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

Premiums For 2015 Silver-Level Health Insurance Plans Being Offered at Lower Rates in Many Geographic Areas Than 2014

Consumers in most of the geographic areas studied will be able to obtain 2015 silver-level health plan coverage at lower rates than were available in 2014 or at premium increases of less than 5 percent found a new study by the Urban Institute.

Observers had been concerned that large premium increases might kick in for year two of the ACA health insurance marketplace experience.

Often the researchers found that a different carrier from the 2014 health plan is offering the lowest priced silver option in a rating area for 2015.

The ACA’s incentives, centered on the silver plan premiums in an area, the study report said, resulted in “healthy competition over rates in many markets in 2014, particularly in urban areas. Markets generally saw a large number of competing carriers offering several plans.”

The Urban Institute report said national commercial plans, “particularly Blue Cross Blue Shield (BCBS) plans, as well as local carriers, entered the health insurance marketplaces in 2014.”

Plans previously providing coverage only for Medicaid beneficiaries and cooperatives also entered the marketplaces in a number of areas, the researchers said. “As a result of competition, premiums were surprisingly modest in many areas, particularly in comparison with benchmarks such as small group market premiums.”

The study analyzed non-group marketplace plans. “We focus on 17 states and the District of Columbia, which were the first to complete their rate review and approval processes,” the researchers said.

Overall, the study found that: Continue reading

What They Learned From the First ACA Open Enrollment Period in California

Affordability means different things to different people, target enrollment groups have unique interests and require tailored messaging, partnerships matter and are transformative, and, many consumers are new to insurance and need extensive education about health insurance terminology, are among the lessons learned by officials at the California Health Benefit Exchange called Covered California in a review of its first open enrollment period 2013-2014.

The new report, “Covered California Open Enrollment 2013-2014: Lessons Learned” looks at the experience from the first year California offered expanded health coverage through new Affordable Care Act subsidies and the expansion of Medi-Cal through the Covered California marketplace, the organization said.

More than 3 million state residents were enrolled in coverage during the first enrollment period — 1.4 million in health insurance through Covered California2 and more than 1.9 million in Medi-Cal, officials said.

“The report,” the organization said, “provides the first in-depth review of our efforts in the first year, including marketing, outreach and education, eligibility and enrollment support, consumer profiles, marketing research, and information about those we still need to enroll.”

The populous state faced “outsized challenges, making it unique among states establishing state exchanges. From the start, California focused on addressing these challenges in the design of the marketplace and in the state’s approach to reaching, educating and enrolling millions of uninsured and underinsured Californians, particularly those who struggle to afford the costs of health care and coverage.”

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The National Directory of Physician Organizations Database

Key contacts information on more than 1,370 physician organizations. including: physician hospital organizations (PHOs), independent practice associations (IPAs), multi-specialty medical groups, management service organizations (MSOs) and primary care networks.

Get details here: The National Directory of Physician Organizations Database

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Covered California said it was also “mindful that its marketplace design and implementation would shape the broader health insurance market in California for those who were not eligible for subsidies through the exchange, many of whom had coverage before the initial open enrollment.”

Some 7.1 million state residents were uninsured, officials said, sometime during the year before implementation of reform.

Among the lessons learned:

* Many consumers are new to insurance and need extensive education about health insurance terminology, how to enroll in coverage and how to use insurance.

* Consumers need clear, straightforward information that explains how insurance works in plain language, without jargon. There is an ongoing need for a comprehensive,accessible, educational campaign to help answer common questions about Covered California’s products and promote the value of insurance. For 2015 open enrollment, advertising messaging is attempting to explain, in first-person testimonials, that health coverage means going to the doctor and getting the care you need.

* Affordability means different things to different people. Many consumers, even with financial assistance through federal subsidies, found cost to be a barrier to obtaining coverage. Future communications need to address the issue of affordability by emphasizing the value of having insurance and the financial security (protection from arge medical bills) that it provides. New advertising and marketing materials include testimonials from newly insured Californians explaining that insurance is a bill they don’t mind paying each month, with an emphasis on the peace of mind of having coverage and the financial security it brings for those able to purchase it.

