Acting CMS Administrator Marilyn Tavenner told attendees at the Federation of American Hospitals meeting they can expect more information on the state insurance exchanges in the weeks ahead.
“We will need your help as we go into 2012 and into 2013 on setting up the exchanges,” Tavenner said in her morning remarks Tuesday at the Marriott Washington Wardman Park. “And we will have more detail on that as the year rolls out—and, in fact, we will have some details in the next couple of weeks as it relates to the exchanges and Medicaid expansion.”
When asked later if she had been referring to a final rule on the exchanges, Tavenner told Modern Healthcare that the rule would be out “soon.” When pressed if “soon” meant this quarter, the former nurse and HCA executive said “very soon.”
http://www.modernhealthcare.com/article/20120306/NEWS/303069969/exchange-rule-coming-very-soon-tavenner
Hat Tip: Modern Healthcare
Showing posts with label Insurance Industry. Show all posts
Showing posts with label Insurance Industry. Show all posts
Tuesday, March 6, 2012
Thursday, March 1, 2012
National- The Future Role for Health Insurance Exchanges, Part 3
In an article in the February issue of Health Affairs journal, William Kramer, executive director for national health policy at the Pacific Business Group on Health in San Francisco, discusses the potential long-term role the public health insurance exchanges could play in helping larger companies manage their health care benefits.
Near-term Opportunities for 2014-2016
In the near term, companies could use the public exchanges to help pre-age-65 retirees who are not yet eligible for Medicare to obtain affordable health coverage. Companies that provide these retirees with only access to purchasing coverage at group health plan rates could easily move these individuals to the private marketplace once the exchanges are up and running.
Similarly, employers that provide some level of subsidized health insurance for pre-Medicare-eligible retirees could convert those subsidies into a defined contribution to a health reimbursement account that retirees could use to purchase coverage through an exchange. Part-time employees who do not usually receive access to employers’ group health plans could also find coverage through the exchanges immediately.
http://businessfinancemag.com/article/future-role-health-insurance-exchanges-part-3-0229
Hat Tip: Business Finance Magazine
Near-term Opportunities for 2014-2016
In the near term, companies could use the public exchanges to help pre-age-65 retirees who are not yet eligible for Medicare to obtain affordable health coverage. Companies that provide these retirees with only access to purchasing coverage at group health plan rates could easily move these individuals to the private marketplace once the exchanges are up and running.
Similarly, employers that provide some level of subsidized health insurance for pre-Medicare-eligible retirees could convert those subsidies into a defined contribution to a health reimbursement account that retirees could use to purchase coverage through an exchange. Part-time employees who do not usually receive access to employers’ group health plans could also find coverage through the exchanges immediately.
http://businessfinancemag.com/article/future-role-health-insurance-exchanges-part-3-0229
Hat Tip: Business Finance Magazine
Tuesday, February 28, 2012
National- Q&A: Leveraging Health Insurance Exchanges, Part 2
In an article in the February issue of Health Affairs journal, William Kramer, executive director for national health policy at the Pacific Business Group on Health in San Francisco, discusses the potential long-term role the public health insurance exchanges could play in helping larger companies manage their health care benefits. In the second part of this interview, Business Finance asks Kramer about how the future with health insurance exchanges might play out and the CFO’s role in evaluating the potential opportunities these exchanges create.
Business Finance: In your article, you discuss a number of scenarios for employer-provided health benefits once the exchanges are up and running. Which of these scenarios is most likely to play out?
William Kramer: If I were a betting person, I would not bet a whole lot on any one scenario. I would spread my bets at this point. There are a number of plausible options available to most employers. Many employers are doing some scenario planning so that they are prepared as the situation develops. If it goes down this track, we should do X. If it goes down another track, we do Y. The best planning focuses on potential scenarios so that employers can decide what to do in each situation before it happens. As soon as the path becomes clear, the employer needs to have plans in place so that those plans can be executed quickly. I am not encouraging anyone to sit back and wait. Companies should be doing the analysis and scenario planning now because potential changes are large and the opportunities are great depending on which path opens up.
http://businessfinancemag.com/article/qa-future-role-health-insurance-exchanges-part-2-0228
Hat tip: Business Finance Magazine
Business Finance: In your article, you discuss a number of scenarios for employer-provided health benefits once the exchanges are up and running. Which of these scenarios is most likely to play out?
