- change ups
Health assessment and education now part of Kent Health Plan
Kent Health Plan, which has undergone an overhaul in the past year, is preparing for more changes.
The KHP is preparing to roll out a new health benefits “multi-share” plan for low-income employed adults modeled after the nationally recognized Access Health program in Muskegon County.
The two county programs are not merging, their leaders say, but they are aligning their plans.
“We totally changed the way we’re doing our program from about one year ago,” said Jim Tuinstra, Kent Health Plan interim president and the retired CEO of Hope Network.
KHP is developing a new version of its Plan C, Director of Program Operations Kristi Kam said. Like the current plan, the new one — which doesn’t yet have a name — will enroll businesses with fewer than 50 low-income employees. Also like the current plan, monthly premiums for the new plan are expected to be under $100, with the employer paying half and the worker paying half. KHP picks up the remainder of the premium price.
But Kam said the new plan will replace U.S. Health and Life Co. insurance coverage with a plan self-funded by KHP. She said KHP hopes to start marketing the new plan to small employers around the end of the summer.
Like the Muskegon program, which was developed about 11 years ago with support from the W.K. Kellogg Foundation and has been emulated in other states, the plan will incorporate health assessment and education, which are now part of all KHP plans.
Jeff Fortenbacher, executive director of Access Health in Muskegon, said the program was designed for service-oriented business such as day care, mom-and-pop retail, bars and restaurants.
“We have been able to integrate the different services already present in the community for lower income individuals and really use the program as an access point to coordinate that,” he said. “It’s really focused on health outcomes and promoting health, and utilizing coverage to move individuals in that direction.”
County health plans in Michigan use matching federal funds and support via local hospitals, foundations and the state to provide coverage for low-income adults. About 46 county health plans provide coverage in all but about 10 of the state’s 83 counties.
Since 2001, the Kent Health Plan has provided several plans aimed at Kent County residents in particular circumstances: childless adults who earn 35 percent of federal poverty level or less; adults ages 19 to 64, regardless of whether they have dependents, who have incomes at 150 percent of the FPL or less who don’t qualify for other programs; and small businesses that employ 50 or fewer people at low wages. The plan also has a medication program.
KHP enrolls about 400 new members during an annual enrollment period, said Kristi Kam, director of program operations. It has served a total of about 5,000 people over the past 12 months.
The first changes involved the nature of Kent Health Plan. Tuinstra said that previously it was “basically an eligibility determination” program with two employees and operations conducted under contracts with McLaren Hospital in Flint, which processed bills, and the Ingham County Health Department, which determined eligibility.
“One of our concerns was under the previous system, 47 percent of our budget was spent in the emergency room,” said Tuinstra, who was a KHP board member before taking on the 10-hour-per-week CEO job. “We looked at really what were the finances. I told the board that if we keep doing what we were doing for three years, we will have spent our reserve and be out of business. We were actually spending more per member per month than what we were taking in from our various sources.”
After reviewing other county health plans in Michigan, the board decided to emulate Access Health.
“Muskegon really had the most comprehensive program,” Tuinstra said. “Their cost per member per month was substantially lower than what ours was. We are spending substantially less per member per month today than we were before, and we believe that people are getting much better health care.”
KHP moved administrative duties in-house, expanded from two to 10 staff members including nurses and social worker, and rented space at 620 Century Ave. SW, Tuinstra said. On a bus line, the new location is in the same building as Pine Rest Christian Mental Health Service’s DeMey Center, which provides counseling for substance use disorders. In KHP’s new office, nurses and social workers conduct the mandatory health assessments and education sessions required for new enrollees.
“Now when people enroll, they have to come in for an orientation and we do a basic health assessment at that time,” Tuinstra said. “We find a lot of diabetes, hypertension, anxiety, various things like that.
“This is the first time anybody’s ever really dealt with them on health issues and how can they have an impact on it. The vast majority of the people we deal with have never had a primary care physician. Their only access to health care really has been the emergency room.
“We’ve definitely seen a shift from the emergency room as the primary provider to being involved with clinics.”
While much of federal health care reform remains up the air until regulations are issued, Kam said the expansion of Medicaid is likely to provide coverage to those served by KHP’s Plan A and Plan B.