E. The Participants
Weaskedsessioncoordinatorstoselectparticipantswhowere:
• Atleastage18andunderage65;
• AbletoreadandunderstandEnglish;
• Computerliterate,haveseenandusedacomputerbefore;and
• Currentlyuninsuredandhavebeenforatleastoneyear.
As the sessions progressed, we found the need for computer literacy wasnotanimportantqualification.Facilitatorseasilytrainedparticipantstouse the laptop computers. A number of participants later stated they would be interested in learning more about computers and were no longer afraid to usethem.DemographicdataforourCHATparticipantsisasfollows:
Geographic
1.GEOGRAPHICREGIONS: The location and geographic region of the CHAT sessions is pinpointed on the map below. Additionally, sponsors and coordinators are detailed in Chapter 6.
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Single withdependents
12%
Couple20%
8%
Single60%
Male32%
Female68%
60 and up16%
50-5934%
30-3912%
40-4927%
18-2911%
2.AGE: The average age of participants in our sessions was much higher than Ohio’s uninsured population. Weattribute this difference to the voluntary nature of the project and the fact that older individuals were readily available to participate in the sessions.
3.GENDER:68%ofourparticipantswerewomen. This number was much higher than Ohio’suninsuredpopulationof47%female.
4.FAMILYSTATUS: A majority of our participants weresingleandonly20%ofparticipantslivedinhouseholds with dependents.
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Black or African American
33%White56%
5.RACE/ETHNICITY:Racialminoritiesrepresented44%ofour participants but made up only27%ofOhio’suninsured.
High Schoolgraduate or GED
42%
Some college or two-year degree
35% 6.EDUCATION: CHAT participants were highly educated whencomparedwithOhio’suninsuredpopulation.Only10%ofourparticipantsdidnotfinishhighschooland48%hadposthigh school education.
22%
33%
40%
7.ANNUALHOUSEHOLDINCOME: 73%ofourparticipantslivedinhouseholds with incomes of less than$21,000andonly5%ofourparticipants reside in households withincomesof$32,000ormore.
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8%
5%
18%
69% Good34%
Fair29%
Poor17%
8.COVERAGEINLASTTWOYEARS: The majority of our participants have had no insurance coverage in the last two years.
9.HEALTHSTATUS:Mostparticipants considered themselves ingoodhealthhowever46%believedthey were in no better than fair health.
No37%
Yes55%
10.DISABILITYORCHRONICCONDITIONINHOUSEHOLD: 55%ofourparticipantslivedwith or have someone in their household with a disability or chronic health condition.
11.REGULARUSEOFPRESCRIPTIONMEDSINHOUSEHOLD:The majority of our participants or members of their households regularly used prescription medication.
No16%
YES82%
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$1-$3042%
$61-$10014%
$31-$6021%
$016%
Between $200and $500
26%
Between $500and $2,000
22%
14.AMOUNTWILLINGTOPAYMONTHLYFORINSURANCE:58%ofourparticipantswerewillingtopaylessthan$30permonthforhealthinsurance.Only7%werewillingtopaymorethan$100permonthforhealthinsurance.
No17%
YES83%
13.STRUGGLEDTOAFFORDHEALTHCAREINLAST12MONTHS:Only17%ofourparticipants did not struggle to afford healthcare in the last 12 months.
12.HEALTHCARESPENDINGINLAST12MONTHS:Householdsof39%ofourparticipantshadspentmorethan$500onhealthcareinthelast12months.Only13%hadnohealthcareexpensesinthelast12months.
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$61-$10014%
$31-$6021% $1-$30
42%
$016%
Chapter 3: Key Values That Influenced Participant Decisions
As participants discussed their choices and priorities in designing a basic plan for all Ohioans, ages 18 through 64, the following values influencedtheirdecisions.
A.Affordability“Gettingatankofgascancompetewithyourpremiums,”commented
one of the participants. Affordability was extremely important to all theparticipants. In fact, they were acutely aware that if they selected themost affordable plan they would sacrifice many other benefit categoriesortherichnessofanygivenbenefit.Theywantedaffordabilityupfrontwithlow premiums, as well as on the back-endwith low co-payments. Oftenparticipants were forced to compromise by selecting the lowest premium amountcoupledwithamid-rangeco-payment.Theypointedoutthathighpremiumscoupledwithhighco-paymentssimplydiscouragedpeoplefromseeking the care they needed.
“Getting a tank of gas can
compete with your premiums...”
No17%
Yes 83%
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B. Quality
“More choice doesn’t always mean that I will get a compassionatedoctororabetterhospital,”pointedoutoneparticipant.Manyparticipantstalkedabouthowtheywouldbequitehappyiftheyhadareliable,responsiveand caring primary care physician but were interested in having some choice with hospitals. Additionally, participants pointed out that some hospitals treated them poorly and others treated them with dignity and compassion. And, thus, they wanted choice concerning hospitals, primarily because they valued being treated professionally and respectfully by hospital physicians, nurses and staff members.
5%
30%
15%20%
13%
9%
3%5%
“More choice doesn’t always
mean that I will get a compassionate doctor or a better
hospital...”
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C.Prevention
“Yourbonesat50willtellyouaboutyourproblemsandthelifeyou’velived” said one of the participants.
Participantsfeltstronglyaboutalllevelsofprevention.Attheprimarylevelof prevention, tests are performed on individuals to discover potential medical problems.Atthesecondarylevelofprevention,orMaintenance,patientsfollowa protocol in order to keep early chronic or diagnosed conditions from getting worse.Atthetertiarylevelofprevention,orComplexChronic,thediagnoseddiseaseisatanadvancedlevel(andcoexistswithotherconditions)andtheindividualrequireslong-termtreatment.
The participants understood all levels are interconnected and a health plan
“Your bones at 50 will tell you about your
problems and the life you’ve lived.”
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shouldnotfocusonpreventivemedicineoverComplexChronic.Participantsbelieved care is necessary for the sick as well as educating others to remain healthy.
D.CollectiveGood
“Weneedtotakecareoftheoldandtheyoung,thesickandthehealthyones” pointed out a participant.
Whenparticipantshadtheopportunitytodiscussindividualproblemsinacollective setting, they were generally sympathetic to concerns that they had notpersonally experienced. TheybelievedOhioanswouldbehealthier andmoreproductiveiftheseissuesweretakenseriouslyinabasichealthplan.Forinstance, partricipants felt that many in their communities were facing addiction problemsandissuespertainingtodepression.Participantsassociatedtheseproblems with the dire economic situations in their communities. Therefore, there was full support for a plan that went beyond only covering advanced mental illness.
Participantsbelievedbothdentalandvisioncoverageshouldbeincludedinthebasichealthplan.Whenfundswerelimitedbyothercategorychoices,participants often settled for dental only coverage. They connected the importance of dental and vision health to the overall health of an individual.
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“We need to take care of the old
and the young, the sick and the healthy
ones.”
Inthecaseofmaternity,participantsselectedtherichertierofcoveragesothatunexpectedcomplicationsofpregnancywouldbecovered.Theyfeltthat having better coverage in all of these areas would be a form of “early prevention” that could mitigate future chronic medical problems.