* Target enrollment groups have unique interests, experiences and perspectives and require tailored messaging and customizable materials. Consumers in different age, income, gender and ethnic groups reflect different circumstances, knowledge and needs for information and support. Media messaging, marketing and collateral materials, assister training, and community outreach and enrollment efforts need to address the specific needs and interests of diverse communities. Community partners, grantees, agents and enrollment counselors need simple, updated fact sheets, fliers, brochures and other materials, including customizable materials for local events and target groups.

Covered California expanded its targeted support to local outreach and has developed, and will continue to develop, customizable, focused materials available to community partners and insurance agents for open enrollment in 2015.

* Most consumers relied on a variety of touch points, including in-person assistance, to successfully complete enrollment. Most consumers needed multiple touch points, whether pursuing self-service or an assistance pathway. They wanted to ask questions, get answers, identify the options and then consider, often in consultation with friends and family, the coverage most suitable for them. Covered California responded by shifting marketing and outreach messaging and encouraging Californians to take advantage of free, confidential, in-person assistance in local communities. More than 6,400 Certified Enrollment Counselors and more than 12,000 Certified Insurance Agents will be part of a comprehensive campaign for enrollment in 2015.

* The multi-channel marketing and media mix struck an effective balance between brand (awareness) and direct response (enrollment) and will continue to be tailored to specific target audiences. The large number of those eligible who enrolled is the strongest indicator that the community-level outreach, marketing and media campaigns, as adjusted in real time, were successful in accomplishing the two program goals: brand awareness and enrollment. Going forward, marketing and advertising will support the community outreach campaign targeting key demographic groups and segments. Building on brand awareness, advertising will be aimed at explaining how to enroll and motivating audiences to enroll by sharing the tangible ways having health coverage is improving the lives of real people.

* Partnerships matter and are transformative. At every stage of planning and implementation for the first open enrollment, Covered California relied on and collaborated with a multicultural and varied set of state and local partners who made the unprecedented effort possible. Covered California partners made real-time adjustments and accommodations as challenges surfaced and consistently helped in resolving and addressing those challenges. The partnerships reaffirm the power of shared commitment, collaboration and common effort.

Following is the link to the report: http://www.coveredca.com/resources/PDFs/10-14-2014-Lessons-Learned-final.pdf

 

 

 

The 2014 edition of the National Directory of Managed Care Organizations Database is Now Available

The 2014 edition of the National Directory of Managed Care Organizations Database is now available.

We have completed a full, thorough update and verification of the database. So it is ‘squeaky clean.’

For ‘bragging’ rights we want you to know that our work is extremely detailed. We especially zeroed in on C-Suite and other senior health plan executives.

Results: 12,282 changes to the database.

There has been – as in other industries – consolidation in the managed care organization arena as well, our research has found.

The research project results reflects the various health plan consolidations – mergers and acquisitions.

The National Directory of Managed Care Organizations Database has been continually researched, verified and compiled by the Managed Care Information Center team since 1996.

The database includes hard-to-find managed care information on HMOs, PPOs, POSs, Specialty MCOs,  health plans that offer consumer driven health plans (CDHPs) and health savings accounts (HSAs) , Medicare Advantage plans, Medicaid Managed Care plans,and Medicare Part D prescription plans.

For details on the new edition of this trusted database visit: http://bit.ly/1gJFVba

 

Transition to Medicaid Managed Long-Term Services and Supports: How Is It Going?

States are rapidly moving from fee-for-service to managed care for Medicaid long-term services and supports (LTSS).

An inventory conducted for the federal government found that the number of states using Medicaid Managed LTSS grew from 8 in 2004 to 16 in 2012, and an AARP Public Policy Institute study  shows 11 states planning to develop new Medicaid Managed LTSS programs in 2013.

