And while the news is focused on public exchanges and whether employers will drop coverage, inside companies there are a lot of open-ended questions, starting with,

“How? What’s the right path?“

The answers employers are looking for are different than what consumers need. Employers have to get under the hood and kick the tires. They can’t afford to find out down the road that their employees and businesses have a need that their exchange is not equipped to deal with.

For most large, high-performing employers who provide health benefits today, the exchange option does not mean letting their employees seek coverage solo on the public exchanges. It involves moving to a new model of managing health benefits – one where employees take a more active role for themselves and one where the employer’s role is also evolving.

When employers interact with exchanges, they need everything consumers need – and a lot more:

• A proven, end-to-end technology foundation - There’s a lot of new code being written right now. Most large, sophisticated employers do not want their employees to be quality assurance testers for a new system. An exchange with a history of sound technology and a track-record of success stands out from the crowd.
• Reports for managing health benefits, population by population - When working with an exchange, employers need to be able to track their employee populations, active and retired. Exchanges must offer a sophisticated suite of business intelligence tools to let employers see how their people are faring so they can continue to execute proactive health benefit strategies.
• Data to manage and workforce health and wellness - High-performing wellness programs are getting more and more recognition as ways to influence population health and contain costs. Employers who have group plans or who self-insure need to manage their health benefits strategically.
• Benefit advisors to manage the questions their in-house HR departments cannot - An exchange needs enough expertise on staff and a sophisticated customer management system to answer the questions that HR cannot. Without an adequate advisory component – including knowledgeable, licensed benefit advisors – employers could risk a flood of questions and concerns from worried employees.
• Individual tracking capabilities that synch with eligibility for federal subsidies - Access to subsidies is a very important to evaluating how employees will fare. It’s not an easy metric to track, as it could depend on criteria like household income, which can vary week to week.
• Funds and claims management tools - Most large employers are looking to exchanges to let them fund greater choice and value for employees – not to end funding but to make it sustainable.
• A great interface - Last but not least, an exchange should have a great user interface that helps consumers crunch a lot of data into practical chunks and provides effective decision support tools.

We put the web element last because that’s the first place people tend to go, and it really is the tip of the iceberg: As you can see, an exchange is a lot more than a website.

We advise employers to get under the hood of an exchange. Kick the tires by checking out analytics, service features and management tools.

An exchange needs to be a lot more than a pretty interface, because there’s no latitude for buyers’ remorse down the road.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare insurance exchange.

The events will feature high-level discussions of potential health care benefit strategies in light of health care reform. They will also introduce employers to OneExchange, a strategic health benefit solution that helps employers leverage health care reform to their advantage using proven, end-to-end, integrated, private and public exchange-based solutions for full-time, active employees; part-time employees; and both pre-Medicare and Medicare-eligible retirees.

Confirmed events are as follows:

• Falls Church, Virginia — March 6
• Atlanta — March 19
• Houston — March 28
• Minneapolis — March 28
• Cincinnati — April 4
• Dallas — April 11
• San Francisco — April 18
• Chicago — April 24

Employers interested in attending may contact Alissa Federspiel, alissa.federspiel@extendhealth.com for more information.

Read the Towers Watson  Press Release >

Reblogged from Watch This:

What’s at stake for health care market players

Health care as we know it evolved organically, giving us a market that covers people who are employed full-time but leaves millions un- or under-covered in a system imploding under the strain of its costs. Before the tipping point of 1/1/2014, there’s much to be done:

• The law continues to shape the market and some key elements for employers are yet to be clarified, such as the final regs on essential health benefits and whether health reimbursement arrangements (HRAs) can be counted as meeting employers’ obligation to provide health care benefits.
• Insurers are building new plan designs to meet qualified health plan requirements and trying to figure out how they must adapt to serve an enormous new consumer-focused market.
• Health care providers are partnering with insurers to implement new models of assessment, patient care and remuneration designed stem the pace of cost increases.
• Employers, who provide health coverage to most of the nation, must determine how to make the most of the law for employees and their businesses.
• People – the consumers of care – whether they’ve had the benefit of employer-sponsored health benefits or little to no coverage – will be able to get more involved in selecting coverage and managing their needs than ever before.

These diverse players will all meet up in the new private and public insurance marketplaces – health care exchanges.

As much as the news is filled with incremental announcements in the development of public exchanges (the state and the federal marketplaces), 2013 may well be the eye of the storm for employers who are figuring out what it all means for them as the health care insurance market gathers definition.

See the Watch This blog “Insights for 2014 from Today’s Most Successful Exchanges” for insights from Bryce Williams – Extend Health CEO and Towers Watson Managing Director of Exchange Solutions – on what industry and business leaders are facing this year.

Read more

• Health Reform: The Political Storms are Far From Over, Brookings Institute
• Experts question employees’ readiness for consumer-driven health care, EBN
• Employer-sponsored health insurance coverage continues to decline in a new decade, Economic Policy Institute

Reblogged from Watch This:

Reblogged from Watch This:

In today’s Bloomberg Businessweek’s Politics & Policy section, Devin Leonard writes on several Republican-headed states that are making some tough decisions on their states' exchanges right now.