E. Exclude Low-Value InterventionsThemajority of participants felt that Quality of Life and Obesity were
the least valuablebenefitcategories.Manybelieved thatqualityof lifewasthemostexpendablecategoryandvotedfornocoverage.Theyfeltthatthisoptionwas“cosmetic”anddidnotcontainanysubstantivehealthcarebenefitoroutcome.Aminoritydisagreedandthoughtthis“wasnotavanitything—ithelps with your job and can become a mental health issue for women without hair.” The same minority felt that infertility was also an important issue.
ManyacknowledgedthatobesityisamajorprobleminboththeUnitedStatesandOhio.Participantsfeltthatindividualsshouldbeabletotacklethisproblem on their own and other categories represented more important medical problems to address. Others thought poverty, the abundance of fast foods and thelackofaffordablenutritiousfoodscreatedtheproblem.Eventhoughafewparticipants were interested in providing access to bariatric surgeries, others wondered about the safety of the procedure. Some suggested that this was simply a matter of bad genes, poor mental health, eating too much or laziness and that either obesity should be tackled under mental and behavioral health or that the individual should take “personal responsibility” for their own life.
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Chapter 4: Creating a Health Plan for Ohio’s Uninsured
ParticipantsfeltthatallofthecategoriesontheCHATHealthPlanwerevery important. They struggled with how to balance individual and community healthneedswith limited resources. Inotherwords, eachcategory in theCHATHealthPlancamewithapricetagthatwasproportionatelyidentifiedby a health actuary and participants had to choose differing levels of coverageoptionswithasetspending limit.Given that, therewerecertaincategories that emerged as most and least important to the participants. Also,certaincategoriesgeneratedsignificantlymorediscussionamongtheparticipants. They include:
Tier 272%
Tier 128%
A.MostImportantCategories1.Premiums:Manyparticipantsfelttheycouldnotaffordamonthlypremiumbutunderstoodtheneedtopayaportionofthecostup-front.AlargemajoritypointedoutrepeatedlythatpremiumsMUSTbeaffordable so those who need the coverage can obtain it.
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“Thank God that Giant Eagle and
Kroger have generics for $4. Something is better than nothing.”
Tier 267%
Tier 133%
Tier 311%
Tier 267%
Tier 122%
2.Co-payments: “Thank GodthatGiantEagleandKrogerhavegenericsfor$4.Somethingisbetterthan nothing” remarked a participant.Participantscouldnot decide which was more important: low premiums or lowco-payments.Allwantedto be sure that once the coverage was purchased, they could afford to see the doctor. A number of participants believed if they had more markers they would select the lowestco-paymentsavailable.The majority settled for the mid-rangeco-paymentasanaffordable compromise.
3.Providers(physiciansandhospitals):“Ifyourdoctordoesn’tcareandyouwanttobefixed–youcouldbe[brokemore]”observedaparticipant.Participantsoftenpointed out that having access to a caring physician and a decent clinic or hospital can faroutweighhavingmorechoiceindoctorsandhospitals.Inotherwords,participantswantedqualityandgoodvalueinsteadofabundantlow-qualitychoiceofphysiciansand hospitals. And, therefore, most participants selected Tier 2 for greater choice.
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“If your doctor doesn’t care and you want to
be fixed – you could be [broke more].”
Tier 189%
Tier 211%
4-a.Prevention (primarylevel):Peoplefeltstronglyabouthaving the opportunity to access a physician who could identify any potential medical problem in its infancy.
Tier 211%
Tier 189%
4-b.Maintenance(orpreventionatthesecondarylevel): Viewedasanimportantsecondsteptopromoteconsistentprevention.89%oftheparticipantsselectedMaintenance.
26
Tier 26%
Tier 194%
Tier 250%
Tier 139%
Tier 311%
5.Catastrophic:Participantspointedoutthat “accidents happen and things like individualbankruptcy(sic)sneakuponyou.” As a group, all participants voted for some level of catastrophic coverage. Only 6%wantedtospendtheadditionalmarkersto pay for treatments that are the last hope and have little chance of working.
Tier 239% Tier 1
55%
4-c.ComplexChronic(orpreventionatthetertiarylevel):Participantswantedtobe productive members of society even astheygotolder.Manywantedrichercoverage within this category but stepped down to lower levels in order to have a more comprehensive plan for all Ohioans.
27
6.Mental/BehavioralDiscussionabout the level of mental/behavioral coverage was engaged and sometimes heated.Participantsweresplitbetweenthosewithdirectexposuretotheseneeds and those with little tolerance for these illnesses. Thoughtful dialogue and personal testimonies allowed participants to reconsider their original positions. All participants agreed to includecoveragewith66%selectingTier2orbetterbenefits.
8.Dental/Vision: A large majority believed stronglyinthebenefitofdentalandvisioncoverage. They felt that they are necessities ratherthanluxuryitems.Somepointedoutthat detecting early signs of dental or vision problems can also provide evidence of to otherkindsofmedicalproblems(suchasheartdiseaseorhighbloodpressure).How-ever, participants would often protect dental (whichtheybelievedwasmoreexpensive)over vision if forced to choose. Alternatively, those who wanted vision covered would saythatvisioncoverageisexpensiveandimpacts how people perform at work and school.Thosewhofeltvisionwasn’tthatimportantsuggestedthatpeoplegotoWal-mart for a pair of glasses.
28
Tier 267%
Tier 133%
7.Maternity:MostpreferredTier 2 coverage that provides for complications of pregnancy. Participantsfeltthatifthemotherfacedunexpectedproblems she should be covered.Manywereconcernedaboutsaddlingthefamilywithhugedoctorandhospitalbills.A small minority felt that maternity coverage was not important at all. Their comments against coverage included “a lot of people out there having kids who cannot afford them or take care of them...” or “just have less children,” and “…if you are going to have a baby you better pay for it. This would be like paying for the down payment for the house you buy.”
Comments supporting coverage included: “All people should have the option to have maternity coverage—justlikeIdid.Peopleshouldhaveaccesstoapediatrician.”and“Peoplearegoingtohavekidsregardless.”Insomewaysthisdiscussionmirroredtheonesinthemental/behavioralandobesitycategorieswheresomeparticipantsfeltthatitwasanindividual’sresponsibilitytomanagetheseproblemsandotherssawitasalargersocietalissuethatrequiredcollectiveaction.
B.LeastImportantCategories
2.Obesity: The obesity discussion had many parallels with the dialogue onmental/behavioralhealthbenefits.Participantseitherridiculedthisasapersonalfailure(thereforenotneedinganykindofpublicpolicy)oridentifiedwith this issue as one needing societal action. The range of collective solu-tions, however, diverged amongst theparticipants.Forinstance,bariat-ric surgery, was seen by some as an unsafequickfixandtoothersitwasmedically necessary.
29
1.QualityofLife:Mostpeoplefeltthatthiswasthemostexpendablecategoryandvoted for no coverage. This one “sounds cosmetic” many said. A minority disagreed andsaidthatthis“wasnotavanitything—ithelpswithyourjobandcanbecomeamental health issue for women without hair.”Others were concerned that infertility isanimportantissuethatwouldbecovered.Intheend,61%agreedtospendthemarker elsewhere.
Tier 211%
Tier 189%
C.OtherRequired&Elective Categories:1.CareManagement:Nearly90%ofallparticipantsselected the mandatory health review form and, if required,caremanagementclasses.Despiteitsoverwhelming approval, this category generated interesting discussion. Some felt that policymakers should understand that people may not to be able to attend classes due to personal barriers. A participant remarked“Idon’tthinkyoucanregulatepeopletogetmoreeducated—peoplewon’tdoit.Youcan’tforcepeopletotakeclasses.Peoplemayhaveahardtimefindingtransportationorchildcareorgettingto
work in order to get to these classes. It’snottheidealsituation—theyhaveto deal with other issues even if they wanttotaketheclasses.Pleasedon’trequire,justrecommendthatpeopletakeclasses.”Forsome,thiswas purely a matter of choice. They did not want to be told what to do and when. Others understood the importance of education as it relates to medical conditions and believed it was necessary to teach patients how to manage their conditions. Some suggested that if the patient had proper education, the problem might ceasetoexist.
“I don’t think you can regulate people to get more
educated—people won’t do it. You can’t force people to take classes.
People may have a hard time finding transportation or childcare or getting
to work in order to get to these classes. It’s not the ideal situation—they have to deal with other issues
even if they want to take the classes. Please don’t require, just recommend
that people take classes.”
2.EpisodicCare:Participantswerecomfortable waiting several weeks orlongertoseethedoctorinanon-emergencysituation.Nonewerewillingto spend more markers to shorten the waiting time. Some remarked that “several weeks or longer” is what they normally wait.
30
3.EndofLife:Aparticipantsaid:“Whydelayit?Whenit’syourtimetogo(andyouarecomfortable)it’syourtimetogo.It’sgoingtohappenanyway.”
Mostparticipantsfeltthepatientandfamilyshouldreceiveadequatepaincontrol, emotional and spiritual support. Veryfewwereinterestedincoveringtreatments that prolong life, such as resuscitation, breathing machines orintensivecare.Surprisingly,11%believed this category should not be covered and families could provide this type of care themselves.
4.Restorative:Participantsunderstoodthe importance of this benefitafteranaccident,surgeryoramajorillness.ManywantedTier2benefitswithcoverageforcrutches and wheelchairs. The majority selected the coverage of Tier 1 to provideabasicbenefitforthe lowest cost.
31
“Why delay it? When it’s your time to go (and you are
comfortable) it’s your time to go. It’s going to
happen anyway.”
32
D.IfYouHadMoreMarkersWhereWouldYouSpendYourMoney?
E.WhatPlanDidTheyUltimatelySelect?
33
$1,000annualmaximundentalplanwithfreeannualcleaningsandx-rays.Planpays80%ofbesicserviceslikecavitiesandoralsurgery.Willpay50%formajorservicessuchascrownsorbridges.Alsocoversvisiontestingannuallyand$75towardglassesevery2years.
Paysforroutinepre-natalcare,normalchildbirthandthecostsofcomplications.
Covershospitalstay,clinictherapyandmedicinefortreatmentofseverementalillness.Examples:bipolardisease,majordepressionandschizophrenia.Alsocoversshort-termcounselingandmedicinefor less severe mental illness, smoking and substance addictions.
Forpatientswhoareseverelyoverweightandmaysufferfromseriouscomplicationslikediabetesorheartdisease.Planpaysformedication,counselingprogramsandifnecessary,stomachsurgery.
No coverage selected.
Co-paymentsfordoctorvisitsare$20,genericdrugsare$10andbrand-namedrugsare$20.Patientspay$100whenusingtheERand$250perhospitalvisit.
Eachindividualpays4%ofthiersalarytowardhealthinsurancepremium.Individualsearning$20,000/yearwillpay$66/monthor$800/year.Individualsearning$30,000/yearwillpay $100/moor$1,200/year.
Coversalimitedchoiceofprovidersandhospitals.Patientsmaybereferredtoaspecialistthroughtheprimary care doctor.
Patientsmustcompleteahealthreviewform.Iftheyhaveachroniccondition,theymustatttentCareManagementclasses.Theseprogramshelppetientstostayashealthyaspossible.There are no co-paymentsfortheseservices.
Dental/VisionTier 2
MaternityTier 2
Mental/BehavioralTier 2
ObesityTier 1
QualityofLife
Co-paymentsTier 2
PremiumTier 2
ProvidersTier 2
Care ManagementTier 1
Healthcare Needs BenefitDescription
Coverswellnessexams,screeningtestsandvaccinesthatmeetnationalstandardsforgoodresults.Examples:flushots,PAPtestsandcolonexamsatage50.Therearenoco-paymentsfortheseservices.
PreventionTier 1
Forregularcheck-upsandtreatmentofearlychronicconditionslikediabetesandhighbloodpressurethatarenotyetserious.Doctorsmustfollowexpertguidlinesfortheleastcostlytreatmentthatworkswellfor90%ofthepatients.
Paysforchronicillnesslikediabetesandheartconditionsoncetheybecomeseriouslong-termproblems.Doctorsmustusetheleastcostlywaysthatworkformostpeopletomanagetheillness.
Treatment of common problems such as a rash, ear infection and strep throat. Care is given by a primarycareproviderwithallemergenciesandurgentcaredealtwithquickly.Ifnoturgent,thepatientmust wait several weeks or longer to see the doctor.
Covers sudden, serious injury or illness like car accidents or deadly cancer. All medical care known tobeusefulisgiventotrytosavethepatient’slife.Treatmentswithlittlechanceofhelpingarenotcovered.
Forrepairingtheabilitytoperformbasicactivities(walking,talking,dressing,bathing,etc)neededafterbrokenbones,strokesoramputations.Willpayfornecessaryrehabilitationservicestoimprovefunctionandartificiallimbsbutnotpatientequipmentusedathome.
Providesforpaincontrol,emotionalandspiritualsupportofthepatientandfamilywhenmedicaltreatmentcannotprovideacureandthepatientisexpectedtodiewithinthenextfewmonths.Doesnot pay for high tech care that postpones death.
MaintenanceTier 1
ComplexChronicTier 1
EpisodicCareTier 1
CatastrophicTier 1
RestorativeTier 1
End-of-LifeCareTier 1
Chapter 5: Conclusion
ChoosingHealthplansAllTogether(CHAT)soughttoexplorewhatwasmostvaluabletouninsuredOhioanstohaveintheirhealthplan,givenafinitebudget. To this end, CHAT focused on healthcare needs rather than services. Additionally,theCHATprojectexploredtheseoptionsinawaythatwouldhelp negotiate the interconnected problems of lack of access to and rising costs of healthcare coverage.
