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Posted by on Apr 7, 2014 in Highlight | 0 comments

Weekly Health Insurance Industry Highlights


Catch up on healthcare news and gain insights from our own industry gurus.

Insurers struggle to calculate rates as enrollment nears end

Modern Healthcare
When open enrollment in the insurance exchanges closes March 31 for most Americans, insurers will be scrambling to evaluate their new membership, assess the Obama administration’s latest rules, guess at their competitors’ strategies—and decide on exchange plan premiums and their choice of markets for 2015. 

In some states, insurers must file their proposed 2015 rates as soon as May 1, while in the 36 states relying on the federal exchange they have until June 27. That already-tight timetable was made even tighter last week when the administration extended open enrollment for consumers who attest that they tried to but could not enroll because of a range of factors beyond their control.

Mercer Marketplace to offer health benefits for part-time employees

Business Insurance
Mercer L.L.C. on Tuesday expanded Mercer Marketplace, which will offer benefits to meet the needs of an employer’s entire workforce, including part-time employees.

How Private Exchanges are Changing the Marketplace

HIX | Health Insurance Exchange
The news has recently been reporting that private exchanges are creating cost savings by allowing employees to purchase health insurance plans that more accurately meet their needs. For some, this may mean they purchase plans that offer less coverage (“buying down”), and others may be purchasing more robust plans to cover their medical needs (‘buying up”). Whatever the case, it is clear that private exchanges are providing a win-win opportunity for businesses.

Providing a useful universal provider search tool within the exchanges’ decision support flow will become vital as the 2015 enrollment period approaches.

Health Exchange IT Market to Balloon

The insurance exchanges spawned by the Patient Protection and Affordable Care Act represent a huge opportunity for the IT industry. But the big bump in revenue generation will come from the private exchanges, not the public ones, says a report by MarketsandMarkets.

While the public exchanges currently represent the lion’s share of IT spending, the private markets will catch up and surpass public exchange spending. The private markets, the report notes, were mostly either recently launched in the last year. (Some have been up and running for several years.) But other research has shown intense interest in the private exchanges by companies eager to identify alternatives to defined benefit health coverage for employees.

One aspect of exchange build out that can be overlooked by IT vendors is the management of provider network data.

Good data adds value for the customer.

Private Exchanges Multiplying: More companies sign on as health care alternative

Crain’s Detroit Business
Private health insurance exchanges are making a slow but steady entrée into Southeast Michigan, with about 70 local companies using the exchanges as one way to pull back the curtain on health care coverage and costs. 

Morales said companies participating in an exchange need to choose one that has a robust employee support decision-making tool and that makes an effort to help employees contain costs. 

Market Forces Appear to Apply to Hospitals, Too

FiveThirtyEight Economics
We tend to assume the market for health care works differently from, say, the market for refrigerators. When people buy a refrigerator, they compare product features and prices and make their decision. But when people are choosing a health care provider, it’s harder to compare “product” features. How good is one hospital compared to another when it comes to care? What are you really buying? And how can you find these things out?

Carriers Need to Recertify QHPs

Inside Health Insurance Exchange
In a March 14 letter to carriers, HHS indicated that people who don’t actively re-enroll during the next enrollment period can remain on their plan into the new benefit year as long as the member doesn’t terminated their coverage. Among other things, HHS’s 47-page “Final 2015 Letter to Issuers in the Federally-Facilitated Marketplaces” also outlines

the process for carriers that intend to renew QHPs for the 2015 plan year. For the most part, carriers that participated in an FFE this year will need to go through the same certification process as carriers that are new to exchanges. HHS indicates that the recertification process will be “streamlined” in future years.

See the letter here.

  • Page 17, Section 3 – Network Adequacy
    Pursuant to 45 C.F.R. 156.230(a)(2), an issuer of a QHP that has a provider network must maintain a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance use disorder services, to assure that all services will be accessible to enrollees without unreasonable delay. All issuers applying for QHP certification will need to attest that they meet this standard as part of the certification/recertification process.
  • In order to determine whether an issuer meets the “reasonable access” standard, CMS will focus most closely on those areas which have historically raised network adequacy concerns. These areas may include the following:• Hospital systems,• Mental health providers,• Oncology providers, and• Primary care providers.
  • For future years, CMS is further considering appropriate formats for collection of provider network data, which would both enable CMS to review provider network adequacy and allow for the creation of a search engine function for consumers to find particular providers and provider types on

We applaud the efforts of our industry to clearly define requirements around network adequacy, access standards and real provider search. These priorities are fundamental to our comprehensive provider network data solutions. Keep checking in with us for updates about our contribution to this effort soon.

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