William Kramer: If I were a betting person, I would not bet a whole lot on any one scenario. I would spread my bets at this point. There are a number of plausible options available to most employers. Many employers are doing some scenario planning so that they are prepared as the situation develops. If it goes down this track, we should do X. If it goes down another track, we do Y. The best planning focuses on potential scenarios so that employers can decide what to do in each situation before it happens. As soon as the path becomes clear, the employer needs to have plans in place so that those plans can be executed quickly. I am not encouraging anyone to sit back and wait. Companies should be doing the analysis and scenario planning now because potential changes are large and the opportunities are great depending on which path opens up.
http://businessfinancemag.com/article/qa-future-role-health-insurance-exchanges-part-2-0228
Hat tip: Business Finance Magazine
Thursday, February 23, 2012
National- Q&A: Leveraging Health Insurance Exchanges, Part 1
William Kramer, executive director for national health policy at the Pacific Business Group on Health in San Francisco, discusses the potential long-term role the public health insurance exchanges could play in helping larger companies manage their health care benefits:
Business Finance: The state health insurance exchanges created by the health care reform law are slated to be up and running on January 1, 2014. Initially, the exchanges will be open only to small businesses and individuals purchasing health insurance. However, starting in 2017, these exchanges could be open to larger employers. Could this be a game changer for large companies looking to manage their benefits more effectively?
William Kramer: There are two ways that the exchanges could be a game changer. First, if the exchanges are able to align with the purchasing strategies of large employers, they might provide a critical mass and send a consistent signal to healthcare providers about what needs to be done to improve the quality and affordability of our healthcare system. Regardless of whether employers actually use the exchanges, the exchanges, by working in alignment with large employer purchasers, could help drive quality and affordability.
Second, if the exchanges provide an alternative way for people to access health benefits even if employers continue to provide financial support for coverage, employers could offload some of the administrative hassle involved in managing health benefits onto the exchanges. In addition, employers could also offer a wider range of choice to their employees through the exchanges, while employees gain the benefit of greater portability of their coverage.
http://businessfinancemag.com/article/qa-leveraging-health-insurance-exchanges-part-1-0223
Hat tip: Business Finance Magazine
Business Finance: The state health insurance exchanges created by the health care reform law are slated to be up and running on January 1, 2014. Initially, the exchanges will be open only to small businesses and individuals purchasing health insurance. However, starting in 2017, these exchanges could be open to larger employers. Could this be a game changer for large companies looking to manage their benefits more effectively?
William Kramer: There are two ways that the exchanges could be a game changer. First, if the exchanges are able to align with the purchasing strategies of large employers, they might provide a critical mass and send a consistent signal to healthcare providers about what needs to be done to improve the quality and affordability of our healthcare system. Regardless of whether employers actually use the exchanges, the exchanges, by working in alignment with large employer purchasers, could help drive quality and affordability.
Second, if the exchanges provide an alternative way for people to access health benefits even if employers continue to provide financial support for coverage, employers could offload some of the administrative hassle involved in managing health benefits onto the exchanges. In addition, employers could also offer a wider range of choice to their employees through the exchanges, while employees gain the benefit of greater portability of their coverage.
http://businessfinancemag.com/article/qa-leveraging-health-insurance-exchanges-part-1-0223
Hat tip: Business Finance Magazine
Wednesday, February 22, 2012
Insurance Industry- With Many States Behind Schedule, CMS Is Likely to Set Low Bar for Certification
While HHS collectively has awarded $729 million to help states stand up an insurance exchange, many states will run out of time long before they run out of cash. As a result, HHS is expected to set the bar low when evaluating certification applications for state insurance exchanges, industry observers tell HEX.
The reform law requires HHS to certify state exchanges no later than Jan. 1, 2013. But with many states still waiting for their legislatures to act, or for the Supreme Court to rule on the constitutionality of the reform law, overall development of state exchanges is woefully behind schedule.