After health care reform was upheld by SCOTUS this summer, many states decided to wait until the election, leaving themselves precious little time to prepare for announcing whether they would run their states’ own exchanges if Obama won.

Read more… 329 more words

Transparency is an important element of the Affordable Care Act (ACA). The rate review provision of the ACA provides an “unprecedented level of scrutiny and transparency to health insurance rate increases” to protect consumers from unjustified premium increases. Consumers in all 50 states will have access to the proposed rate increases, an explanation from the insurer as to why it believes an increase is necessary, and, for the first time, be able to comment on the proposed rate increase. After analysis and public comment the final determination, and the reasoning behind it, are made public.

Rate review information is available on HealthCare.gov at: http://companyprofiles.healthcare.gov/. You can look up proposed rate increases by insurance company or overall by state.

The transparency that the rate review program provides not only protects consumers from unjustified rate increases, it promotes competition and encourages insurers to keep costs down. It builds on other provisions (such as the Medical Loss Ratio 80/20 rule) and aligns with the ACA’s goal to make health care more affordable.

Every state must have an “effective” rate review program. If it doesn’t, HHS will review rates for the state. The Center for Consumer Information & Insurance Oversight defines “An effective rate review system” as follows:

• Must receive sufficient data and documentation concerning rate increases to conduct an examination of the reasonableness of the proposed increases.
• Must consider the factors below as they apply to the review:
  • Medical cost trend changes by major service categories
  • Changes in utilization of services (i.e., hospital care, pharmaceuticals, doctors’ office visits) by major service categories
  • Cost-sharing changes by major service categories
  • Changes in benefits
  • Changes in enrollee risk profile
  • Impact of over- or under-estimate of medical trend in previous years on the current rate
  • Reserve needs
  • Administrative costs related to programs that improve health care quality
  • Other administrative costs
  • Applicable taxes and licensing or regulatory fees
  • Medical loss ratio
  • The issuer’s capital and surplus
  • Must make a determination of the reasonableness of the rate increase under a standard set forth in State statute or regulation.
  • Must post either rate filings under review or preliminary justifications on their websites or post a link to the preliminary justifications that appear on the CMS website.
  • Must provide a mechanism for receiving public comments on proposed rate increases.
  • Must report results of rate reviews to CMS for rate increases subject to review.

Source: CCIIO http://cciio.cms.gov/resources/factsheets/rate_review_fact_sheet.html

Forty-four states and the District of Columbia have rate review programs that the HHS has deemed “effective.”  Some states have the power to deny or modify the proposed rate increase if it is deemed unreasonable. Other states can determine the rate is unreasonable, but don’t have the authority to stop the insurer from implementing the increase. HHS will review proposed rate increases for states that do not have an “effective” review program, but it lacks the authority to deny rate increases.

The $250 million Rate Review Grants Program is designed to provide states with funding to improve their rate review programs. These funds have made it possible for states to build and improve the quality and efficiency of their rate review programs and provide consumers with greater transparency and protection from unjustified rate hikes. HHS anticipates awarding additional funds in 2012 and 2013 to help states further improve their ability to protect consumers.

According to the 2012 Annual Rate Review Report: Rate Review Saves Estimated $1 Billion for consumers, the rate review grants program has helped 21 states expanded the scope of their rate review efforts, 41 states have improved the quality and efficiency of their rate review process, and 42 states have increased consumer transparency. In addition, it has helped states empower consumers with information that was previously not available.

Before the ACA most consumers were left in the dark regarding premium rate increases. Many experts believe this lead to insurance company abuses and unnecessarily high premiums. The Rate Review Program and the Rate Review Grants Program have helped states provide consumer protection by analyzing and disclosing proposed double digit rate increases to consumers.

Read: Rate Review – Protecting Consumers from Unjustified Premium Increases: Part One

Resources:

2012 Annual Rate Review Report: Rate Review Saves Estimated $1 Billion for Consumers

http://www.healthcare.gov/law/resources/reports/rate-review09112012a.html

Quantifying the Effects of Health Insurance Rate Review

http://www.kff.org/healthreform/8376.cfm

http://www.kff.org/healthreform/upload/8376.pdf

CCIIO http://cciio.cms.gov/resources/factsheets/rate_review_fact_sheet.html

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare insurance exchange.

Rate review helps ensure that premium increases are based on realistic costs. Insurance companies in small group and individual markets that want to raise premiums 10 percent or higher are required to submit justification for the increase for review. The state Department of Insurance (DoI) reviews each proposed rate increases to verify that it is reasonable, and make the information about the review available to the public. If the DoI does not have an “effective” rate review program, HHS will review the proposed increase. This scrutiny and transparency promotes competition, motivates insurers to keep health care costs down, and protects consumers from unjustified rate increases.