Pros and Cons There are advantages as well as concerns about moving to capitated, risk-based managed care for Medicaid enrollees with LTSS needs.

For the full article click on:
http://blog.aarp.org/2013/08/16/the-transition-to-medicaid-managed-long-term-services-and-supports-how-is-it-going/

Physician Organizations – IPAs – PHOs Can Improve Care Management For Smaller Practices, New Study Finds

On average, physician practices participating in independent practice associations (IPAs) and physician hospital organizations (PHOs) provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did, the results of a new study found.

The difference is dramatic – 10.45 percent versus 3.85 percent, found the researchers. And, half of these processes were provided only by IPAs or PHOs.

All the recent initiatives surrounding physician practice including pay-for-performance, public reporting, and accountable care organization programs places pressure on physicians to use health information technology and organized care management processes to improve the care they provide.

The problem is physician practices that are not large may lack the resources and size to implement such processes.

The researchers said they used data from a “unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which IPAs and PHOs might make it possible for these smaller practices to share resources to improve care.”

Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients, the study found.

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IPA-PHO Database – The National Directory of Physician Organizations profiles more than 1,300 physician organizations. Listings include: physician hospital organizations (PHOs), independent practice associations (IPAs), multi-specialty medical groups, physician primary care networks, and management service organizations (MSOs) The National Directory of Physician Organizations

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These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations, said the researchers.

“The data presented suggest that IPAs and PHOs may be able to provide an additional, potentially viable organizational alternative during an era of major changes in how health care is delivered and paid for,” the study authors wrote.

The research team was led by Lawrence P. Casalino, MD. The study results appeared in the August Issue of Health Affairs.

Tax Credits Estimated to Average $2,700 Per Family Next Year for People Who Now Buy Their Own Insurance

Americans who currently buy their own insurance through the individual market would receive tax credits averaging nearly $2,700 next year for coverage purchased through new insurance marketplaces, found a new study.

The tax credits or subsidies would cover 32 percent of the premiums on average for this group of enrollees in a so-called “silver” plan, according to the Kaiser Family Foundation analysis. .

Foundation researchers released the analysis as some states are releasing information on what premiums will be in 2014 when the Affordable Care Act’s market reforms and newly created health insurance marketplaces take effect.

The rate announcements illustrate “sticker prices” that do not reflect federal subsidies that will offset the cost of insurance for many current individual market policy holders, said the foundation based in Menlo Park, California.

“Tax subsidies are an essential part of the equation for many people who buy insurance through the new marketplaces next year,” Foundation President and CEO Drew Altman said. “They will help make coverage more affordable for low- and middle-income people.”

Under the ACA tax credits will be available to subsidize premiums for people who buy their insurance in the new marketplaces, do not have access to other affordable coverage, and have incomes between 100 percent and 400 percent of the federal poverty level (between about $11,500 and $46,000 for a single person, and $24,000 and $94,000 for a family of four).

An estimated 48 percent of people who currently have individual market coverage will be eligible for tax credits, researchers found. Tax credits among those eligible will average $5,548 per family, and subsidies will average $2,672 across all families now purchasing their own insurance, the researchers said.

Many people who are now uninsured will also be eligible for subsidies in the new marketplaces, and their tax credits will likely be higher on average since they have lower incomes than those who now buy their own coverage, the researchers said.

Using data from the Congressional Budget Office (CBO) and the federal government’s Survey of Income and Program Participation, study authors said the analysis estimates the average impact of the ACA on the individual market by quantifying how current enrollees will fare once relevant provisions of the health law are implemented.

Premium data released by states thus far suggest that the CBO premium projection is reliable, the researchers said. While subsidies and premiums will vary widely depending on each enrollee’s personal characteristics, the analysis focuses on averages to provide an indication of how much overall assistance the law will provide to people buying their own coverage today, the study authors added.