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Archive for October, 2014

Sam’s Club to launch a private health insurance exchange – The Washington Post

October 23rd, 2014 Comments off

The exchange, known as The Aetna Marketplace for Sam’s Club, will be available in 18 states beginning this month to members, their employees and their families. Employers can choose whether to offer a defined contribution plan or one that gives workers a flat, pre-tax contribution to apply toward a plan of their choice.

One of Sam’s Club’s chief rivals, Costco, already offers a private insurance marketplace that is geared at individual shoppers. The Sam’s Club marketplace is different in that it was designed specifically to appeal to small-business owners, although individual members could potentially sign up for it. Sam’s says that some 70 percent of its customers who hold business memberships have five or fewer employees.

via Sam’s Club to launch a private health insurance exchange – The Washington Post.

This collaboration exploits the weak 2013-14 rollout of the Small Business Health Options Program (SHOP) states must operate within their health benefit exchanges as the exchanges prioritized the individual plan side of their operations and outreach efforts.

Private sector marketplaces like this one compete with the SHOP. But the SHOP offers something they cannot: income tax credits for small employers with 25 or fewer employees paid an average of $50,000 or less annually. The credits can be claimed for a 2-year period provided the employer pays at least half of the premium.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Healthcare Reform Update: More providers, insurers showing appetite for narrow networks | Modern Healthcare

October 17th, 2014 Comments off

The ACA is driving much of the shift toward these narrow-network products, said Gerald Kominski, director of the UCLA Center for Health Policy Research in Los Angeles. The healthcare reform law standardizes health plan benefits and sets caps on out-of-pocket costs. So providers and insurers are using unique networks as a differentiator. “If you’re competing on price and you can’t vary copayment structure or deductibles, the only thing you can do is try and keep your networks as affordable as possible,” Kominski said.It’s not surprising to see providers and insurers try to copy Kaiser Permanente, said Peter Lee, executive director of Covered California, the state’s insurance exchange, at a virtual conference Wednesday organized by Modern Healthcare. “People understand when you pick Kaiser, you get a designated set of care delivery. I think it’s a very healthy thing for the entire health system to compete on delivery.”But experts caution that Kaiser has half a century of experience in operating a staff-model HMO, and other providers and insurers won’t be able to replicate that model quickly.

via Healthcare Reform Update: More providers, insurers showing appetite for narrow networks | Modern Healthcare.

Narrow networks help bridge the tradeoff between richer benefits mandated by the ACA and keeping premiums affordable –which in turn promotes the spread of risk fundamental to the viability of all insurance products. However, for narrow networks to properly function in the marketplace, they have to be true provider networks and not simply a list of suggested providers offered along with a major caveat emptor that there’s no guarantee a particular provider is in the network and accepting plan members.

Why? Because individuals and families purchase health insurance for the peace of mind it provides and the certainty that care is available when needed and covered per the coverage terms. That’s the key value. Otherwise, it functions more like those garbage “health plans” the ACA was designed to do away with that offered discounted services provider lists that could not be relied upon as accurate and current. As a vertically integrated risk bearing and provider entity, Kaiser Permanente holds a major advantage over other commercial health plan issuers in that its providers are in house, sparing Kaiser members the risk associated with provider network volatility and uncertainty that can hamper other commercial health plan issuers.

Because by definition there are fewer available providers in narrow network plans, there’s also less room for error when a member is seeking an in-network provider. That’s why it’s essential narrow network plans have networks with provider rosters that are accurate and up to date.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Aetna, Hill Physicians Medical Group and Dignity Health’s Hospitals and Medical Foundation Form Accountable Care Collaboration in Northern California

October 6th, 2014 Comments off

The agreement features a new payment model to reward Hill Physicians and Dignity Health for meeting quality, efficiency and patient satisfaction measures, including:

  • The percentage of Aetna members who get recommended preventive care and screenings;
  • Better management of patients with chronic conditions, such as diabetes and heart failure;
  • Reductions in avoidable hospital readmission rates; and
  • Reductions in emergency room visits.

via Aetna, Hill Physicians Medical Group and Dignity Health’s Hospitals and Medical Foundation Form Accountable Care Collaboration in Northern California – The Health Section.

 

This agreement affects Aetna’s group market; the insurer withdrew from California’s individual health insurance market as of 2014.

The move follows by two weeks the unveiling of an individual market Accountable Care Organization (ACO) formed by Anthem Blue Cross and 6,000 doctors and 14 hospitals across seven Southern California health systems.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Viewpoints: Lack of doctors in Humboldt reflects rural problems with access to health care – California Forum – The Sacramento Bee

October 5th, 2014 Comments off

The takeaway by Humboldt-Del Norte County Medical Society executive director Penny Figas: “The patients don’t have access.”

Humboldt is one of 22 rural Northern California counties to make up Covered California’s pricing Region 1. Anthem has signed up 91 percent of the region’s 49,665 enrollees. If Humboldt’s profile resembles its rural brethren, of its 5,679 enrollees, more than 5,000 will have a lot of trouble finding a physician to see them.

Without question, access is a major issue facing Obamacare’s implementation in California. What good is it to sign up for and pay for health insurance if you can’t find a doctor to see you?

via Viewpoints: Lack of doctors in Humboldt reflects rural problems with access to health care – California Forum – The Sacramento Bee.

While the Patient Protect and Affordable Care Act’s reforms of the individual health insurance market and expanded Medicaid eligibility have increased access to coverage, that coverage becomes far less valuable when health care providers don’t accept it. The health insurance crisis may be morphing into a provider access crisis, with the first indications showing up in rural America where provider networks are the least robust.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Rapid Growth in Wisconsin’s Medicaid Program Could Cause Strain on State Budget | MacIver Institute

October 1st, 2014 Comments off

[Madison, Wisc…] The Department of Health Services (DHS) has requested a $2.78 billion increase in funding for the 2015-17 biennium. The new dollars would grow the agency’s total budget to nearly $23 billion, or roughly one-third of the entire state budget.

Almost half of the new money, $1.25 billion, would come from the federal government, which already provides $10.5 billion to the agency for federally sponsored programs. Another $831.5 million would come from Wisconsin’s General Fund, made up of state tax dollars paid by the average Wisconsinite.

What is driving such an increase in costs for the agency? The answer lies mostly in its massive Medicaid program.

Of the $831.5 million in additional state dollars requested by DHS, $760 million would be added to Wisconsin’s Medicaid program and its outcrop, BadgerCare.

via Rapid Growth in Wisconsin’s Medicaid Program Could Cause Strain on State Budget | MacIver Institute.

This is likely to become a major budgetary issue in the states. This summer, California had to appropriate more than $2 billion in increased tax revenues in its fiscal year 2014-15 budget toward offsetting rising Medicaid cost sharing.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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