Author Anthony Nefouse

In the United States, Medicare benefits compar...
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Chicago Tribune

Accountable Care Organizations are starting gain traction.. Chicago looks like they have cut a deal with Anthem Blue Cross of Illinois to the ACO model in place.

The ACO model is going to have physicians accountable for care. The physician will be rewarded for positive outcomes with patients. This is a huge jump from the fee for service model that is in place today.

Some of the smaller medical practices have major concerns with the how the ACO model is being set up.

The ACO could impact  health insurance not only in the Medicare field but in the health insurance exchange also.   Blue Cross of Illinois stated that the only way they can deliver savings in the exchange model is with the ACO approach.  If the ACO model reduces medical costs then we will see it in the state bases exchanges.

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The Medical Loss Ratio of the Health care Reform law is having a negative effect on carriers entering or staying in new markets.

What has happen is a carrier will go into a new market and that block of business is profitable.  So let’s say they are operating at a 70% loss ratio. Under the new law they have to be at 80% or they have to rebate the difference to the insured’s.  

The carriers are now trying to figure out how they can operate at the 80%. So until the figure out that equation they are pulling out of certain markets.  So for now the MLR is reducing competition in the Individual and small group health markets.

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In the near future we will see Mobile Technology for health insurance and wellness in the from of an APP.

People will have the option of downloading APP to their phone which will give them constant communication on health insurance and wellness programs. There are programs that are all ready developed like Calorie Counter.  The  next generation of health & wellness app are going to be developed by the carriers. Imagine to have immediate access to cost for a certain procedure. Open the app to see if where you are on the calendar year deductible. Maybe a social app for your company to address wellness and keep you connected with health goals.

The new apps that are coming out are going to have unlimited capabilities.

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The Hill

Health and Human Services have canceled their “Mystery Shopper” program. This program was to give HHS information on getting Doctor Appointments. They wanted information on how long someone would have to wait to be seen. They would call a medical practice and state they had Medicare, Medicaid, & Private Insurance to see if waiting times were different.  They could have been trying to make a case that Doctors will treat patients faster if they have an insurance policy that pays more.

The New York Times broke the story and soon after that there was pressure to end it from both politicians and medical providers.

This kind of information could be used to determine rationing, but HHS needs to go about collecting it in more transparent way.

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HL-ISY.com released a study showing a trend for small groups to shift towards a self funded health insurance. The report stated groups with as few as 50 employees could find savings in the self insured market.

We could see in the very near future where small employers entertaining taking on their employees medical risk in order to save money on health insurance premiums.

Stop-Loss Reinsurance products are being developed for small groups. This could create valuable options which would result in more choices for small group health plans.

The national carriers will not allow Third Party Administrators to get a market segment advantage. The national carrier will developed and market products to these groups. National carrier will develop administration only plans for small group.

Employers then will be able to weigh the pros and cons of a self funded health plan.  The self funded approach would give a small group an entirely new perspective on health care.

There are current self funded plans in the market.

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My News

Businessweek.com

Reported a positive view of the Accountable Care Organization (ACO) The ACO is one of the main programs to reduce health care cost in the new health care law. This is really the 1st publication that states this type of approach to health care can be successful.  The Gov. is developing this platform for Medicare but there seems to be a huge investment by the health insurance industry in this model. The health insurance industry is suggesting this could save 40%.

If this approach works for Medicare then we will see it in the private insurance markets. This could have a huge impact on health insurance.

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Huffington Post

National Journal

It looks like under the new health law if you have house hold income of $64,000 you will qualify for Medicaid benefits.  For Indiana and other states this would allow a lot of people the option of Medicaid. This could devastate health insurance markets over night and add a huge burden on the state in the forms of claims.  We could also see many doctor restrict the treatment of medicaid patients because of low reimbursement rates.

It is expected that 20 million additional people could qualify for Medicaid in 2014.

The people that wrote this law might have had good intentions but the consequences are going to be massive. Right now states are already struggling with how to pay for Medicaid services and now by law there is going to be a huge influx of new Medicaid recipients.

I have been following health care reform since the inception and I did not know about this. What else is in the law that we don’t

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 McKinsey study just released the methodology that they used to generate the report. The group released questions and results by the people that took the survey.

This study has become political so there will be arguments on both sides for and against.

I looked at the survey and results.

First thing that jumped out is over 35% represented companies with less than 50 employees. This is very important aspect of the survey with relations to health care reform. If a group is under 50 employees they will not have to provide benefits in 2014.

 When it came to the question about dropping health benefits in 2014 almost 29% of the surveyors that said they would drop benefits came from the under 50 class. This makes complete sense for these groups to look at alternative through the health insurance exchanges.

The other aspect of the survey that was interesting was that none of the surveyors had 100% complete authority over the group health insurance.

I do not think you can discredit the study. This was a 100+ questionnaire that people took the time to answer.

My News

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The Indianapolis insurance Commissioner is asking for a waiver of Patient Protection and Affordable Care Act’s (ACA) 80 percent minimum medical loss ratio (MLR).

The commissioner states that 10% of the health insurance companies have left Indianapolis. If the waiver is granted that would encourage companies to stay in the individual health market. The commission is only asking the wavier on Consumer driven health plans.

There is a real problem in the health insurance market with a lack of competition. There is serious concern that we could lose another large individual carrier.

Aetna recently left the individual market here locally. The risk of loss was not worth the reward. What average people don’t see is that the individual market is not that profitable for the carriers. So now we have new laws on the medical loss ratio that could create even more risk for the carriers to offset individual loses.

I do believe the Commission is acting in the best interest of Hoosiers.

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The Hill

Chairman Max Baucus is not happy about the Mickinsey study that state 30% of employers will drop their group health plans after 2014. Chairman Baucus has order a full disclosure on the methodology of the study.

It will be interesting to see what methodology was used.

Being a health insurance broker with extensive experience in the small group market I think 30% is low. Groups under 100 lives I think we could see 50% of groups drop traditional employer sponsored health plans. This is not to say they will not replace them with some other approach to health care under the health care reform.  If employers can establish other qualified health plans through the exchange or guaranteed issued individual policies they will.

At this point I am not sure how large groups are going to be able to drop group health plans.  These plans are about attracting talented employees and retaining them.

As Chairman Baucus reviews the methodology of the Mickinsey study he should also review the methodology of how the health care reform law was developed.

Nefouse News

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