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Posted by on Jun 2, 2014 in Highlight | 0 comments

Weekly Health Insurance Industry Highlights


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


In California, insures are adding providers to narrow networks. A recent tweet from Covered California – @CoveredCA:

Anthem, Blue Shield and Health Net are continuing to expand their #CoveredCA networks for enrollees


Narrow networks are common in new health insurance plans, but what about tiered networks?

According to the Kaiser Family Foundation, 23% of employers are offering plans with narrow or tiered networks.

The use of narrow and tiered networks is on the rise. “We’re seeing a trend with commercial and exchange marketplace plans,” says Matt Eyles, executive vice-president at consulting group Avalere Health. “We’re hearing more about it in Medicare Advantage plans, too.”


Vermont has renegotiated its contract with CGI, the state’s exchange contractor, to set a target date of July 2 for the website to be fully operational; the deadline may be moved back if technical problems arise in the next few weeks.

The U.S. Department of Health and Human Services is developing a “star rating” program for HIX health plans. CMS is preparing to publish the QHP rating program paperwork review notice Friday in the Federal Register.

Ascension Health, the nation’s largest not-for-profit health system, is looking to acquire an insurance company with operations in 18 states.

WellCare, a Medicare and Medicaid managed-care company based in Tampa, Fla., operates across 18 states, including 12 that overlap with Ascension Health’s markets, said Ana Gupte, a Leerink managing director and senior analyst, in a research report.

Centene, based in St. Louis where Ascension is headquartered, operates in 20 states, Gupte wrote.


New HIX Coverage Options in 2015

Several insurers are looking to offer HIX coverage in 2015 – while some are looking to expand, others are looking to enter specific markets.

Assurant Health is joining the exchanges “to serve more consumers and provide additional choice for customers purchasing on and off the exchange,” Mary Hinderliter, a spokeswoman, said in an email. “We are evaluating exchanges on a state-by-state basis and continue to finalize our strategy,” she said.

Cigna’s chief executive, David Cordani, said in an interview that the company’s “bias” was to expand beyond the five states where it now offers coverage on the exchanges.

Wellmark, the Blue Cross for Iowa and South Dakota, has said it plans to offer coverage on the exchanges this year.

WellPoint has no plans to leave any markets.

UnitedHealth Group Inc. intends to offer individual policies in Illinois, according to sources familiar with the company’s plans. The Illinois market was dominated in 2014 by Blue Cross and Blue Shield of Illinois.

Blue Cross this year wrote about 92 percent of the policies bought on the Illinois health insurance exchange.

While United would neither confirm nor deny its plans to offer policies in Illinois next year, a spokesman said the Minnesota-based insurer intends to increase its participation over time in exchanges nationwide.

The New York Times | Insurers once on the fence plan to join health exchanges in ’15

Chicago Tribune Business | Sources: UnitedHealth to enter Illinois health exchange

What Are Providers Saying About HIX Plans

Medical Group Management Association (MGMA)

Medical Group Management Association (MGMA) conducted member research in April 2014 to better understand the impact of the Affordable Care Act’s (ACA) insurance exchange implementation on medical group practices. The survey includes responses from more than 700 medical groups in which more than 40,000 physicians practice nationwide.

Almost 80% of survey respondents reported their practice is participating with new health insurance products sold on the ACA exchanges and more than 90% of these practices have already seen patients with this coverage.

Of practices participating with ACA exchange products, 85% are contracting with one to five products and almost 60% reported they are participating in order to remain competitive in their local market.

MGMA | Medical Group Management Association | MGMA ACA Exchange Implementation Survey Report | May 2014

California Medical Association (CMA)

The California Medical Association (CMA) recently conducted an email survey of physicians who were members of medical associations statewide. Here are some of the survey highlights:

At least 80 percent said they were confused about their participation status in new networks.

About 50 percent of the doctors participating in the survey said they were in a QHP network, and 21 percent said they were not sure whether they were in a QHP network or not.

Thirty-six percent of the providers said they got into the QHP networks through some kind of voluntary, active process.

Thirty-seven percent said they got into a QHP when networks they were already doing business with automatically opted them into a network under the same terms that apply to their base commercial plan contracts.

Fifteen percent said commercial plan networks automatically opted them into the QHP networks under different terms.

Nineteen percent still don’t why they’re in QHP networks.

About half of the doctors who refused to join QHP networks said they thought participating in QHP networks would involve too much bureaucracy, and 74 percent said the QHP network pay levels were unacceptable.

About 40 percent of the doctors who participated in the survey said they lost relationships with more than 10 patients due to QHP network-related confusion.

Contra Costa Times | Chances are your doctor and you are confused about Covered California

BenefitsPro | Some docs are accidental exchange plan providers

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