CHAT participants did not accept these restrictions easily and struggled with playing the game. If current cost constraints weren’t a factor theparticipantswouldhaveincludedeverything(atthemostgenerouscoveragelevel) on the CHAT wheel. But most of all, they saw value in meetingeveryone’shealthcareneedsinacost-efficientandclinicallyeffectivemannerthatintertwinedwithmaximizingthepatient’sinterests.Forinstance,inthepost-CHAT survey, individual participants identified the following asmostimportant when considering healthcare coverage:
•Payingaslittleaspossibleformymedicationsordoctorvisits.
•Payingaslittleaspossibleformyshareofhealthinsurancepremium.
•My doctor being able to order tests and medicationswithoutgettingapproval.
•HavingachoiceofwhichhospitalIgoto.
•Beingabletogetanappointmentwithmydoctorquickly
The sentiments expressed above were always negotiated with thelimitations of costs. Participants recognized that the growing numbers ofuninsured Ohioans (like themselves), coupled with budgetary constraints,wouldforcethemtosetlimitsandmakesacrifices.Inthepost-CHATsurvey,57%agreedthatitisreasonabletolimitwhatiscoveredbyhealthinsurance.Oneparticipantcommented:“Irealizedhowdifficult it istochoosewhat’simportanttothemajority,withoutforgettingtheminority.”Participant’svaluesinfluencedafinalplanwheretheycompromisedtogetherandcameupwithabasicplanthatmaximizedpublicgoodandminimizedpublicharm.
This basic health plan emphasized reasonably comprehensive coverage withaffordablepatientcost-sharing.High-valueandlow-valueinterventionswere carefully discussed by the participants in order to limit and include what wasseenasnecessary.Tosatisfycost-savings,cost-efficienciesandclinicalefficacies, participants placed many restrictions on medical interventions,hospital and physician use as well as the use of allied healthcare.
34
MostviewedtheirparticipationinCHATpositively,with46%believingitwould make a difference in the way they consider healthcare coverage and 50% felt it gave themsomething to thinkabout. Only3%ofparticipantsreceivednonewinformationbutfounditenjoyable,andaminor1%didnotthink itwasagooduseof their time. As it relatestoplandesign,96%ofparticipantsexpressedsomesatisfactionwiththebasichealthplancreatedby their group, and if the coveragewas offered, 86%would bewilling toabidebythegroup’scoveragedecisions.
Finally, the participants first expressed surprise and then value in thefact that policymakers would actively count the opinions of the uninsured. To thequestion“WhatdidyoufindmostvaluableaboutdoingCHAT?”manyparticipants responded, “having my voice be heard and it possibly make a difference” and “that uninsured people were actually being given a chance to provide feedback.”
35
“I’m glad Ohio is taking a pro-active approach to
healthcare reform.”
“Everyone’s opinion helps to make a
better plan.”
6. Sponsors
OhioDepartmentofInsurance•AARP•OhioHospitalAssociation•FoundationforHealthyCommunitiesof theOhioHospitalAssociation• OhioBusinessRoundtable •TheAcademyofMedicineofCleveland&NorthernOhio•GoodSamaritanHospital
36
Coordinators
OhioAssociationofFreeClinics•HealthPartnersofMiamiCounty•NorthCoastHealthMinistry•ViolaStartzmanFreeClinic•Toledo-LucasCountyCareNet•TheToledoHospital•ReachOutofMontgomeryCounty•OhioAssociationofCommunityHealthCenters•FamilyCaringClinic•CenterStreetCommunityClinic•AllenCountyHealthPartners•TheHealthcareConnection•FamilyHealthcare,Inc.•MuskingumValleyHealthCenter•AccessHealthColumbus•St.VincentCharityHospital•ToledoJobsWithJustice•KaleidoscopeYouthCenter•
HolzerMedicalCenter-Jackson•St.ElizabethHealthCenter•GoodSamaritanHospital
37
7. Appendices
AppendixA: Ohio CHATs About Healthcare Categories and Tiers
AppendixB: Ohio CHATs About Healthce ProjectPlan
AppendixC: Ohio CHATs About Healthcare SessionPlanningPacket
AppendixD: Ohio CHATs About Healthcare Pre-andPostSurveyQuestions
38
39
44
52
60
A. Ohio CHATs About HealthcareCategories and Tiers
1. Catastrophic: Treatment of sudden, serious injury or illness. Examples:liverfailurefromfoodpoisoning;beingbadlyhurtinacarcrash;deadly cancer.
Tier1-(4)Treatmentsaregiventotrytosavetheperson’slife.Insurancepays for all medical care that is known to be useful.
Tier2-(1)Iftheusefultreatmentsdonotwork,alsocoverstreatmentsthat have little chance of helping but are the only hope left.
2. Complex Chronic: For treating chronic illness like diabetes,heart conditions and arthritis, when they have become serious long-termproblems.
Tier 1- (8) The doctor uses the least costly ways to manage chronic illness. Such treatments work well for most people, but sometimes they may not work as well as more costly ones, which are not covered in this tier.
Tier2-(4)InadditiontoTier1,alsocoversthemorecostlytreatmentsthatmayimprovefunctioning.Examples:newkneeifarthritismakeswalkingdifficultoraninsulinpumpfordiabeticstostayinbettercontrol.
Tier3-(1)Forthoseattheendstageofdisease,thisalsocoversveryexpensivetreatments(suchashearttransplant)thatmighthelppatientslivelonger.
3.Dental&Vision:Forpreventingandtreatingdentalproblems;testingand correcting for problems with eyesight.
Tier1- (4)Dentalcareonly. Cleaningsandx-raysyearlywithoutco-payment. Basic dental services are 80%covered, such as emergencies,cavities,oralsurgery.Pays50%ofcrownsandbridges.Maximumcoverageis$1,000/year.
Tier2-(1)InadditiontodentalcareinTier1,coversvisioncare,whichincludesvisiontestingonceayear,ifneeded.Covers$75towardsglassesevery 2 years but not contact lenses.
4.End-of-lifeCare: This is care when medical treatment cannot provide acureandthepersonisexpectedtodiewithinthenextfewmonths.
Tier1-(1) Covers hospice care in the home or hospital. This provides good pain control, treats other discomforts, and gives emotional and spiritual support to thepatientand family. Itdoesnotpay forhigh-techcare thatdelays dying.
Tier2- (1)Covershospicecare. If thepatientor familywants it, thisalso covers treatments that delay death for a few days, weeks or months. Examples:hospitalintensivecare,CPRandbreathingmachines.
39
5.EpisodicCare: Treatment for common problems such as sprained ankle, ear infection, strep throat and poison oak. Also includes emergency cases like appendicitis.
Tier 1- (6) Care is given by the regular primary care provider for treatment.Allemergenciesandurgentcarearedealtwithquickly.Ifitisnoturgent,patientsmayhavetowaitseveralweeksorLONGERbeforeseeingthe doctor.
Tier2-(2) As in Tier 1, care is given by the regular primary care doctor fortreatment.Allemergenciesandurgentcarearedealtwithquickly.Ifitisnoturgent,thereisamuchshorterwaitingtime-severalweeksorLESSbefore seeing the doctor.
