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.

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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

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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:
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=137

2015 Health Plan Member Satisfaction Study Released by J.D. Power

Health plan overall member satisfaction averages 679, a 10 point improvement from 2014, found a new study by J.D. Power.

The study now in its ninth year measures satisfaction among members of 134 health plans in 18 regions throughout the U.. by examining six key factors: coverage and benefits; provider choice; information and communication; claims processing; cost; and customer service. Satisfaction is calculated on a 1,000-point scale, the firm said..

“Following a year filled with negative news coverage about health insurance, a bumpy start to the launch of the Affordable Care Act, and an atmosphere of fear, member satisfaction with health plans has increased significantly as plan administrators take a customer-centric approach, helping to build member trust and loyalty,” the study revealed.

The increase in satisfaction is driven by improved performance across all factors, most notably in information and communication (+17 points), which is primarily a result of efforts among many of the health plans to retool their approach by refining messaging, adjusting message frequency and upgrading their website. Satisfaction in the customer service factor has increased by 11 points, driven partially by matching communication methods to member preferences, such as mobile and text. Cost satisfaction increases by 13 points while fewer members indicate having experienced an increase in their monthly premium, as well as a decline in overall out-of-pocket expenses for individuals and families.

“Health plans have come a long way since last year as the focus has shifted toward better serving member needs and building trust. However, there is still a lot of work to do,” said Rick Johnson, senior director of the healthcare practice at J.D. Power.

“Health plans need to take a more customer-centric approach and keep their members engaged through regular communications about programs and services available through their plan. When members perceive their plan as a trusted health partner, there is a positive impact on loyalty and advocacy.”

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Now, a Managed Care Directory – Database of Business Information Just For Your State!

No need to buy a directory of managed care for the whole country when
you only need to know about the MCOs in your state. The National Directory
of Managed Care Organizations Database State Edition 
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The database provides key executive contacts and benchmarking business
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This is MCO business information that you need to successfully do business
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Starting at $195 with free shipping. Pricing for this practical and
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organizations – health insurers in a state.

For more information and to order now, visit:
The National Directory of Managed Care Organizations Database State Edition

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The study found that overall satisfaction is significantly higher among the 19 percent of members who strongly agree their health plan is a trusted partner in managing their health. Among members who say they “strongly agree” that their health plan is a trusted partner, satisfaction increases by 201 points.

 KEY FINDINGS

  • Members who say they “strongly agree” that their health plan is a trusted advisor are less likely to switch health plan providers.
  • Within information and communication, satisfaction ratings have improved from 2014 in the factor’s four attributes: ease of understanding your plan’s benefits and services (6.4 vs. 6.2, respectively, on a 10-point scale); frequency of communications (6.3 vs. 6.1, respectively); usefulness of information (6.4 vs. 6.2, respectively); and variety of communications (6.3 vs. 6.1, respectively).
  • Similarly, satisfaction ratings have also improved year over year in the attributes within the cost factor: premiums (5.9 vs. 5.7, respectively); deductible amount (5.8 vs. 5.7, respectively); co-pays for prescription medication (6.4 vs. 6.2, respectively); and co-pays for doctor visits (6.3 vs. 6.2, respectively).
  • Overall member satisfaction is 108 points higher among members who have contacted their plan via mobile app at least once in the past 12 months than among those who haven’t.  While members under 40 years old contact their plan via text and mobile app at a significantly higher rate than older members, the telephone is still the most frequently used contact method across all age cohorts.

Study Rankings

Satisfaction is highest among health plan members in the California (695), Northwest (693), IllinoisIndiana (689), Michigan (688) and Mountain (686) regions. Satisfaction is lowest among members in the New England (664) and the Southwest and MinnesotaWisconsin regions at a tie (665).

In a related development, J.D. Power plans to release a Health Insurance Marketplace Exchange Shopper and Re-enrollment Study (HIX), focused on member satisfaction with health plans purchased through public exchanges, as well as the shopping experience on those exchanges, this month. In October 2015, J.D. Power will also release a Medicare Advantage Study, focused on member satisfaction with Medicare Advantage plans.

The 2015 Member Health Plan Study is based on responses from more than 31,000 members of 134 commercial health plans across 18 regions in the United States. The study was fielded in November and December 2014. For more comprehensive health plan rankings for all 18 U.S. regions, please visit www.jdpower.com.

Following Are Member Satisfaction Index Rankings :

US Hospitals Could Save Billions If They Took This Lesson from the VA – Defense One

healthcarereimagined

Most hospitals don’t have good ways of measuring the complex costs associated with an individual patient’s stay in the hospital. The VA is one surprising exception.

The success of health reform in the US depends on finding ways to control the growth of costs. Hospital care is expensive. And when patients have to be readmitted unexpectedly after discharge, it can really crank up spending.

As we strive to keep health care costs in line, reducing hospital readmissions is drawing a lot of attention. Reducing preventable readmissions could reduce health care spending and improve quality of care at the same time.

But very little research on readmission costs has been done. An exception is a study that found that one in five elderly Medicare patients is readmitted to the hospital within 30 days of being discharged, at an estimated cost of $17.4 billion in 2004.

Most hospitals don’t…

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