Weekly Health Insurance Industry Highlights
Catch up on healthcare news and gain insights from our own industry gurus.
The development and evolution of high-value provider networks
Health plans have been at the forefront of health-system delivery and payment reforms that hold promise in reducing costs, while also improving efficiency of care delivery and enhancing quality of care and patient outcomes. The implementation of the Patient Protection and Affordable Care Act (ACA) has brought about increased focus on the range of tools that health plans have used to keep coverage as affordable as possible for consumers. The use of high-value provider networks is one of the tools used by health plans to reduce costs and provide incentives for high-quality and cost-effective care for consumers. By identifying providers that consistently meet quality and safety metrics and are more efficient relative to their peers, health plans have created an important tool that can be used to advance and improve the provision of high-quality care.
This paper primarily focuses on the development of high-value networks in the new marketplaces and how these tools are evolving to meet the healthcare cost and quality challenges ahead.
Read the full report: AMERICA’S HEALTH INSURANCE PLANS / MILLIMAN | HIGH-VALUE HEALTHCARE PROVIDER NETWORKS
Growth in Private Exchanges
There is no question the Affordable Care Act is bringing transformational change in the way human resources departments need to think about employee benefits, with rising health care costs and increased compliance requirements.
Employers are thus beginning to look at private exchanges as an attractive option. A survey from the Private Exchange Evaluation Consortium, a group formed by PricewaterhouseCoopers and several employer coalitions, estimates that by 2018, 45% of employers will have implemented or plan to consider utilizing a private exchange for their active, full-time employees.
Read the full article: EMPLOYEE BENEFIT NEWS | DIGGING IN TO PRIVATE EXCHANGES
2015 HIX Participants
At the request of the state Department of Insurance, QualChoice Health Insurance, which participated on the state’s HIX in 2014, will not offer its limited-network plans on Arkansas’ health insurance exchange next year, the company and department officials said Wednesday. QUALCHOICE’S LIMITED PLANS OFF EXCHANGE
Insures planning to participate on Georgia’s HIX in 2015:
- Alliant Health Plans | 2014 Participant
- Blue Cross and Blue Shield of Georgia (Anthem / WellPoint) | 2014 Participant (statewide)
- Humana | 2014 Participant
- Kaiser Permanente | 2014 Participant
- Peach State Health Plans (Centene – Ambetter) | 2014 Participant
- UnitedHealthcare | New Entrant
- Coventry (Aetna) | New Entrant (filed in 2014 but withdrew) (statewide)
- Cigna | New Entrant
- Time Insurance Company (Assurant) | New Entrant (statewide)
CHRISTUS Health Plan, a subsidiary of CHRISTUS Health, has applied to sell individual policies on the exchange, said CHRISTUS spokeswoman Abby Lowe McNeil.
Currently there are four insurers – New Mexico Health Connections, Blue Cross and Blue Shield of New Mexico, Presbyterian Health Plan and Molina Healthcare of New Mexico – that sell to New Mexicans on the individual exchange. As of May, 34,200 New Mexicans had enrolled in individual plans through the federal exchange, according to healthcare.gov. ALBUQUERQUE BUSINESS FIRST | CHRISTUS HEALTH PLAN MAY JOIN NEW MEXICO EXCHANGE
Insures planning to participate on New York’s HIX in 2015 have filed rates.
THE NEW YORK TIMES | INSURERS ON NEW YORK STATE’S HEALTH EXCHANGE SEEK SIGNIFICANT RATE INCREASES
UnitedHealthcare this week became the third health insurer to propose selling federally subsidized health insurance in North Carolina, a move that would expand choice and increase competition here.
United, the nation’s largest health insurer, notified the N.C. Department of Insurance on Wednesday that it intends to sell subsidized coverage in the state under the Affordable Care Act, filing just days ahead of a Friday deadline for insurers to submit plans for federal certification.
Blue Cross is one of just two insurers in North Carolina that offer subsidized policies this year. The other is Coventry Health Care of the Carolinas. Both have notified state insurance officials that they plan to participate in the federal insurance exchange in 2015. NEWSOBSERVER.COM | THIRD HEALTH INSURER TO ENTER NC EXCHANGE FOR 2015