Region 18

Orange County
COVERED
CALIFORNIA
AffordabIe Care Act
Coverage Improvements


guaranteed coverage

no annuaI Iimits, no deniaI for pre-existing conditions

rates not based on
heaIth status

requires Iarge empIoyers
to offer coverage

affordabIe coverage - pubIic or private - required for
individuaIs



Coverage improvements begin 1anuary 1, 2014
EssentiaI heaIth benefits:

ambuIatory patient services

emergency services

hospitaIization

maternity and newborn care

mentaI heaIth and substance use disorder services,
incIuding behavioraI heaIth treatment

prescription drugs

rehabiIitative and habiIitative
services and devices

Iaboratory services

preventive and weIIness services and chronic
disease management

pediatric services
AffordabIe Care Act
Coverage Improvements
Who We Are
Your destination for
affordabIe heaIth
care
improve the health oI all CaliIornians
access aIIordable care
provide quality care
increase insured CaliIornians
improve health care quality
lower costs
reduce health disparities
choice and value
Operated by the State of CaIifornia

the Iirst state health exchange Iormed
under the AIIordable Care Act


established as CaliIornia Health
BeneIit Exchange
one oI 17 state-based marketplaces


dot-com but state-run


name-brand health insurance policies
Who We Are
Who We Serve
Covered CaIifornia Must Reach
5.3 million Californians who are currently
uninsured or purchase health insurance on their own

2.6 million who qualify for subsidies in our plans and
2.7 million who do not qualify for subsidies but now
benefit from guaranteed coverage and can enroll
inside or outside of Covered California

an additional 1.4 million Californians who may be
newly eligible for Medi-Cal
Enrollme
nt
Foundations for Success


Affordable Health
Plans


AffordabIe
HeaIth
PIans
Effective
Outreach &
Marketing
HeaIth Insurance That's AffordabIe

premiums based on income



copays that are not a deterrent to care



zero deductible Ior many plans



Iree preventive care



lower out-oI-pocket maximums
PubIic and Private
Insurance Companies
Alameda Alliance for Health
Anthem Blue Cross of California
Blue Shield of California
Chinese Community Health Plan

Contra Costa Health Plan

Health Net
Kaiser Permanente L.A. Care
Health Plan Molina Healthcare
Sharp Health Plan Valley Health
Plan
Western Health Advantage
Anthem Blue Cross of California

Blue Shield of California

Delta Dental of California
LBERTY Dental Plan of California

Premier Access Dental and Vision
HEA L T H I NSUR ANCE PL ANS
DEN T AL I NSUR ANCE PL ANS
Linda pls insert slide 32 from the PDF here
"What We Do: outreach/ed/marketing
Linda pls insert slide 39 from the PDF here
"What We Do: enrollment
Enrollme
nt
Foundations for Success


Affordable Health
Plans


AffordabIe
HeaIth
PIans
Effective
Outreach &
Marketing
ACA 2717: Setting the FederaI Stage
By March 2012, the Secretary of Health and Human Services in consultation with
experts in health care quality and other stakeholders is to develop requirements for
health plans to report on quality improvement activities with respect to pIan or
coverage benefits and provider reimbursement structures that:

(A) improve health outcomes;
(B) implement activities to prevent hospital readmissions through a comprehensive
program for hospital discharge;
(C) implement activities to improve patient safety and reduce medical errors;
(D) implement wellness and health promotion activities

And Section 1311:
.the implementation of activities to reduce health and health care disparities

22
Covered CA ModeI Contract:
A "tooIkit" to promote higher quaIity, better vaIue
HEDS/CAHPS reporting

Health assessments, identification of at-risk enrollees

PCPs as point of care coordination

Preventive health and wellness

ntegrated care models

At-risk enrollees: transition, access to services

Patient decision support
23
improve the health oI all CaliIornians
access aIIordable care
provide quality care
increase insured CaliIornians
improve health care quality
lower costs
reduce health disparities
choice and value