In November 2011, CMS issued a 14-page draft certification application, which states must submit this fall. But HHS has said little about what the certification process will look like. And given that a majority of states won’t be fully ready for certification — either by choice or circumstance — HHS is expected to help states make progress, rather than reject applications that fall short, according to a source who has worked with CMS’s Center for Consumer Information and Insurance Oversight (CCIIO) but asked not to be identified. HHS will most likely allow conditional approval with an action plan for states that don’t meet all of the certification requirements, she tells HEX.
http://aishealth.com/archive/nhex0212-01
Hat tip: AIS Health/ Inside Health Insurance Exchanges
The reform law requires HHS to certify state exchanges no later than Jan. 1, 2013. But with many states still waiting for their legislatures to act, or for the Supreme Court to rule on the constitutionality of the reform law, overall development of state exchanges is woefully behind schedule.
In November 2011, CMS issued a 14-page draft certification application, which states must submit this fall. But HHS has said little about what the certification process will look like. And given that a majority of states won’t be fully ready for certification — either by choice or circumstance — HHS is expected to help states make progress, rather than reject applications that fall short, according to a source who has worked with CMS’s Center for Consumer Information and Insurance Oversight (CCIIO) but asked not to be identified. HHS will most likely allow conditional approval with an action plan for states that don’t meet all of the certification requirements, she tells HEX.
http://aishealth.com/archive/nhex0212-01
Hat tip: AIS Health/ Inside Health Insurance Exchanges
Tuesday, February 21, 2012
National- Four Months After Leaving HHS, Ario Remains Bullish on Exchange
It’s been four months since Joel Ario left HHS’s Office of Health Insurance Exchanges, a department that he headed after it was created in fall 2010. The office is part of CMS’s Center for Consumer Information and Insurance Oversight (CCIIO).
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HEX: What do you see as the biggest barriers health insurers will face in developing and selling qualified health plans through state exchanges?
Ario: The transition to guaranteed issue in the individual market will be challenging. It is the
heart of the law and is the key to covering everyone, but it will require insurers to change their business models. In essence, they will have to compete for individual business the way they compete for [administrative services only] business in the large group market. With large employers, insurers do not identify the most costly people and put them in a separate
risk pool. They work with employers to manage costs of the overall pool…healthy and sick. Risk selection is deep in the DNA of insurers, and they are very worried about the 2O14 transition. But Massachusetts shows it can work if everyone cooperates. The bottom line is that the alternative to implementing this law is a whole lot more uncertain and there are potential downsides for insurers.
...
HEX: One of the chief complaints I hear from states and health plans is that regulations have been too slow in coming out. What are the challenges in finalizing regulations?
Ario: The core proposed rules came out last summer, but it was a long road to get to those and I’m sure it has been another long road to go from those proposed rules to the final ones. But I do think those rules need to come out this spring. They’re expected to be out in February. Carriers have told me that their drop-dead date for knowing the final regulatory landscape is June, which is 18 months out from the start date for exchange-based coverage. Plans have said that while 18 months isn’t ideal, it still gives them a manageable timeline. Defining essential health benefits was the most difficult piece of this for the federal government. And much of this responsibility has now been given to the states.
http://aishealth.com/sites/all/files/marketplace_pdf_samples/samplehex.pdf
Hat tip: AIS Health/ Inside Health Insurance Exchanges
...
HEX: What do you see as the biggest barriers health insurers will face in developing and selling qualified health plans through state exchanges?
Ario: The transition to guaranteed issue in the individual market will be challenging. It is the
heart of the law and is the key to covering everyone, but it will require insurers to change their business models. In essence, they will have to compete for individual business the way they compete for [administrative services only] business in the large group market. With large employers, insurers do not identify the most costly people and put them in a separate
risk pool. They work with employers to manage costs of the overall pool…healthy and sick. Risk selection is deep in the DNA of insurers, and they are very worried about the 2O14 transition. But Massachusetts shows it can work if everyone cooperates. The bottom line is that the alternative to implementing this law is a whole lot more uncertain and there are potential downsides for insurers.
...
