Expanding the Network of Care

 Expanding the Network of Care

Dayton’s CareSource is diving into the new health care marketplace.

Employees celebrating the launch of CareSource’s new logo.

The open market for health insurance is here and a Dayton-based healthcare provider is on the forefront. CareSource, a nonprofit managed care company, has expanded its business model to take part in the insurance exchanges that opened in October. It’s a big step for the state’s largest Medicaid plan and one that includes answering many questions about affordable healthcare options.

“There is a lot of false information out there right now,” says Steve Ringel, CareSource senior vice president of market and product group. “If this law didn’t benefit the underserved, CareSource would not have participated in the exchanges.”

CareSource, which has 971,000 members enrolled in Ohio and another 15,000 in Kentucky, pioneered the Buckeye state’s first mandatory Medicaid managed care program in the Dayton area in 1988. Originally called the Dayton Area Health Plan, CareSource has blossomed into one of the largest Medicaid managed health care plans in Ohio and one of the largest in the country.

As a nonprofit health plan serving nearly 1 million, CareSource has a seasoned understanding of the uninsured. The nonprofit currently serves about 1 in 10 Ohioans, and hopes to serve more with the implementation of the Affordable Care Act. Its participation in the health insurance marketplace is part of a commitment to provide affordable coverage to low-income Ohioans.

“The marketplace is an extension of our core mission, and we’ve been excited about the Affordable Care Act since its inception,” says Pam Morris, CareSource president and CEO.

Her excitement is based on the potential of the ACA, but navigating the health care exchanges is still a challenge. The new exchanges offer bronze, silver, gold and platinum plans, with platinum offering the most coverage and bronze the least coverage. In general, bronze plans offer lower premiums with higher deductibles and cover 60 percent of a person’s total healthcare costs. Conversely, higher plans, like platinum, cover roughly 90 percent of costs but charge higher premiums. Depending on age and income, some plans carry tax credits and subsidies that cover the cost. With varying degrees of premiums and deductibles, health consumers—especially with those who’ve never had insurance—can find it difficult to steer through the healthcare landscape.

It’s one reason why CaresSource has hired a full-time staff to educate the public on the exchanges. “We want to be the go to experts,” says Morris. “We’ve been training for this for over a year.”

From libraries to community events, CareSource has embarked on a campaign to explain the intricacies of the new marketplace. They even offer free education sessions for anyone looking to find the plan that best fits them and their family.

To set new insurance rates, CareSource counseled with actuaries and experts to help create the most affordable costs. The nonprofit, known for taking a holistic view of health care, thinks it can be the most competitive plan on the market. “We want to be the plan of choice that consumers would see as the most affordable,” says Ringel. “We wanted to provide the lowest overall price plan with the best coverage.”

Ringel says most of the plans CareSource has created fall under the Silver plan packages. “We’ve positioned ourselves as a continuation of the Medicaid coverage,” he says.

While it’s easy to inform the public about the details of the plans, the biggest challenge remains extinguishing the rumors, he says. “Many people still say they hate Obamacare, but they think affordable health care is a good thing,” says Ringel. “It goes to show how much misinformation is out there.”

Since the Supreme Court overturned the ACA requirement that states must expand Medicaid, the Ohio state legislature has been gridlocked on expanding coverage under multibillion dollar federal subsidies. Under the President’s plan, the federal government will pay 100 percent of the cost from 2014 through 2016. Beginning in 2020, the federal government would then pay 90 percent, while the state would contribute 10 percent.

Estimates vary on the number of Ohioans potentially covered under an expanded Medicaid program, some say 250,000, while others say as high as 750,000. It’s a significant figure no matter how the numbers are crunched. “Think of how many people will now discover something preventable by being able to visit the doctor instead of waiting till the problem gets worse and then have to go to the emergency room, where costs are that much higher,” says Ringel.

Morris, who’s worked with Medicaid recipients throughout her health care career, is optimistic about the program’s expansion in Ohio. “We fully expect everything to get settled,” says Morris.

In 2014, CareSouce will celebrate its 25th anniversary in Dayton. Morris credits the hometown’s support and people for the company’s success. She says Dayton’s reputation for innovation and affordable living were a huge help. “We couldn’t have done this alone,” says Morris. “It’s just a tremendous amount of support hat we’ve received from the community.”