6.Maintenance:Forregularcheck-upsandtreatmentforearlychronicconditionswhen they are not yet serious. Examples: asthma, highbloodpressure and diabetes. This will help keep these problems from getting worse.
Tier1-(5)Thedoctormustfollowexpertguidelinesfortests,treatmentand drugs that work well and are the least costly way to control chronic illness.Thoughmostpeopledofinewiththese,about10%ofpatientsneedmore than this level of care.
Tier 2- (3) If Tier 1 treatment does notworkwell, also coversmoreexpensivemedicalneeds,suchasnewbrand-namedrugsorcostly tests.Doctormuststillfollowexpertguidelines.
Tier 3- (1) The doctor can order any tests, treatment and drugs that he or she thinks will help, without having to follow expert guidelines foreffectiveness.
7. Maternity: For medical care of women during pregnancy andchildbirth.
Tier 1- (2)Covers routine pre-natal care and normal childbirth. Thisincludesmonthlydoctorvisits,pre-natalmedications,testing,deliveryofthebabyandshorthospitalstay.DoesNOTcoveranyadditionalcostsifthereareunexpectedproblems.
Tier2- (2) Inaddition toTier1, coverscosts if thereareunexpectedproblemsduringpregnancyorchildbirth.Examples:ifpregnancyisnotgoingwellandpatienthastostayinhospitalorifac-sectionisneeded.
8. Mental & Behavioral: For detecting and treating mental illness.Also covers treatment for unhealthy habits like smoking and substance addiction.
Tier1-(1)Paysfortreatmentofseverementalillness.Examples:bipolardisease, major depression and schizophrenia. Covers hospital stay, clinic therapyandmedicine.DoesNOTcoversmoking,alcoholorotheraddictionproblems.
Tier2-(1)InadditiontoTier1,coversshort-termcounselingandmedicineforlessseverementalhealthproblemslikemilddepressionoranxiety.Alsocovers counseling and medicine for smoking, alcohol and other addiction problems.
40
Tier3- (1)Coverage isbetter than inTier2. Now includes long-termcounseling for less severe mental health problems. Also covers treatment in the hospital for alcohol and drug addiction, if no other treatment has helped.
9.Obesity: Treatment for patients who are severely overweight. This condition often leads to medical problems such as diabetes and heart disease and other serious medical conditions.
Tier1- (1) Covers medication and counseling programs. Also covers stomach surgery if the obesity is having a severe impact on an individuals ability to function or has lead to serious medical problems.
10. Prevention: To help prevent many diseases and find medicalproblems as early as possible. THERE ARE NO CO-PAYMENTS FORTHESESERVICES.
Tier1- (1)Coverswellnessexams,screening testsandvaccines,butonlywhentheymeetnationalstandardsforgettinggoodresults.Examples:flushots,PAPtestsatacertainage,colonexamsatage50andcholesterolscreening.
Tier2-(1)InadditiontoTier1,alsocoversscreeningevenwhenchancesare very small that problemswill be found. Examples:mammograms forwomen under 40 or annual physicals when there is no medical reason to do them.
11.QualityofLife: Covers problems in function, appearance or comfort thatarenotseriouslydisablingbutaffectpeople’squalityoflife.Examples:injuries that keep people from playing sports; infertility; impotence; and hair loss.
Tier1-(1) Covers all drugs, medical and surgical treatment to try and correct these problems.
12.Restorative:Forrepairingtheabilitytodobasicactivities(walking,talking,dressing,bathing,working).Thisisoftenneededafterbrokenbones,surgery on joints, strokes or amputations.
Tier1-(1)Coversallnecessaryrehabservices(suchasphysicaltherapy)to improve important functions. Covers artificial limbs but not patientequipmentusedathome.
Tier2-(1)InadditiontoTier1,coversbasicequipmentneededfordailyactivities, like crutches and regular wheelchairs. Also covers half the cost of morecostlyequipmentlikeelectricwheelchairs.
THESE ARE THE “REQUIRED” CATEGORIES (participants have topickatierineachone;theyarenotoptional):
13.CareManagement:(REQUIRED)Theseareprogramstohelppeoplestay as healthy as possible. This includes a health review form and care managementclassesforthosewithchronicillness.THEREISNOCOSTTOTHEPATIENT.
41
Tier1-(1)AllnewpatientsMUSTcompleteahealthreviewform.Iftheyhaveachroniccondition(likediabetesorasthma),theyMUSTattendcaremanagement classes if their doctor says to.
Tier2-(2)Newpatientsdonothavetocompleteahealthreviewformunlesstheywantto.Iftheyhaveachroniccondition,theymayattendcaremanagementclassesbutarenotrequiredtodoso.
14.Co-Payments:(REQUIRED)Thesearetheamountsthatindividualspaywhentheyusehealthcareservices.Co-paymentsareNOTrequiredfortheservicesinthePreventionorCareManagementcategories.
Tier1- (1)Thereareco-payments formostservices,suchas$35 fordoctorvisits,$15forgenericdrugsand$30forbrand-namedrugs.Individualspay$150whenusingtheERand$500forahospitalstay.
Tier2- (2)Co-paymentsare lower thanTier1. Doctorvisitsare$20.Genericdrugsare$10andbrand-namedrugsare$20.Individualspay$100whenusingtheERand$250forahospitalstay.
Tier3- (2)Co-paymentsare lower thanTier2. Doctorvisitsare$10.Genericdrugsare$5andbrand-namedrugsare$15.Individualspay$25whenusingtheERand$100forahospital.
15.Premium:(REQUIRED)Mostofthemonthlyhealthinsurancepayments(premium)willbepaidbygovernmentandbusinesses.Thiscategorysetsthe amount that individuals pay as part of the monthly premium.
Tier1-(1)Eachpersonpays6%ofhisorhersalary.Ifasinglepersonmakes$20,000ayear,theperson’sshareis$1,200yearlyor$100amonth.Ifsalaryis$30,000ayear,theperson’sshareis$150amonth.
Tier2-(4)Eachpersonpays4%ofhisorhersalary.Ifasinglepersonmakes$20,000ayear,theperson’sshareis$800yearlyor$66amonth.Ifsalaryis$30,000ayear,theperson’sshareis$100amonth.
Tier3-(4)Eachpersonpays2%ofhisorhersalary.Ifasinglepersonmakes$20,000ayear,theperson’sshareis$400yearlyor$33amonth.Ifsalaryis$30,000,theperson’sshareis$50amonth.
16.Providers:(REQUIRED)Thesearetheprofessionalsthatprovidealltheregularmedicalcare,suchasexamstokeeppatientshealthy,short-termand chronic illness care, and hospital care.
Tier1- (1)Servicesareprovidedbya specificgroupofprimarycaredoctors. Referrals to specialists are not easy to get. If hospital care isneeded, the patient has no choice about which hospital to go to.
Tier2-(4) Choice of doctors and hospitals is greater than in Tier 1, but the list is still limited. A referral to see a specialist is a little easier to get.
Tier3-(4)Thereisawidechoiceofdoctorsandhospitals.Referralfromprimary care is not needed to see a specialist.
