Are CO-OPs Doomed to Fail?

Over on FierceHealthPayer is asking the question: Are Co-Ops doomed to fail? She notes that of the 24 Co-Ops now open for business, one has closed, another is struggling and at least nine other startup insurance companies are projected to have financial problems.

Where they not designed with enough financial support, or are there other problems at work? – See more at FierceHealthPayer.com.

 

Should Health Care Systems Become Insurers?

A new article published in the Journal of the American Medical Association (JAMA) asks the question: Should Health Care Systems Become Insurers?

An introduction to the article explains that incentives under the Affordable Care Act (ACA) are spurring increasing numbers of health care systems to assume the risk of paying for patient care, blurring the boundaries between care delivery organizations and insurers. New arrangements such as bundled payments, value-based purchasing, and accountable care organizations (ACOs) transfer financial risk from payers to health care systems. The union of payer and care delivery functions may engender opportunities for health systems to invest in prevention and more comprehensive, coordinated, patient-centered care.

The entire article is available at JAMANetwork.com and is available to registered members.

CAQH CORE, the Quiet Side of the Affordable Care Act

With health care exchanges dominating the news with regard to the Affordable Care Act (ACA), another piece of the health care reform legislation that will affect more people than the individual mandate or the public exchanges is being implemented with much less fanfare and media attention.

Those are the sections of the law that require administrative simplification and the development of standards for financial and administrative transactions. Sections 1104 and 10109 of ACA will impact nearly everyone who uses, pays for or delivers health care.

Essentially these sections of the law are aimed at bringing the health care industry (hospitals, health plans and other stakeholders) to a place that the financial services industry has been for years. That is having universal standards in place that allow financial institutions to communicate with one another in the same electronic language. It is what allows someone to use an ATM at a bank branch or at a gas station.  Continue reading

The Amish Health Care Plan

An article on FierceHealthFinance.com reminds us that not all health plans are insurance plans. The article titled, “The Amish way of healthcare finance,” explains that the Amish have legally opted out of participating in the Affordable Care Act, but that does not mean they are doing without a plan for taking care of their member’s health care needs..

The article says that various Amish communities have negotiated prices with local hospitals for its members in exchange for quick cash payments. The communities then use a combination of church aid and benefit auctions to raise money for any member who is unable to pay their bill, according to Reuters.

“We have our own healthcare,” an anonymous Amish community member told Reuters. “They [hospitals] give you a bill,” he said. “If you can’t pay it, your church will.”

See the full story at: FierceHealthFinance.com

Priority Health Opens One-Stop Insurance Shops in Michigan

Last week we reported here that Blue Cross Blue Shield of Michigan (BCBSM) had announced that it is re-focusing its 10 welcome centers located across the state of Michigan to help consumers understand and navigate ACA marketplace changes. Today, another Michigan health insurer, Priority Health has has opened three new information centers to provide resources for the uninsured and others needing to purchase insurance coverage.

“Priority Health is committed to improving the health and lives of those we serve,” said Joan Budden, chief marketing officer for Priority Health. “That’s why, as the health care landscape continues to change, we are making sure that we are positioned to answer questions and provide information to help consumers make informed decisions when choosing a health plan.”

BCBSM Refocusing Welcome Centers to Help Consumers Navigate ACA Marketplace Changes

Blue Cross Blue Shield of Michigan (BCBSM) has announced that it is re-focusing its 10 welcome centers located across the state of Michigan to help consumers understand and navigate ACA marketplace changes.

The walk-in centers allow consumers to talk directly with a health plan advisor or licensed Blue Cross agent.

“Of the many questions consumers have, the most common include cost, being able to determine subsidy eligibility and understanding the difference between products,” said Terry Burke, vice president for individual business, BCBSM.

In addition to the walk-in centers, Blue Cross Blue Shield of Michigan is hosting a number of community education sessions throughout the month of October

See the full story at BCBSM.com.

 

Trading Access for Price in Healthcare Exchanges

To add a follow up the the previous post about Independence Blue Cross (IBC) offering state exchange consumers “tiered networks,” Fierce Health News is reporting that hospitals are pushing back on limited health exchange networks.

A story on the FierceHealthcare website notes that Seattle Children’s Hospital has sued Washington state’s Office of the Insurance Commissioner, claiming the health insurance exchange will prevent some patients from receiving care at the hospital,

The article also points out that most plans sold through health insurance exchanges limit patient choice of doctors and hospitals, believing consumers will trade provider choice and access for lower premiums.

The questions is, do the people buying these plans know they are giving up access for a lower price, and do they care?

What do you think? Comment below.

See the full story at FierceHealthcare.com

Humana and CVS Announce Strategic Retail Partnership

LOUISVILLE, Ky. & WOONSOCKET, R.I.–(BUSINESS WIRE)–Humana Inc. and CVS/pharmacy have announced a strategic retail partnership designed to educate individuals and their families about their health care coverage options under the Affordable Care Act (ACA).

Humana representatives will be present at CVS/pharmacy’s Project Health events starting this month. Humana will also be holding in-store events at CVS/pharmacy locations to educate individuals and their families about health care coverage options under the ACA.

Humana and CVS/pharmacy will also provide educational brochures and other materials that will be available to individuals and their families.

See the full story at Humana.com.

Lower Health Insurance Premiums in CO-OP States

States with new member-owned CO-OP health plans as part of Obamacare have premiums that are more than 8 percent lower than states that don’t, a new study shows.

The Consumer Operated and Oriented Plans, with startup money loaned by the health care law, have zero or very few customers yet, given all the problems with the sign-up system. But they are going toe-to-toe with traditional insurers on the exchanges in 22 states, introducing new competition to insurance markets.And there’s some early evidence that they may be helping to lower costs.

CO-OPs aren’t the only new insurers operating on the exchanges. Some markets, including New York, attracted other new players, too. And the whole exchange system is designed to spur competition because plans are battling head-to-head for customers who will be able to compare apples-to-apples offerings — assuming the exchanges are able to work through their early technology woes.

See the full story at Politico.com

 

Health Insurance Sales Hit the Mall

A story in USA Today examines how the Affordable Care Act has prompted to open stores in malls as a way for the newly consumer-focused insurers to draw the uninsured to the plans they are offering in state exchanges starting Oct. 1.

Meanwhile, consumer advocates worry that the new stores will attract uninsured people who should be shopping on their state’s health exchange where they can compare all the plans offered for sale.

What do you think of this retailization of health insurance?

See the full story at USAToday.com