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Option 2: Employers must pay a fee of $2 per employee/per hour, with a weeklymaximum of $80 or $320 per month. The fee is higher than the current HMO average premiumfor 2003 ($222/month). It also compares favorably to the premiums for Kaiser, Blue Shield andthe PacAdvantage plans. A fee of this level ensures that both providing insurance and payingthe fee remain viable alternatives for employers.Exemptions/WaiversBusinesses may be exempt from HCAO for a number of reasons. Some reasonsinclude the following: (1) if the business employees too few employees (20 or fewer employeesfor for-profits, and 50 or fewer employees for non-profits; (2) if the contract is with a public entity,(3) if the contract was entered before 2001, (4) if the contract duration is less than a year.FinancingThe City/County estimated that HCAO would cost approximately $4 million annually.This is based on the assumption that one-third of all contracts would be renewed or modified.These additional costs were to be funded through the City’s General Fund.III. Lessons LearnedInnovative Strategies for Expanding CareOur review suggests that there are design features that can be used to expand systemsof local safety net care including: new organizational forms that allow for community-wideplanning and coordination, standardized eligibility processes to identify and limit patientpopulations and assign them to a medical home, integrated data systems to make patienteligibility and medical information readily available to providers, provider networks that offeraccess to comprehensive services, case management services to encourage care coordination,and provider payment methods that create incentives to serve low-income uninsured patients.Existing governance structures often present difficulties when trying to operate acoordinated health care safety net system involving multiple agencies, public and privateproviders, and different sources of financing. One of the ways that safety nets have extendedcare is to make organizational changes that establish relationships among community-basedsafety net organizations and ensure commitments to work toward common goals, such ascommunity-wide planning and service coordination. The actual form taken to achieve theseorganizational improvements may include:Consolidation - When health care agencies merge for policy, administration and deliveryof services. The main intent is to centralize authority and provide a more efficient andaccountable system.Collaboration - When health care agencies develop arrangements to take jointresponsibility for policy, administration and delivery of services.D-27