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Posted by on Apr 28, 2014 in Highlight, Oregon, Washington | 0 comments

Weekly Health Insurance Industry Highlights


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

Health insurance exchanges are growing; many insurers are expressing interest in expanding participation in 2015 on the public health insurance exchanges and private exchanges are positioned to grow exponentially in the coming years. This consumer-centric transition, which puts more responsibility on the consumer to select their best-fit product, delivers an opportunity to support an individual’s decision-making process. As states like Washington, work to implement tighter regulations surrounding network design and access to current information, health plans will be required to prove the adequacy of networks and ensure consumers have access to care.

Reform Update: Exchanges look more appealing to insurers second time around

Modern Healthcare

Health insurers appear to be increasingly bullish on the fledgling state and federal exchanges, in spite of disastrous rollouts in many of the online marketplaces last fall. Mounting evidence suggests more health plans are poised to compete for exchange business during the 2015 open-enrollment period.

In most states, insurers don’t have to submit products until May or June, and in most cases, they have until September to withdraw coverage offerings. Insurers are currently scrutinizing the emerging enrollment data for 2014 to determine market opportunities and offer competitive products. The next open-enrollment period is scheduled to begin Nov. 15.

Companies that have expressed intent to expand offerings in 2015 include:

  • UnitedHealth Group: We do have a bias to increase that participation in 2015,” Gail Boudreaux, executive vice president of UnitedHealth Group said. “The size of the overall market is positive.”
  • Cigna: “We have a bias to extend, but it’s (to be determined) right now,”
  • Wellmark Blue Cross and Blue Shield: plans to compete in insurance exchanges in South Dakota and Iowa in 2015, after sitting out the initial enrollment period.
  • New co-ops: West Virginia, Idaho, New Hampshire

How Medicare helped to define the exchange shopping experience

AISHealth | Inside Health Insurance Exchanges

Ease of Use is Key to Exchanges

While exchange developers cannot satisfy everyone who will interact with their platform, there has been a universal commitment to strike a balance between the information that must be provided and what consumers are willing to answer during the application process.

Consumers using private exchanges to purchase health insurance coverage through their employer, directly from a health plan provider, or through a broker — as well as retirees navigating Medicare online — care about the same things when it comes to signing up for health coverage: having different plans from which to choose (but not too many), a broad network of physicians and ancillary services, the ability to keep their current doctor, and coverage for specific prescriptions. Exchanges that respect what consumers want, and that incorporate conversational questioning to gather preferences and need data to intuitively guide users toward a decision, will likely increase traffic, enrollments and renewals and reduce costly call-center interactions. Surprisingly, consumers, including retirees, are not as concerned about the amount of their monthly insurance premium, as long as their other needs are met.

In the coming years, the consumerization of private health insurance through online exchanges for both the under- and over-65 population will increasingly become the norm as expectations for an easy-to-use, intuitive user interface and consumer choice are met and continue to improve.

What’s next? Private exchanges will become more popular as employers look for new ways to offer affordable benefits to their retirees. Most employers want to get out of the health benefits business to help save money. This can be achieved by partnering with brokers who can provide employees — current and former — with more choices, as well as guidance on how to make the best health coverage decisions.

As health care acumen increases across the general population, more consumers will leverage shopping tools. As a result, these tools will evolve with this new level of sophistication. 

We wholeheartedly agree that our industry’s approach to providing care is being positively transformed by a renewed focus on the consumer. We know that with this transition comes the opportunity to support an individual’s decision-making process with (among other things) accurate and contextual data.

The story with more than 2 sides: Washington’s new health insurance rules

Puget Sound Business Journal

It seems almost no one is happy with the new rules for health insurance plans in Washington state.

Insurance Commissioner Mike Kreidler introduced the rules earlier this year with the goal of improving patient access to medical care. The changes newly require the insurance industry to prove that the networks of doctors and providers they include in their health plans are accessible.

Insurance companies argue the new requirements are burdensome and will drive up costs.

Doctors and hospitals argue the rules don’t go far enough to require insurers to include a robust variety of options for consumers.

At its core, the debate is about the rising prominence of narrow networks in health plans in the state exchange: Insurance companies are building lower-cost networks that don’t include doctors and hospitals that insurers consider too expensive.

It’s unusual for me to accept three different guest columns on any given topic, but this one has created so much angst in every sector of the health care industry that it has surpassed the proverbial “two sides” to a story.

I wanted to provide one place that includes each of the columns and perspectives:

Kreidler’s op-ed is here, while the insurance industry’s perspective is represented here, and doctors and hospitals get their say here.

The impacts of network composition are a growing part of the ongoing discussion of public exchange services to consumers. With so many important dimensions to consider, it makes sense to include objective, third-party data about each market’s provider networks to establish a baseline for discussion. We can help.

Detailing the winners: Who scored the most health exchange sign-ups

Kaiser Health News

California: Anthem Blue Cross signed up the most Californians though April 15, 425058 people or 30.5% of California’s exchange market.

Colorado: Kaiser Permanente, Rocky Mountain Health Plans and Colorado HealthOp lead enrollment in Colorado with Kaiser enrolling almost half or 58,344 of 127,233 people.

Private exchange impact

Human Resource Executive Online

Private healthcare exchanges may not be dominating the employee benefits scene right now, but some believe they will eventually have a serious impact on U.S. healthcare.

In a 2013 report, Accenture Research, for example, predicted that private health insurance exchanges will “rapidly upend insurance purchasing” for many of the 170 million people who receive benefits through their employer. According to that report, private exchange participation will approach public exchange enrollment levels (the Congressional Budget Office says 30 million by 2017) and surpass them soon thereafter. That means that, by 2017, about 18 percent of Americans will purchase insurance through exchanges, radically transforming the health insurance landscape.

With that as context, Vanessa Scott, a partner at Atlanta-based law firm of Sutherland Asbill & Brennan, recently authored a Tax Notes alert that discusses some of the employment law issues revolving around private exchanges. She also answered a few key questions for HRE on the subject.

We agree that private exchanges are poised to grow exponentially over the next few years, and we are already serving the provider data needs of many of the nation’s leading private exchange platforms. If you are involved with building a private exchange and would like to ensure your consolidated provider search service provides the value your consumers demand, contact us for more information.

States that did not expand Medicaid may see higher premiums: Health experts

Business Insurance

Some industry experts are warning that states that chose not to expand Medicaid coverage under Obamacare could see higher insurance premiums next year as hospitals continue to shift the costs of uncompensated care to private insurers.

Washington state Insurance Commissioner Mike Kreidler raised the issue at the White House last week during a gathering of state insurance commissioners with President Barack Obama.

Others, though, question whether uncompensated care could have much effect if any on 2015 rates, arguing that the rates are more likely to reflect each market’s competitive landscape and the costs of caring for people newly covered through the insurance exchanges.

Oregon panel recommends switch to federal health exchange

NY Times

With encouragement from the Obama administration, an Oregon panel recommended Thursday that the state scrap the website for its beleaguered health insurance exchange and use the federal marketplace instead.

State officials concluded that it would be much less expensive to use the federal site,, than to repair the one built specially for the state, Cover Oregon. The first option would cost $4 million to $6 million, while the second would cost $78 million, state officials said.

For more details, read the April 25, 2014 Cover Oregon Board of Directors meeting Agenda.

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