42
43
B. Ohio CHATs About HealthcareProject Plan
OhioDepartmentofInsuranceCHATTeam
August 19, 2008
44
Contents GOALS i
TARGETAUDIENCE i
SOFTWARE/GAME i
PLANNING ii
ESTIMATEDCOST iii
PLANNEDUNINSUREDSESSIONS iv
TIMETABLES UninsuredSessionSamplePlanningTimetable v UninsuredSessionSampleTimetable v
45
GOALS
I.TosolicitinputfromOhio’sinsuredanduninsuredpopulationsaboutwhata basic health plan should cover
II.ToeducateOhioansabouthealthcarecoveragechoices
III.To provide feedback to Ohio’s SCI team regarding uninsured andstakeholder choices
TARGETAUDIENCE
•Ohio Uninsured: Individuals under age 65, who can read English, arefamiliar with computers and have been uninsured for at least one year.
•Ohio Stakeholders: Includes the general public, taxpayers, communityleaders, government officials, small employers, providers, insurers andsales agents.
SOFTWARE/GAME
TheUniversity ofMichigan andTheNational Institutes ofHealthwithsupport from the Robert Wood Johnson Foundation have developed theproprietary and educational game and research tool known as Choosing HealthplansAllTogether™ (CHAT). CHAT isacomputer-basedprogramconcerningconsumerhealthcarechoices inacontextof finite resources.The program was introduced to Ohio through a separate contract with Center forHealthcareDecisions.TheCenterforHealthcareDecisionswillcontinuetosupportthiseffort.CHAThasbeentailoredtoreflecttheOhiohealthcarecoverage environment.
Inagroupof12to15,participantstacklethetoughestquestioninhealthpolicy today:What ismost important toprovide forOhioans ifwecannotafford healthcare coverage for everything? Each session consists of fourdistinct rounds. In Round 1, each participant designs his/her own basichealthplan.Participantscombineintosmallgroupsofthreeorfourtodesignaconsensusbasicplan inRound2. Potential illnessesandhealtheventsare introduced at the end of each of the proceeding rounds to demonstrate howmuchthebasicplanchosenwouldpay.Round3bringsallparticipantstogetherinonegrouptocreateauniformplanwiththehelpofafacilitator.Inthefinalround,participantsgobacktodesignabasichealthplanalonewitha new appreciation for others choices and needs.
Avarietyofquestionswillbepresentedfordatacollectionpurposes.Alldatawillbecollected,compiledandanalyzed.Reportswillbedevelopedcomparingand contrasting the answers of the uninsured and the stakeholders.
i 46
PLANNING
1. WeconsultedwithUniversalHealthcareActionNetwork(UHCAN)ofOhio,OhioAssociationofFreeClinics,OhioAssociationofCommunityHealthCenters and Access HealthColumbus to locate the uninsured throughout the state.
2. WithassistancefromtheHealthPolicyInstituteofOhioandutilizingcontactsdefined in1,wedetermined thecounties tosurvey. Weplan tosurvey nine metropolitan, five appalachian, four rural and two suburbancounties. We will conduct two uninsured sessions in each metropolitancounty and one session in each of the remaining counties.
3. In addition to the criteria detailed in the target audience section,weare requestingparticipationof adiversepopulationwith regard to thefollowing:
a. Age and gender;
b. Race/ethnicity;
c. Incomeandemploymentstatus;and,
d. Geographicalarea.
4. TheDepartmentwillplantheOhiouninsuredCHATsessionswithareacommunityorganizationsandthecontactsin1.ODIwillworkwiththeorganization to secure the appropriate facility for the session. The organization is responsible for recruiting, reminding and assuring attendance of uninsured participants. the department will be responsible for the computers, software and facilitators.
5. Ithasbeendeterminedthatameaningfulstipendandrefreshmentsare required toassureparticipationof theuninsured. Agrocerystoregiftcardof$30.00issuggested.Adrinkanda“hearty”boxlunchconsistingofasandwich,sidedish,chips,dessertandfruitarerecommended.Refreshmentswillrunbetween$7.00and$10.00perperson.
6. The department will work with stakeholders to bring the CHAT program to their membership. The department will offer at the minimum facilitationservicesandadditionalassistanceasrequired.
ii47
TOTALESTIMATEDCOST
$10,440.00 Stipendat$30.00/uninsured,348totalparticipants
$3,480.00 Foodat$10.00/uninsured,348totalparticipants
$ 13,920.00 Total Estimated Cost
All funding has been secured.
iii 48
iv
PLANNEDUNINSUREDSESSIONS
Adams*
Allen*
Athens*
Clinton*
Cuyahoga**
Delaware*
Franklin**
Hamilton**
Harrison*
Jackson*
Lake*
Lucas**
Mahoning**
Marion*
Miami*
Montgomery**
Muskingum*
Ross*
Shelby*
Stark*
Summit**
VanWert*
Wayne*
Appalachia
Metropolitan
Appalachia
Rural
Metropolitan
Suburban
Metropolitan
Metropolitan
Appalachia
Appalachia
Suburban
Metropolitan
Metropolitan
Rural
Suburban
Metropolitan
Appalachia
Appalachia
Rural
Metropolitan
Metropolitan
Rural
Rural
OACHC,UHCAN
OACHC(SessionheldJuly22,2008)
OACHC,OAFC,UHCAN
OAFC
OAFC,St.VincentCharityHospital(SessionsheldMay1&2,2008)
OAFC
AHC,KYC(SessionsheldApril30&August28,2008)
OACHC,OHA(SessionsheldJuly29&November20,2008)
OACHC, OHA
OHA(SessionheldSeptember3,2008)
OAFC,UHCAN
OAFC,TJWJ(SessionsheldJune25&July23,2008)
OHA(1stSessionheldSeptember4,2008)
OACHC(SessionheldJuly1,2008)
OAFC(SessionheldApril28,2008)
OAFC(1stSessionheldJuly21,2008)
OACHC(SessionheldAugust27,2008)
OACHC(SessionheldAugust5,2008)
OAFC
OACHC,OAFC
OACHC,OAFC
OACHC,(SessionheldJune20,2008)
OAFC(SessionheldMay2,2008)
* = One session planned for the county** = Two sessions planned for the county = Sessions for county completed
49
County Region AvailableConsultant
v
Evening
AM
PM
45
30
15
7
1
Food/Registration
Session
Stipend
Food/Registration
Session
Stipend
Food/Registration
Session
Stipend
5:30PM-6:00PM
6:00PM-9:00PM
atEnd
8:30AM-9:00AM
9:00AM-12:00PM
atEnd
1:00PM-1:30PM
1:30PM-4:30PM
atEnd
Meetwithorganization;determinepossibledatesandfacilityoptions;
providelistofresponsibilitiesandexpectations.
Finalizedate,locationandflyer;schedulesoftwareinstallationand
machine check, if necessary; invite attendees and provide directions.
Confirmattendeecount,arrangefood.
Send reminders to attendees, forward software to facility for installation,
if necessary.
Check computers, if necessary; arrange room and registration table; call
attendees;confirmfinalfoodcount.