Overview of results

Fifty percent of the rate review determinations made so far have resulted in either a lower increase than originally proposed or no increase at all. On average, rate increases implemented were 2.8% lower than the proposed increase. To date, rate review has saved consumers in the individual and small group markets an estimated $1 billion, and resulted in lower premium increases for nearly 800,000 people.

Source: 2012 Annual Rate Review Report: Rate Review Saves Estimated $1 Billion for Consumers by HHS/Healthcare.gov

In its October 2012 report Quantifying the effects of Health Insurance Rate Review The Kaiser Family Foundation analyzed rate review data from 32 states and the District of Columbia. Kaiser found that 20 percent or the rate filings “resulted in lower premium increase than the insurer initially requested.” The KFF study also found that rates varied by market (individual or small group) and by state.

Source: Quantifying the effects of Health Insurance Rate Review, by Kaiser Family Foundation.

The rate review program has had a positive impact on keeping insurance rate increases in check, not only by rejecting unjustified increases, but by motivating insurers to withdraw or modify their proposed rate increases due to the scrutiny and public exposure the rate review program provides. Of the rate increases submitted for review:

• 26% were deemed unreasonable or rejected
• 12% were withdrawn prior to determination
• 26% modified the proposed rate
• 36% no reduction to requested increase was made

While review programs were in effect in many states prior to the ACA, rate hikes often faced little or no scrutiny. The rate review program under the ACA provides much greater scrutiny and transparency, and helps to protect consumers from unjustified premium increases.

In part two of this series on rate review we’ll take a closer look at transparency, requirements for an “effective” state program, and how the rate review grants program is helping states improve their review processes.

Resources:

2012 Annual Rate Review Report: Rate Review Saves Estimated $1 Billion for Consumers

Quantifying the Effects of Health Insurance Rate Review (PDF)

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare insurance exchange.

HHS Secretary Kathleen Sibelius said, “People with Medicare have more high quality choices and the performance of Medicare Advantage plans is improving,” and there are “more four and five star plans than ever before.”

To encourage people to enroll in higher quality plans, CMS is notifying people who have been enrolled in low performing plans (plans that received less than 3 stars for the past three years) that they can enroll in a new plan if they want to. Star ratings, in addition to cost and coverage, help consumers compare plans and choose the right one for their needs and budget.

5-star plans are allowed to market and enroll people throughout the year, and thousands of people “took advantage of this opportunity to join a top performing plan,”  according to Sibelius. People can switch to a 5-star plan at any time during the year, but they can only do so once each year.

In addition to better quality, HHS announced that Medicare Advantage benefits are increasing and premiums are holding steady. According to HHS data, average premiums fell 10% and enrollment increased 28%. Premiums for Part D prescription drug plans are expected to remain steady with last year at about $30 on average for 2013.

Related Stores:

Health plans “score” with Medicare’s 5-star rating system

New MA star ratings released by CMS

Preliminary CMS 2013 Medicare Advantage payment and policy guidelines

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare insurance exchange.

The Affordable Care Act Changes to Part D Prescription Drug Plans in 2013

The Affordable Care Act includes provisions that, over time, are reducing the cost of prescription drugs for people who fall into the coverage gap, or “donut hole.” In 2011 and 2012, the discount for brand name drugs was 50%; in 2013 and 2014, it will increase to 52.5%, and will grow after that until it reaches 75% in 2020.

The discount for generic drugs is increasing too; in 2013, it will be 21% so that you will pay 79% of the cost of your generic prescription medications. The generic drug discounts will also continue to increase, until they reach 75% in 2020, with the remaining 25% to be paid by you.

Other changes to Part D plans in 2013 include:

• The standard Part D plan initial deductible will increase to $325 (up from $320 in 2012). Your deductible may differ.
• Premium costs in 2013 are expected to remain at 2012 levels, around $30.00 per month on average. If you see a large increase in your Part D premium, you can make changes during the Open Enrollment Period.

Special Enrollment Period to switch to 5-star rated Medicare Part D or Medicare Advantage plans

CMS developed its quality rating system for Medicare Advantage and Medicare Part D plans a few years ago, basing it on well-established measures of health care delivery quality such as access to care, responsiveness, and beneficiary satisfaction. Plans can earn from 1 to 5 stars.

Although 5 star plans were few in 2012, forecasters are predicting they will be more widely available in 2013 as more insurance companies achieve the service levels necessary to earn the rating.

If you want to switch to a 5-star rated plan in your area, you can do so at almost any time during the year. The Medicare Advantage and Medicare Part D 5-star plan Special Enrollment Period this year runs from December 8, 2012 through November 30, 2013.

Special Enrollment Period to leave a consistently low rated Part D or Medicare Advantage plan

If either your Medicare Advantage or Part D plan has failed to achieve at least a 3 star rating from CMS over the last three years, you should expect to receive a letter from CMS offering you a Special Enrollment Period to leave your plan and choose a new one.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare insurance exchange.