HEX: One of the chief complaints I hear from states and health plans is that regulations have been too slow in coming out. What are the challenges in finalizing regulations?
Ario: The core proposed rules came out last summer, but it was a long road to get to those and I’m sure it has been another long road to go from those proposed rules to the final ones. But I do think those rules need to come out this spring. They’re expected to be out in February. Carriers have told me that their drop-dead date for knowing the final regulatory landscape is June, which is 18 months out from the start date for exchange-based coverage. Plans have said that while 18 months isn’t ideal, it still gives them a manageable timeline. Defining essential health benefits was the most difficult piece of this for the federal government. And much of this responsibility has now been given to the states.
http://aishealth.com/sites/all/files/marketplace_pdf_samples/samplehex.pdf
Hat tip: AIS Health/ Inside Health Insurance Exchanges
Insurance Industry- Creating Effective Insurance Exchanges
For the first few years, these exchanges will be open only to individuals and small businesses (limited to businesses with 50 or fewer employees or, at the state's discretion, 100 or fewer employees) purchasing health insurance. Starting in 2017, the exchanges could be open to larger companies with more than 100 employees.
...
The experiences of this group will greatly influence the experience larger employers will have in the future if they choose to use the exchanges in 2017 and beyond.
...
For example, some basic offerings include a single point of entry for employers, readily available information that shows how one health plan differs from another, a single application, a call center or easy-to-use Web site, and a single premium payment for each employer. He also suggests that exchanges can provide added value by providing support for wellness programs, COBRA coverage, and flexible spending accounts.
...
Other states looking to create options with lower administrative overhead and greater cost efficiencies might also consider merging individual and small-business exchanges. With more members, exchanges have more clout in the marketplace and could use the resulting leverage to offer plan options that provide more value at a better cost than small businesses are used to seeing. For example, he notes that in Massachusetts the Network Health Plan with its low-overhead has accumulated 40% of total exchange enrollment.
http://businessfinancemag.com/article/creating-effective-insurance-exchanges-0221
Hat tip: Business Finance Magazine
...
The experiences of this group will greatly influence the experience larger employers will have in the future if they choose to use the exchanges in 2017 and beyond.
...
For example, some basic offerings include a single point of entry for employers, readily available information that shows how one health plan differs from another, a single application, a call center or easy-to-use Web site, and a single premium payment for each employer. He also suggests that exchanges can provide added value by providing support for wellness programs, COBRA coverage, and flexible spending accounts.
...
Other states looking to create options with lower administrative overhead and greater cost efficiencies might also consider merging individual and small-business exchanges. With more members, exchanges have more clout in the marketplace and could use the resulting leverage to offer plan options that provide more value at a better cost than small businesses are used to seeing. For example, he notes that in Massachusetts the Network Health Plan with its low-overhead has accumulated 40% of total exchange enrollment.
http://businessfinancemag.com/article/creating-effective-insurance-exchanges-0221
Hat tip: Business Finance Magazine
Sunday, February 19, 2012
Insurance Industry- Reform Law Could Fuel Self-Funding
Starting in 2014 under the Patient Protection and Affordable Care Act, companies with 50 or more employees either must offer health care coverage or pay a per-employee fee to the government. While smaller companies will be able to purchase health care benefits via state insurance exchanges created in response to such legislation, health care benefits experts expect many employers with 100 or more employees will opt to self-fund rather than buy commercial coverage.
Although self-funded benefits will be subject to many of the same coverage requirements imposed on insured plans, such as providing coverage for what the Department of Health and Human Services deems are “essential benefits,” the cost of self-funded benefit plans will continue to remain lower than that of insured plans because self-funded plans are not subject to state benefit mandates or premium taxes that add to plan costs, experts say.
...
Because self-insured plans are governed by the federal Employee Retirement Income Security Act, self-funded employers also will continue to have the flexibility to make value-based plan design changes that deter employees from using expensive health care providers or nonessential services, or to encourage healthy behaviors, experts say. By contrast, insured programs will continue to be standardized to meet state insurance regulations, which do not permit such modifications, they say.
