Exchange, CO-OP, ACA
As details on state healthcare exchanges continue to become public, there will likely be some surprises, but one thing is certain—nothing will match the drama that has unfolded in Vermont. In May, Vermont became the only state (out of 24) to reject a healthcare consumer-oriented and -operated plan, which had hoped to offer products in the state’s health insurance exchange. CO-OPs are regional health insurance plans established by nonprofit groups to provide more competition in the commercial sector, including state health insurance exchanges. Originally, the Affordable Care Act included $3.8 billion to fund loans to CO-OPs, and $1.9 billion of that amount was loaned to 24 nonprofits nationally to help get CO-OPs up and running. During the fiscal cliff budget negotiations in January 2013, most of the remaining $1.9 billion was cut, meaning there is no further funding to develop additional CO-OPs. Read more.
Posted on: 6/7/2013 10:31:10 AM
Now that the curtain has lifted on Covered California, potential customers of the insurance marketplace can breathe a bit easier. The premiums proposed by 13 carriers approved for the individual exchange came in lower than many expected. Read more.
Posted on: 6/3/2013 3:44:54 PM
Contributor: Bill Melville Read more.
Topic: Exchanges, ACA, carriers
As more states show their cards on health exchange participation, their hands seem to match their existing insurance markets.
New Hampshire has only has one insurer (Anthem Blue Cross and Blue Shield of New Hampshire) planning to participate in the exchange, not surprising given Anthem’s dominance there. California has 13, Minnesota has nine and even Georgia’s federally facilitated exchange will include seven carriers.
Posted on: 5/30/2013 11:25:26 AM
Guest Blogger from Decision Resources: Roy Moore Read more.
Topic: Medicare, Part D, MLR, CMS
The Centers for Medicare & Medicaid Services made a decision last week that could cut into the profits of Part D plans and certainly focuses more attention on how they are spending premium revenue.
Posted on: 5/29/2013 12:36:26 PM
Are all states destined to have managed Medicaid programs, regardless of how their current Medicaid programs are performing? That’s a question that should be top of mind as North Carolina intends to apply for a Medicaid waiver that would allow the state to move from a primary-care case management program to a managed Medicaid program. Read more.
Posted on: 5/24/2013 1:01:34 PM
Rhode Island being the smallest state, you might think word would travel faster there. But according to a recent survey commissioned by the Rhode Island Health Benefits Exchange, four out of five state residents have never heard of the exchange. So much for brand awareness. Regardless, Rhode Islanders—and consumers across the nation—best do their homework as the October 2013 exchange launch date, for coverage effective Jan. 1, 2014, rapidly approaches. The structure of state exchanges, including participating health plans, is taking shape, and there are developments worth noting in one of the bellwether exchange regions—New England. Read more.
Posted on: 5/23/2013 2:56:15 PM
Contributor: Paula Wade Read more.
Topic: Exchanges, medical loss ratio, rate increases, national MCOs
Is it just me, or is anyone else getting tired of all the poor-mouthing by the quite profitable health insurance industry?
After posting hefty profits in 2012, the publicly traded health plans have released pretty darn good first-quarter earnings and most even upped their forecasts for the year. Aetna, Cigna, Humana and UnitedHealth Group reported profit margins in the 5 percent range, good by insurance industry standards (a few years ago they averaged in the 3 percent range). For UnitedHealth, that amounted to $1.24 billion, or a 4.09 percent margin. And, by the way, their stock prices are up.
Posted on: 5/22/2013 5:15:18 PM
Contributor: AnnJeanette Colwell
Topic: Physicians, managed care, ACA
Physician leadership was a recurring theme at the National Association of Managed Care Physicians conference in Orlando, which I recently attended. Indeed, the topic is becoming more prominent at a number of conferences focused on preparations for healthcare reform. Read more.
Posted on: 5/20/2013 3:25:09 PM
Contributor: Chris Clancy
Topic: Pharmacy benefits, P&T committees, value-based formularies
When it comes to assessing the clinical benefits of a drug and deciding on which tier that drug is placed, the conversation traditionally begins and ends with a plan’s Pharmacy and Therapeutics Committee. However, now that Premera Blue Cross in Washington has seen its value-based formulary implemented by a couple of large, healthcare-related employers in the Puget Sound area, a new avenue of cost savings may exist for insurers wanting more bang for their drug-purchasing buck. Read more.
Posted on: 5/16/2013 1:41:53 PM
Contributors: Laura Beerman and Ed Park Read more.
Topic: ACOs, hospitals, medical devices, healthcare reform
A recent survey by consultants L.E.K. of more than 200 hospital executives paints the picture: the next five years will likely see spending decreases for large device med tech spending. With 80 percent of those respondents already members of or planning to join accountable care organizations, there are three things med tech should put on its radar.
Posted on: 5/14/2013 12:51:17 PM