Prepcomputersforsession,obtainfood.
DaysPrior Duties
UninsuredSessionSampleTimetable
UninsuredSessionSamplePlanningTimetable
Session Activity Time
50
2 hours
51
C. Ohio CHATs About HealthcareSession Planning Packet
OhioDepartmentofInsuranceCHATTeam
August27,2008
52
Contents SESSIONGOALS i
UNINSUREDPARTICIPANTQUALIFICATIONS i
ADDITIONALCONSIDERATIONS ii
METHOD iii
PLANNING/RESPONSIBILITIES iv
SESSIONSPACECRITERIA v
MISCELLANEOUSITEMSTOCONSIDER v
TIMETABLES UninsuredSessionSamplePlanningTimetable vi UninsuredSessionSampleTimetable vi
53
SESSIONGOALS
I.TosolicitinputfromOhio’suninsuredpopulationaboutwhatabasichealthplan should cover
II.ToeducateOhioansabouthealthcarecoveragechoices
III.ToprovidefeedbacktoOhio’sSCIteamregardinguninsuredchoices
UNINSUREDPARTICIPANTQUALIFICATIONS
1.Twelveindividuals,ages18–64;
2.AbletoreadandunderstandEnglish;
3. Computer literate, have seen and used a computer before; and,
4. Currently uninsured and has been for at least one year.
i 54
ADDITIONALCONSIDERATIONS
•Individualsmustbeabletoworkindependently,inasmallgroupandinalarge group of twelve.
•Thesessioncanbeaslongasthreehours.Whiletherearenoformalbreaks,participantswhomustleaveareaskedtoreturnasquicklyaspossible.Individualsmustbeabletoworkcomfortablyforthreehourswithout a formal break.
•InadditiontothequalificationsdetailedonPagei,wearerequestingparticipation of a diverse population with regard to the following:
a. Age and gender
b.Race/ethnicity
c.Incomeandemploymentstatus
d.Familystatus
•Itmaybedifficultforindividualstoparticipateiftheyaredistracted.Childcare may need to be available for those with small children.
•Thetimeuninsuredcanbereducedtosixmonthsifyouareunabletorecruit enough participants who have been uninsured for at least one year.
•Participantsmustcompletethesessiontoreceivethestipend.Anyindividual leaving before the session is completed will not be paid.
ii55
METHOD
TheUniversity ofMichigan andTheNational Institutes ofHealthwithsupport from the Robert Wood Johnson Foundation have developed theproprietary and educational game and research tool known as Choosing Healthplans All Together™ (CHAT). CHAT isacomputer-basedprogramconcerningconsumerhealthcarechoices inacontextof finite resources.Theprogramwas introduced toOhiobyCenter forHealthcareDecisions.TheCenter forHealthcareDecisionsbroughtCHAT toanumberofstatesand will continue to support this effort in Ohio. CHAT has been tailored to reflecttheOhiohealthcarecoverageenvironment.
Inagroupof12,participantswilltacklethetoughestquestioninhealthpolicytoday:WhatshouldbetheminimumcoverageforOhio’suninsured?Eachsessionconsistsoffourdistinctrounds.InRound1,eachparticipantdesignshis/herownbasichealthplan.ParticipantscombineintosmallgroupsofthreeorfourtodesignaconsensusbasicplaninRound2.Potentialillnessesand health events are introduced at the end of each of the proceeding rounds todemonstratehowmuchthebasicplanchosenwouldpay.Round3bringsall participants together in one group to create a uniform plan with the help of afacilitator.Inthefinalround,participantsgobacktodesignabasichealthplan alone with a new appreciation for others choices and needs.
Avarietyofquestionswillbepresentedfordatacollectionpurposes.Alldatawillbecollected,compiledandanalyzed. Reportswillbedevelopedcomparing and contrasting the answers of the uninsured in different regions around the state.
iii 56
PLANNING/RESPONSIBILITIES
1.UsingtheUninsuredParticipantQualificationsandtheAdditionalConsiderations, select twelve individuals to participate in the session.
2.Over-recruitingmaybenecessaryifyoubelieveallindividualswillnotattend as scheduled. You may want to advise those considering that thesessionisonafirstcomefirstservebasisandwhenallseatsarefilledyoucanacceptnomore.Stipendscanonlybepaidtothosewhocomplete the session.
3. Inadditiontorecruiting,itisstronglyrecommendedyouremindyourparticipants at least one week prior and again the day before the session. You may have time to recruit replacements with early notice of a no show.
4. Ithasbeendeterminedthatameaningfulstipendandrefreshmentsarerequiredtoassureparticipationoftheuninsured.Agrocerystoregiftcardof$30.00issuggested.Adrinkanda“hearty”boxlunch consisting of a sandwich, side dish, chips, dessert and fruit are recommended.Refreshmentswillrunbetween$7.00and$10.00perperson.
5.TheOhioDepartmentofInsurance(ODI)isworkingwithsponsorstosecurefundingofthestipendandrefreshments.Wewelcomeanysuggestions and assistance you can provide in this matter.
iv57
SESSIONSPACECRITERIA
1.TrainingRoomorConferenceRoomthatcanaccommodate13computersandaprojector.ConfigurationdetailsarefoundintheattacheddocumententitledExhibitA-CHATConfiguration.
2. The room should be handicap accessible and close to the participants in terms of location.
3.ARegistrationtableisneeded,preferablyinsidetheroom.
4.Wewillneedaccesstothespaceatleast1hourpriortoregistrationforsetup.
5.Wewillrequireatleast1hourafterthesessiontouploaddataandpackequipment.
MISCELLANEOUSITEMSTOCONSIDER
•Volunteerassistanceduringthesessionmaybeneededtoregister,direct,feed and pay the participants.
•Theneedtosurveyboththeemployedandunemployedmustbeconsideredwhensettingsessiontimes.Eveninghoursareavailable.
•Uninsured meetings can be held in concert with community leaderinformationsessions.Weencouragethisoptiontoeducategovernmentandcommunityleadership.PleasecontactODIifyouareinterested.
