(Editor’s note: Though it hasn’t been much noted in local media, there’s a revolution coming Oct. 1 when state-run health cooperatives open across the United States under the Affordable Care Act, or Obamacare. This was first posted on the Kentucky Health Cooperative website.)
A revolutionary new model for health insurance has arrived in Kentucky.
There has never been anything like Kentucky Health Cooperative, Inc., an all-new, nonprofit health insurance provider based in Louisville. Open enrollment begins Oct. 1. The CO-OP will offer a variety of plans for individuals and small businesses – all at competitive prices. Its new plans are set to begin paying benefits on Jan. 1, 2014.
“Unlike much larger insurance companies, Kentucky Health Cooperative answers to policyholders rather than shareholders,” said Janie Miller, CEO of the CO-OP. “Everything we do is for the benefit of our members, not to make money for shareholders.”
Kentucky Health Cooperative’s products will be available on kynect, Kentucky’s Healthcare Connection. Kynect is the commonwealth’s new health insurance marketplace, allowing consumers to compare and select insurance plans. There consumers will find out if they qualify for payment assistance, special discounts or tax credits to help cover the costs of coverage for themselves, their families or their employees.
There are several advantages to choosing Kentucky Health Cooperative:
• The CO-OP offers coverage based on the well-being of its customers rather than focusing on the cost of their treatments
• The CO-OP uses real people who can help explain their options
• The CO-OP offers members with special health-care needs personalized assistance and consultation on health issues
• The CO-OP emphasizes overall wellness as well as treating the customer’s conditions
The CO-OP offers streamlined, easy-to-understand options
Because the CO-OP will be member-governed, its policies and procedures also will be flexible and unusually responsive to its customers’ needs, Miller said. “We are directly responsible to our members,” she said. “Our members will elect the board members of the CO-OP – the people who direct the staff,” she said.
“Not only that, but if we collect revenues above expenses, that money goes back to our members in the form of better benefits or lower premiums.”
Miller, a former commissioner of the Kentucky Department of Insurance, said the CO-OP has assembled a team of seasoned, experienced leaders with strong track records in developing and overseeing health plan operations.
For example, Richard Schultz, vice president of Clinical Care Integration, has 35 years of health-care experience. He was the director for Quality Improvement for the Kentucky Spirit Health Plan prior to taking this current position.
He was also the senior advisor for Retiree Health Care of Kentucky Retirement Systems for over six years. Schultz previously worked as the director of population management at Bluegrass Family Health and director of quality management at Advantage Care, both regional managed-care companies.
During the past year, Kentucky Health Cooperative has built a comprehensive network of health care providers across the state. In addition, the CO-OP employs its own staff of clinical nurses to do assessments of its customers and work directly with them to ensure that they stay as healthy as possible. “It’s a more compassionate, more involved service-delivery model,” Miller said.
New agents and brokers are still being sought. Miller said the CO-OP offers its agents and brokers a desirable, competitive compensation package.
The federal Affordable Care Act established the Consumer Operated and Oriented Plan (CO-OP) Program of which Kentucky Health Cooperative is a part. The program was designed to foster the creation of qualified nonprofit health insurance issuers to offer competitive health plans in the individual and small group markets. The Kentucky CO-OP is one of 24 CO-OPs that will operate in different states around the nation.
Under ACA guidelines that take effect in 2014, health insurance plans can no longer refuse to cover people – or charge them more – if they have a pre-existing health condition.
Kentucky has a proud history of innovation in health care since at least 1809, when Dr. Ephraim McDowell of Danville became the first surgeon to successfully remove an ovarian tumor. Other medical advances included the first human hand transplant in the United States, the first self-contained artificial heart transplant, and development of the first cervical cancer vaccine.
However, Kentucky is also one of the least healthy states in America, ranking 49th in the 2012 Gallup-Healthways Well-Being Index. It has the highest smoking rate and ranks first in preventable hospitalizations, first in cancer deaths and sixth in the number of obese adults. Approximately 15.3 percent of Kentuckians were uninsured in 2010 – close to the national average.
“We have our work cut out for us,” Miller said. “But these are exactly the sorts of issues Kentucky Health Cooperative is designed to address. We are smaller and more nimble than many traditional health insurers, which means we can be more responsive. By working closely with our customers, we hope to contribute to positive health outcomes for Kentuckians without the need for profit as a company.”