“Moving into 2014, there's one more reason to move to self-funding,” said Mark Whiting, a principal with consultant Mercer L.L.C. in Kansas City, Mo. “PPACA may be enough to push a client that's been teetering on the edge to move to self-funding.”
http://www.businessinsurance.com/article/20120219/NEWS05/302199999?tags=%7C74%7C278%7C305%7C339%7C342
Hat tip: Business Insurance
Although self-funded benefits will be subject to many of the same coverage requirements imposed on insured plans, such as providing coverage for what the Department of Health and Human Services deems are “essential benefits,” the cost of self-funded benefit plans will continue to remain lower than that of insured plans because self-funded plans are not subject to state benefit mandates or premium taxes that add to plan costs, experts say.
...
Because self-insured plans are governed by the federal Employee Retirement Income Security Act, self-funded employers also will continue to have the flexibility to make value-based plan design changes that deter employees from using expensive health care providers or nonessential services, or to encourage healthy behaviors, experts say. By contrast, insured programs will continue to be standardized to meet state insurance regulations, which do not permit such modifications, they say.
“Moving into 2014, there's one more reason to move to self-funding,” said Mark Whiting, a principal with consultant Mercer L.L.C. in Kansas City, Mo. “PPACA may be enough to push a client that's been teetering on the edge to move to self-funding.”
http://www.businessinsurance.com/article/20120219/NEWS05/302199999?tags=%7C74%7C278%7C305%7C339%7C342
Hat tip: Business Insurance
Wednesday, February 15, 2012
Insurance Industry- California: Making a Place for Small Businesses in Exchanges
Small businesses know the power of collectives.
From agricultural co-ops to trade associations, small businesses frequently pool their resources and increase their buying power, leveraging better deals for their members.
That's the very idea behind the Small-Business Health Options Program.
State-based exchanges will go online in 2014, aiming to offer more affordable health insurance options in the individual market. At the same time, states will also create exchanges for small businesses. The Affordable Care Act leaves it up to states on whether these exchanges will be combined or run separately.
A series of articles last week in Health Affairs, supported by the Commonwealth Fund, lays out the benefits, pitfalls and possibilities of SHOP exchanges.
As Editor-in-Chief Susan Denzter noted, "These insurance stores for the small-group market ... sound simple in concept, but as [the articles] make clear, they are anything but."
http://www.californiahealthline.org/road-to-reform/2012/making-a-place-for-small-businesses-in-exchanges.aspx
Hat tip: California Healthline/ California Healthcare Foundation
From agricultural co-ops to trade associations, small businesses frequently pool their resources and increase their buying power, leveraging better deals for their members.
That's the very idea behind the Small-Business Health Options Program.
State-based exchanges will go online in 2014, aiming to offer more affordable health insurance options in the individual market. At the same time, states will also create exchanges for small businesses. The Affordable Care Act leaves it up to states on whether these exchanges will be combined or run separately.
A series of articles last week in Health Affairs, supported by the Commonwealth Fund, lays out the benefits, pitfalls and possibilities of SHOP exchanges.
As Editor-in-Chief Susan Denzter noted, "These insurance stores for the small-group market ... sound simple in concept, but as [the articles] make clear, they are anything but."
http://www.californiahealthline.org/road-to-reform/2012/making-a-place-for-small-businesses-in-exchanges.aspx
Hat tip: California Healthline/ California Healthcare Foundation
Monday, January 30, 2012
Insurance Industry-State Flexibility on EHBs Could Encourage Exchange Development
Recent clarity about how essential health benefits (EHBs) are likely to be defined could provide a small push to procrastinating states when it comes to building an insurance exchange.
Rather than develop a national EHB standard, which was largely expected, a 13-page “bulletin” issued by CMS’s Center for Consumer Information and Insurance Oversight on Dec. 16 proposed that states use an existing health plan to define the benefits that must be included in individual and small-group plans beginning in 2014.
...