v 58
vi
Evening
AM
PM
45
30
15
7
1
Food/Registration
Session
Stipend
Food/Registration
Session
Stipend
Food/Registration
Session
Stipend
5:30PM-6:00PM
6:00PM-9:00PM
atEnd
8:30AM-9:00AM
9:00AM-12:00PM
atEnd
1:00PM-1:30PM
1:30PM-4:30PM
atEnd
MeetwithODI;determinepossibledatesandfacilityoptions;receiveSessionPlanningPacket
Finalizedate,locationandflyer;inviteattendeesandprovidedirections
Confirmattendeecount,determinemenu,arrangeforfood
Send reminders to attendees
Arrangeroomandregistrationtable;callattendees;confirmfinalfoodcount
Roomavailableforcomputersetup;pickupfood
DaysPrior Duties
UninsuredSessionSampleTimetable
UninsuredSessionSamplePlanningTimetable
Session Activity Time
59
2 hours
D. Ohio CHATs About Healthcare Pre- and post survey questions
(wordsinred arethesoftwarecodesusedtodesignatethatquestion)
Pre-CHATsurveyquestions(thesefirstfourarepermanentlyinthesoftware;alltheothersarecreatedbytheprojectsponsor)
Participant’sname(ID)________Player
Yearofbirth:19_____DOB
Gender:Male____Female____Gender
Familystatus:Familystatus
Single_______
Singlewithdependents_____
Couple______
Couplewithdependents______
------------------------------------------------------------------------
1.Race/EthnicGroup(chooseallthatapply):Ethnicity
____Asian-American
____BlackorAfrican-American
____HispanicorLatino
____Multiracial
____NativeAmerican
____White
____Other(specify:_________________________)
2. Highest grade or level of school completed: Education
____8thgradeorless
____Somehighschool
____HighschoolgraduateorGED
____Somecollegeortwo-yeardegree
____Four-yearcollegedegree
____Post-graduatedegree
60
3. Household yearly income: Income
____$0tolessthan$10,000
____$10,000tolessthan$21,000
____$21,000tolessthan$32,000
____$32,000tolessthan$45,000
____$45,000tolessthan$60,000
____$60,000tolessthan$90,000
____$90,000ormore
4.Generally,wouldyousayyourhealthstatusis: Health Status
____Excellent
____Verygood
____Good
____Fair
____Poor
5.Doyouoranyoneelseinyourhouseholdhaveadisabilityorchronichealthcondition?Disability
____Yes
____No
____Notsure
6. Are you or anyone else in your household regularly taking prescription medicine?Prescriptions
____Yes
____No
____Notsure
7.Duringthepast12months,howmuchdidyourhouseholdspendonmedicalanddentalcare?(Notincludingthecostofhealthinsurancepremium)Health spending
____None
____Lessthan$200
____Between$200and$500
____Between$500and$2,000
____Morethan$2,000
____Don’tknow
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8.Duringthepast12months,haveyouoranyoneinyourhouseholdstruggledwithhealthcarebecauseyoucouldnotaffordit?Affordability
____Yes
____No
9.Doyoucurrentlyhavehealth insurance (private,MedicareorMedicaid)? Ifno,godirectlytoquestion13. Have insurance
____Yes
____No
____Notsure
10.DoyouknowthetotalcostofyourmonthlyhealthinsurancepremiumthatispaidbyyouremployerANDyou?TotalPremium
____Yes
____Donotknow
11. How much of your monthly health insurance premium is paid by you or someoneinyourhousehold?Premiumpaid
____Donotknow
____$0(employerorgovernmentpaysall)
____$1--$30
____$31--$60
____$61--$100
____$101--$200
____Morethan$200
____Iormyfamilypaytheentirepremium
12.Allhealthplanshavesomecoveragerestrictions.Whichbestdescribeshowmuchyouknowaboutyourhealthplanrestrictions?Restrictions
____Iknownothing
____Iknowalittle
____Iknowafairamount
____Iknowalot
13.Ifyoucurrentlyhavenoinsurance,describehowmuchcoverageyouhavehad in the last 2 years. Time covered
____Nocoverageatall
____Coveredlessthan6months
____Covered6monthsbutlessthan1year
____Covered1yearbutlessthan2years
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14.Ifyoucurrentlyhavenoinsurance,howmuchareyouwillingtopaymonthlyforhealthinsurancecoverageforyourself?Willingtopay
____$0
____$1-$30
____$31-$60
____$61-$100
____$101-$200
____Morethan$200
Post-CHATsurveyquestions
1. If youhadmoremoney (markers) tospendon the last round,whichONEcategorywouldyouhavespentthemon?Moremarkers
___________________________________________________________________
2.Towhatextentwereyousatisfiedwiththehealthplanchoicesmadebythewholegrouptogether?Satisfied
____Verysatisfied
____Somewhatsatisfied
____Somewhatdissatisfied
____Verydissatisfied
3. If you needed insurance coverage, would you be willing to abide by thecoveragedecisionsthatthegroupmadetoday?Accept decision
____Yes,definitely
____Yes,probably
____Probablynot
____Definitelynot
____Notsure
4.Forme,makingdecisionsonwheretoputmyCHATmarkerswas:Markerdecisions
____Veryeasy
____Somewhateasy
____Somewhatdifficult
____Verydifficult
63
5.DoyouthinkeveryoneshouldcompleteaHealthReviewFormasarequirementoftheirhealthinsurance?Health form
____Yes,definitely
____Yes,probably
____Probablynot
____Definitelynot
____Notsure
6. If patients are having health problems, do you think they should have toattendCareManagementclassesiftheirdoctorthinksitisimportant?Care classes
____Yes,definitely
____Yes,probably
____Probablynot
____Definitelynot
____Notsure
7.Agree or Disagree: I think it is important for employees to have a role indeciding about health care coverage for their company. Employeerole
____Agreestrongly
____Agreesomewhat
____Disagreesomewhat
____Disagreestrongly
____Notsure
____Doesnotapply
8. Of the factors listed below, select 3 that are most important to you in considering your health insurance coverage. Prioritylist
____HavingachoiceofwhichhospitalIgoto
____Payingaslittleaspossibleformyshareofthehealthinsurancepremium
____Havingalargeselectionofprimarycaredoctorstochoosefrom
____Seeing a specialist without having to be referred by my primary caredoctor
____Beingabletogetanappointmentwithmydoctorquickly
____My doctor being able to order tests and medicines without gettingapproval
____Payingaslittleaspossibleformymedicineordoctorvisit
____Beingabletoseeaspecialistwhoisnotpartofmyhealthplan
64
9.Of the factorsyouselected in the lastquestion,whichONE thing ismostimportant?MostImportant
____HavingachoiceofwhichhospitalIgoto
____Payingaslittleaspossibleformyshareofthehealthinsurancepremium
____Havingalargeselectionofprimarycaredoctorstochoosefrom
____Seeing a specialist without having to be referred by my primary caredoctor
____Beingabletogetanappointmentwithmydoctorquickly
____My doctor being able to order tests and medicines without gettingapproval
____Payingaslittleaspossibleformymedicinesordoctor’svisits
____Beingabletoseeaspecialistwhoisnotpartofmyhealthplan
10.Agreeordisagree:Giventherisingcostofhealthcaretoday,itisreasonableto limit what is covered by health insurance.Limitsreasonable
____Agreestrongly
____Agreesomewhat
____Disagreesomewhat
____Disagreestrongly
____Notsure
11.WhichstatementmostcloselyrepresentsyourviewaboutparticipatinginCHATtoday?ViewofCHAT
____ThiswillmakeadifferenceinthewayIconsidermyhealthcarecoverage.
____Thishasgivenmesomethingtothinkabout.
____Nonewinformationbutitwasenjoyable.
____Itwasnotagooduseofmytime.
12. Briefly,what (if anything) surprised youmost in today’s session? Whatsurprised
___________________________________________________________________
13. Briefly,what (ifanything)didyoufindmostvaluableaboutdoingCHAT?Mostvaluable
___________________________________________________________________
65
Voices of the Uninsured
Ohio CHATs About Healthcare