Interview: Ralph Prows of Oregon’s Health CO-OP

logoOregon’s Health CO-OPs CEO talks about frustrations and impact of Cover Oregon’s dysfunction.

Health CO-OPs are one of the quirkiest creations of the Affordable Care Act. Short for “consumer oriented and operated plans,” CO-OPs are non-profit insurance companies with health insurance plans reflecting what their members want in their health plans—including types of care and affordability.

Oregon, one of the most competitive states in the county, characteristically has two—Oregon’s Health CO-OP, and Health Republic of Oregon.

While co-ops can sell insurance policies on the private market, it is expected that the bulk of their enrollees will come from participating in state insurance exchanges. Because co-ops are new with no prior relation to consumers, the problems Cover Oregon is experiencing enrolling people will have a bigger impact on the CO-OPs’ bottom line than other insurance carriers.

Ralph Prows, the CEO and president of Oregon’s Health CO-OP and former chief medical officer for Regence Northwest/Intermountain Region, thinks Cover Oregon’s website needs to get up and running, soon, before people lose trust and interest.

Q:  Generally speaking, what is your reaction to the fact that Cover Oregon isn’t able to enroll anyone online?

I think we’re all shocked and amazed and very worried about where things are today. People are now very shy of even talking about Cover Oregon or going to the website. Their reluctance on top of what we’ve always been worried about—whether the young and healthy are going to enroll—compounds that concern. I think it’s going to reduce enrollment altogether in 2013, particularly in that segment of the population.

Q:  How dependent is Oregon’s Health CO-OP on Cover Oregon for enrollment?

Cover Oregon plays this role as the sorting hat. Their job is to sort people into three groups: those eligible for tax credits and subsidies, those are who are not, and those who are eligible for Medicaid. We’re dependent on Cover Oregon just like every other carrier for the enrollment of people who are eligible for tax credits and subsidies. But we are not reliant on Cover Oregon for anyone else. Individuals, small and large employers can enroll directly. We had great traffic the first week. It was very busy.

Q:  Will you be able to meet your enrollment projections?

With everything that is going on right now with Cover Oregon…we’re kind of waiting to refigure what those projections might be.  [And] we’re waiting for what the Oregon Insurance Division will decide [regarding] the president’s announcement that it will be fine if individual states allow insurance carriers to carry forward their 2013 insurance products. [Oregon Insurance Commissioner] Laura Cali decided that she would allow…health plans to offer those 2013 plans, only at their current rates and through the end of March 2014. Whether she decides to allow that for the entire year or not is unclear. Either way, her decision will impact our enrollment projections.

Q:  How will decreased enrollment affect Oregon’s Health CO-OPs business plan?

We’re very well funded. That’s not such a concern. Even if our enrollment projections fell by two-thirds, we’d be fine. It’s just more time to break even. But you do need a critical mass of 25,000 enrollees for a health plan to be a sustainable model.

Q:  Is Oregon’s Health CO-OP doing anything to not let excitement flag?

Yes, but I can’t talk about them just yet. What we’re doing requires approval from the Insurance Division. What I can talk to you about is how we will manage our members…in terms of how proactive we will be with contacting them, welcoming them, and get them their assurances of coverage, both in terms of the speed and sending out a premium bill and collecting that bill. What we really don’t want is for people going to the doctor on January 2 and not being sure they have coverage.

Q:  What do you think should be done to keep the young and healthy demographic interested in purchasing insurance through Cover Oregon?

That is one of the biggest challenges in this whole recipe for the success of the Affordable Care Act. First of all, the system has to work. You can’t expect people to embrace this new system when it’s doing so poorly. It’s got to establish a track record of working, and get up and operating, be customer-friendly, and engaging of people of that age group. The noise and confusion puts them off. I think Cover Oregon has a lot of damage control to do.

Q:  Do you think Oregon’s Health CO-OP has any of its own damage control to do?

That’s a good question. We’ve talked about that and thought about that. I think at this point our message is that we’re here to stay. We’re already fully funded, licensed, and accredited. We’re moving forward. We’re already enrolling people. We’re waiting for Cover Oregon to get ready to go. None of those problems apply to us.