What State Policies Best Foster Insurance Market Competition?

What State Policies Best Foster Insurance Market Competition? | At the intersection of health, health care, and policy.

“It is important to better understand how different regulatory environments may affect the functioning and competitiveness of insurance markets. In the case of rate review, a recent study suggests that pre-ACA premiums were lower in states that took a more active regulatory approach. ACA rate review grants sought to reduce regulatory variation by collectively raising the bar.”

Source: Health Affairs Blog 

Employer Health Insurance Benefits Plan Premiums Rose 4 Percent, Study Finds

The average health insurance premium increase in during the past year is 4% for both single and family coverage, according to the 2015 employer health benefits survey sponsored by the Kaiser Family Foundation.

The annual single coverage premium is $6,251 while the average family coverage premium is $17,545, the survey found.

Researchers found that the percentage of firms offering health benefits to its employees – 57 percent – as well as the percentage of workers covered at those firms – 63 percent – is statistically unchanged from 2014.

Large employers with 200 or more workers said they have analyzed their health benefits to determine whether they would be subject to the high-cost health plan tax when takes effect in 2018, the study found.

“Some employers are already making changes to their benefit plans in response to the tax,” study researchers said.  Continue reading

Consolidation Among Managed Care Organizations Seen Heating Up; Aetna and Cigna Licking Their Chops

There has been a wave of mergers and acquisitions in the health insurer marketplace in recent years, our research for the National Directory of Managed Care Organizations has found.

The numbers of MCOs keeps shrinking, according to our research for the database.

Just the other day Humana announced that it was working with advisers at Goldman Sachs Group Inc., according to people familiar with the matter, the Wall Street Journal reported. “Aetna Inc. and Cigna Corp. are among those that have held preliminary discussions with the company,” the WSJ reported.

“We view this step as a trigger event in a managed-care industry overdue for consolidation, the   “analysts at Leerink Partners LLC wrote in a research note Friday afternoon, The WSJ reported.. “We expect the next year will see multiple strategic actions among the major players.”

“It’s sale may trigger consolidation that shrinks the number of large publicly traded health insurers from five down to three, said analyst Ana Gupte, PhD, Leerink’s Managing Director for Healthcare Services.. “It’s a huge push for scale,” she added.

The National Directory of Managed Care Organizations Database

This unique database provides managed care market business
intelligence on more than 1180 managed care organizations
that offer 5,279 health insurance plan products.

This managed care directory also covers specialty HMOs and PPOs,
and includes details on PBMs, TPAs, PSOs, POSs, EPOs, Medicare,
Medicaid Plans, and Medicare Advantage Health plans.

The National Directory of Managed Care Organizations Database


Executives from Aetna and Anthem Inc. have said in recent weeks they are interested in doing large deals, Reuters reported. Analysts said on Friday that Anthem may also look at Humana.

“The government has pressured health insurers to cut costs with the new Obamacare exchange plans and in Medicare while employers have also gotten tough on spending for medical procedures and drugs,” reported Reuters.

“Acquiring Humana would vault Cigna to the lead in the market for Medicare Advantage policies, Continue reading

Hospital Consolidation: Can It Work This Time?

One of the consequences of the Affordable Care Act (ACA) is that it has sparked a giant wave of hospital consolidation: 100 deals were completed in the sector in 2014 — up 14% from the previous year, according to Wall Street research firm Irving Levin Associates.

What’s particularly notable about the recent spate of M&A is that it’s both “horizontal” and “vertical,” meaning hospitals aren’t just buying other hospitals, they’re picking up physician practices, rehabilitation facilities and other ancillary health care providers. Consider New York’s North Shore-LIJ, for example. Its aggressive M&A plan has turned it into the state’s largest employer, encompassing 18 hospitals, plus rehab centers, a medical research center, home-care services and hospice facilities. And last year it began offering health coverage through its own insurance company, CareConnect.

Wharton’s health care experts predict the trend of hospital consolidation will continue at a fast clip, particularly as health systems set up more and more Accountable Care Organizations (ACOs) in response to the ACA.

Full details: http://knowledge.wharton.upenn.edu/article/hospital-consolidation-can-it-work-this-time/

Medicaid Primary Care Parity

From Health Affairs:

For 2013 and 2014, the federal government raised payment rates to Medicaid primary care providers. Only some states plan to extend the rate increase.

Section 1202 of the Affordable Care Act (ACA) required states to raise
Medicaid primary care payment rates to Medicare levels in 2013 and 2014,
with the federal government paying 100 percent of the increase. This
provision–often referred to as “Medicaid primary care parity” or the
“Medicaid primary care fee bump”–was intended to encourage primary care
physicians to participate in Medicaid, particularly in the face of an
expected increase in enrollment as a result of the ACA’s expansion of
the program.

Federal lawmakers failed to reauthorize the fee bump during the 113th
Congress, ending in December 2014. As a result, states must decide
whether to revert to previous primary care payment levels or continue
at a higher level but without the benefit of the enhanced federal match.
Full details: