Weekly Health Insurance Industry Highlights
Catch up on healthcare news and gain insights from our own industry gurus.
Consumer perceptions of network adequacy
Media outlets have focused extensively on consumer complaints about “limited networks” and not being able to find a doctor under qualified health plans (QHPs) offered through the Health Insurance Marketplaces (HIMs). In response, the Obama administration released new standards which will require all QHPs to contract with a larger proportion of essential community providers within its service area.
At the heart of the recent changes lies a fundamental question worth exploring: Is consumer satisfaction with, and perceptions of health plan “network adequacy” grounded in the number of choices for doctors within network, or is it something different?
Most consumers only need one primary care doctor and perhaps a specialist or two. Also, if you ever had the experience of looking for a new doctor using traditional provider directories, you may have been overwhelmed by the sheer number of names and addresses to sort through.
Instead, it’s possible that consumers might be better served by having information to help them “match” with doctors or other health care providers based on factors of consumer preference, such as proximity and languages spoken, and provider availability, such as accepting new patients and number of days to the next available appointment.
There is no simple or single measureable definition or benchmark for network adequacy, and bluntly forcing QHPs across all markets to broaden their networks will not guarantee that a consumer’s preferred provider will now be included within a network, or that consumers’ experience of finding an available provider will be any easier.
How to Improve Consumer Perceptions of Network Adequacy Without Broadening QHP Networks:
Enable consumers to pick QHPs based on provider. Some consumers may highly prefer their choice of health care provider even at a higher cost, and exchanges may be able to help them with tools to easily filter plans by provider and/or facility.
Provide consumers with better information on how their health plan works. Help consumers understand the basic steps of finding a provider, obtaining care in-network, and understanding their rights.
Require higher standards for provider directories. Provider directories are not useful to consumers if the information is not accurate and are a serious consumer protections issue. Several marketplaces are beginning to consider accuracy standards for QHP carriers, but it is not clear how to best audit and keep carriers accountable.
Aside from provider names, specialties, and addresses, Health Insurance Marketplaces could also require more robust information in provider directories such as provider-level availability or average wait time to next available appointment by plan, geo-location tools, and even provider-level quality information to help consumers find the right provider for their needs. In addition, HIMs could require usability standards that make provider directories more consumer-friendly.
Consumers need health insurance information in one place
After the initial roll-out of the state’s health benefit exchange this year, Insurance Commissioner Mike Kreidler heard from consumers who were upset to find their new health plan didn’t include their preferred doctor or hospital. The problem stemmed from ambiguity about the plans and how people could find the information they needed.
To fix the problem, Kreidler instituted a new rule that increases transparency for consumers. It went into effect prior to last month’s filing deadline for the 2015 state approved and regulated plans that people will pick from when enrollment opens again on Nov. 15.
The new rule makes a significant improvement for consumers trying to compare and pick the plan best for them or their families. But more work needs to be done.
It’s unlikely this information will be available on the health exchange website by November. This year, consumers will have to go to each insurance carrier to know precisely what providers are in or out of their networks.
That leaves an obstacle some will find frustrating.
We understand the technological challenges in getting each carrier’s medical provider information on the exchange website. It’s a late development and involves lots of data.
But people won’t enjoy the full benefit of Kreidler’s new rule until all the information that people need to make their best choice can be easily found in one place.
The state health benefit exchange should double-down on efforts to make that happen as quickly as possible.
Health Insurance Exchange Automatic Renewals
The Obama administration plans to automatically renew for next year the health plans and premium subsidies that consumers obtained through the Affordable Care Act’s federal insurance exchange.
WALL STREET JOURNAL | FEDERAL HEALTH-EXCHANGE PLANS TO ALLOW AUTOMATIC RENEWALS
Acquisitions and Sales
Banner Health to acquire University of Arizona Medical Center and affiliates
Banner Health to acquire the University of Arizona Medical Center and its south campus, which have 624 beds between them, UAHN’s faculty practice, University Physicians Healthcare and the system’s three health plans.
MODERN HEALTHCARE | BANNER HEALTH TO ACQUIRE ARIZONA’S ACADEMIC HEALTH SYSTEM
Aetna looking to sell Coventry assets
Aetna Inc, the third largest U.S. health insurer, is exploring a sale of some of Coventry Health Care Inc’s assets worth as much as $1.5 billion, according to people familiar with the matter, a year after it acquired its rival for $5.6 billion.
Aetna is working with Bank of America Merrill Lynch on a sale process for Coventry’s workers’ compensation business that is expected to attract interest from other companies in the sector as well as private equity firms.
REUTERS | AETNA MULLS SALE OF COVENTRY HEALTH CARE ASSETS – SOURCES
2015 HIX Participants – Update
McKinsey’s 2015 Individual Exchange Filings as of June 26, 2014 provides a great overview of the state of 2015 HIX filings in 12 states
MCKINSEY ON HEALTHCARE | 2015 INDIVIDUAL EXCHANGE FILINGS
Individual State Updates
For more information about a specific state, click on the state name to be directed to the state’s 2015 HIX Competitors page. These state specific pages will be updated regularly as information becomes available about 2015 insurers and product offerings.
The Colorado Division of Insurance (DOI) released preliminary information from plans submitted by health insurers for Affordable Care Act (ACA) coverage in 2015, including 312 proposed plans to be offered through Connect for Health Colorado, the state’s health insurance exchange.
- All Savers Insurance Company (UnitedHealthOne/UnitedHealthcare) | 2014 Participant
- Cigna Health and Life Insurance Company | 2014 Participant
- Colorado Choice Health Plans | 2014 Participant
- Colorado Health Insurance Cooperative, Inc. | 2014 Participant
- Denver Health Medical Plan, Inc. | 2014 Participant
- HMO Colorado Inc. (WellPoint) | 2014 Participant
- Humana (Humana Health Plans Inc.) | 2014 Participant
- Kaiser Foundation Health Plan of Colorado | 2014 Participant
- New Health Ventures, Inc. (Access Health Colorado) | 2014 Participant
- Rocky Mountain Health Maintenance Organization , Inc. / Rocky Mountain HMO | 2014 Participant
- Rocky Mountain Hospital & Medical Service, Inc. (Anthem BCBSCO) (WellPoint)
District of Columbia
The D.C. Department of Insurance, Securities and Banking received proposed health insurance plan rates to sell on the District of Columbia’s health insurance marketplace, DC Health Link, for plan year 2015.
- Aetna (Individual and Small Group)
- CareFirst (Individual and Small Group)
- Kaiser Permanente (Individual and Small Group)
- UnitedHealthcare (Small Group)
DEPARTMENT OF INSURANCE, SECURITIES, AND BANKING | INSURERS FILE PROPOSED RATES FOR 2015 HEALTH PLAN OFFERINGS ON DC HEALTH LINK
DEPARTMENT OF INSURANCE, SECURITIES, AND BANKING | HEALTH PLAN RATE FILINGS
- Anthem Blue Cross and Blue Shield
- Physicians Health Plan of Northern Indiana
- MdWise Inc.
- Coordinated Care Corporation (CCC) – Ambetter (Centene)
- Indiana University Health Plans
- SIHO Insurance Services
- All Savers Insurance Co.
- Time Insurance Company
- Blue Cross Blue Shield of Rhode Island
- Neighborhood Health Plan of Rhode Island
- UnitedHealthcare of New England
Initial reports stated that Florida HIX insurers would not be raising rates in 2015. While the insurers appeared to file for “zero” percent increases in premiums, state regulators suggested that the numeral indicated a claim of trade secrets, not an actual rate filing.
About a dozen health insurers filed documents by the federal deadline indicating they intend to sell marketplace plans in Florida next year. The list includes returning big players like Florida Blue, Aetna, Cigna and Humana, as well as United Healthcare, which did not participate in the marketplace this year. Each insurer can sell multiple types of plans, and rates can vary across the state.
Follow our blog to get the latest news about participants and products on the public health insurance exchanges: STRENUUS INSIGHTS: PUPLIC EXCHANGES