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.

Hub and Spoke ACOs May be Hard Sell In U.S.

A post today on AISHealth.com describes a new alliance in western Pennsylvania between Highmark Health Services and six Allegheny Health Network (AHN) hospitals as being “like an ACO without walls.”

The article, which was reprinted from THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS, reported that this alliance is part of Highmark’s effort to accelerate the shift from volume-based, fee-for-service (FFS) payment to a system that pays for value.

Highmark describes the alliance, in this article, as a way to foster more integrated care, moving beyond primary care physicians (PCPs) in its Patient-Centered Medical Home (PCMH) program to add specialists and hospitals to the mix. Continue reading

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.”

Are Private Exchanges Good or Bad for Health Insurer Profits?

An article that appeared in today’s AISHealth is saying that health insurers could see their profit margins more than double if their large employer clients transition from a self-insured model to full risk via private insurance exchanges.

The article, which was reprinted from INSIDE HEALTH INSURANCE EXCHANGES, says that the Sept. 17, announcement that Walgreen Co. would move its 160,000 self-insured employees to Aon Hewitt’s multicarrier insurance exchange has gotten the buzz started. Continue reading

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.

 

PA Blues Plan Offers Consumers Choice Of ‘Health-Care Tiers’

An article in today’s Kaiser Health News produced in association with the Philadelphia Inquirer describe how two new HMO plans introduced last week on the federal insurance exchange by Independence Blue Cross (IBC) are offering Philadelphia-area consumers a road map to cut out-of-pocket health-care costs.

The article notes that consumers who sign up for Blue Cross’ HMO Proactive plans will need to choose hospitals, primary-care physicians, and specialists in the least expensive of IBC’s three price tiers of health-care providers.

IBC officials emphasized that tier one, the cheapest, is not a limited or narrow network because customers have access to the entire network; they just have to pay more if they choose a provider – a doctor or a hospital – in tiers two or three.

The article notes that it is far too soon to say how IBC’s tiered network will affect the Philadelphia market because it is uncertain how many people will choose such plans.

What do you think? Join the discussion below.

See the full story at KaiserHealthNews.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

 

The Rise of the Small Insurer

Yesterday was, in some ways, the grand opening of Obamacare. It’s the day that open enrollment begins for state health exchanges. But several of the nation’s largest health insurers are sitting out the exchanges. And this has created an opportunity for smaller companies to expand their business.

L.A. Care is a health plan provider located on the 10th floor of a high rise in downtown Los Angeles. It only offers plans to low-income individuals through Medicare and Medicaid. But starting today, anyone can buy private insurance form L.A Care.

L.A. Care expects to sign up 20,000 new customers in the first month. And that’s just in L.A. County.

See the full story at MarketPlace.org

 

As Some Companies Turn to Health Exchanges, G.E. Seeks a New Path

Some major firms, like Walgreen, the drugstore chain, are giving those who qualify money to buy insurance on a private health exchange. In Cincinnati, General Electric is taking the opposite approach to reining in health care costs

One of the largest employers in the nation, it spends more than $2 billion a year offering coverage to 500,000 employees and retirees and their families. And it is using its considerable clout in places like this — where its giant aviation business gives it a major presence — to work directly with doctors and hospitals to improve care and reduce costs.

Over the last few years, G.E. has pushed for the creation of so-called medical homes, in which an individual medical practice closely coordinates a patient’s care by having access to all of the patient’s medical records.

In Cincinnati, about 118 doctors’ practices have converted to medical homes, and all five of the major health systems are making their primary care practices move in that direction. G.E. has also pushed for greater transparency of results.

See the full story at NewYorkTiems.com.

 

 

More Large Companies Opt To Drop ‘Bare-Bones’ Health Plans

A growing number of large employers are choosing to stop offering their so-called bare-bones or “mini-med” health plans — which typically provide basic, minimum coverage — rather than upgrading the plans to be compliant with the Affordable Care Act’s requirements, the Wall Street Journal reports.

More than 1,200 employers offer such minimum-coverage plans, which must be phased out by Jan. 1. An estimated four million workers are enrolled in the low-cost plans, which are common in low-wage industries and typically limit total benefits to as little as $3,000 a year.

According to the Journal, many companies are opting to shift hundreds — or in some instances, thousands — of employees into private health insurance exchanges or the public marketplaces created under the ACA.

See the full story at CaliforniaHealthLine.org