But some states still might not take action. “As we have seen with the exchanges, some states are more reluctant than others to adopt” reform-law provisions, says Adam Solander, an attorney in the health care practice at Epstein Becker & Green. “I expect that some states will not take action and the default benchmark plan (i.e., the largest plan in the state’s small-group market) will be adopted. However, at the end of the day states will have to choose a plan that balances costs and richness of benefit structure.”
http://aishealth.com/archive/nhex0112-03
Hat tip: AIS(Atlantic Information Services) Health
Rather than develop a national EHB standard, which was largely expected, a 13-page “bulletin” issued by CMS’s Center for Consumer Information and Insurance Oversight on Dec. 16 proposed that states use an existing health plan to define the benefits that must be included in individual and small-group plans beginning in 2014.
...
But some states still might not take action. “As we have seen with the exchanges, some states are more reluctant than others to adopt” reform-law provisions, says Adam Solander, an attorney in the health care practice at Epstein Becker & Green. “I expect that some states will not take action and the default benchmark plan (i.e., the largest plan in the state’s small-group market) will be adopted. However, at the end of the day states will have to choose a plan that balances costs and richness of benefit structure.”
http://aishealth.com/archive/nhex0112-03
Hat tip: AIS(Atlantic Information Services) Health
Insurance Industry- Final Rule Regarding Insurance Exchange Eligibility May Be Near
Federal officials could release a final rule in the coming days implementing key provisions of the 2010 federal healthcare overall on Medicaid and insurance exchange eligibility.
Regulations implementing provisions of the Patient Protection and Affordable Care Act expected to expand Medicaid access by 16 million people and to determine eligibility for state exchanges that will insure another 16 million people were submitted for approval late last week from the Office of Management and Budget. Approval by OMB is usually the final step before rules are publicly released.
...
Other exchange details expected from the rule include the role that tax credits will have in covering the cost of premiums for people in the new state insurance marketplaces. Both the exchanges and the Medicaid expansion will begin in 2014.
http://www.modernhealthcare.com/article/20120130/NEWS/301309957/final-rule-regarding-medicaid-insurance-exchange-eligibility-may-be
Hat tip: Modern Healthcare
Regulations implementing provisions of the Patient Protection and Affordable Care Act expected to expand Medicaid access by 16 million people and to determine eligibility for state exchanges that will insure another 16 million people were submitted for approval late last week from the Office of Management and Budget. Approval by OMB is usually the final step before rules are publicly released.
...
Other exchange details expected from the rule include the role that tax credits will have in covering the cost of premiums for people in the new state insurance marketplaces. Both the exchanges and the Medicaid expansion will begin in 2014.
http://www.modernhealthcare.com/article/20120130/NEWS/301309957/final-rule-regarding-medicaid-insurance-exchange-eligibility-may-be
Hat tip: Modern Healthcare
Thursday, January 26, 2012
Insurance Industry: Exchanges- The World Small to Rule the Big
A pair of industry experts espoused the benefits of insurance exchanges and small agencies today and in the future during the recent Insurance Industry Roundtable run by the WIAA Education & Research Foundation in Irvine, Calif.
...
Insurance exchanges do provide market access as one of their primary functions, Kerr said, but beyond that, an insurance exchange can help agents “complete a number of issues that independent agents have had to deal with historically that are challenging for them.”
Those issues might be human resources, accounting, management and the “types of things that make it difficult for them to accomplish their primary function, which is to sell insurance,” Kerr said, adding his pitch that an exchange is great for new agencies just starting out.
...
In fact, Kerr thinks exchanges will become so popular, that they will come to rule the industry.
“I think that the exchange concept will replace traditional distribution,” Kerr said. “I do believe that wholesalers and MGAs will need to either affiliate with an exchange or become one in-and-of themselves. The difficulty there is the land grab is on, and either you’ve built the model and you’ve grabbed your piece of real estate or you haven’t, and first mover’s advantage.”
http://www.insurancejournal.com/news/west/2012/01/26/232823.htm
Hat tip: Insurance Journal (with video embed of interview)
...
Insurance exchanges do provide market access as one of their primary functions, Kerr said, but beyond that, an insurance exchange can help agents “complete a number of issues that independent agents have had to deal with historically that are challenging for them.”
Those issues might be human resources, accounting, management and the “types of things that make it difficult for them to accomplish their primary function, which is to sell insurance,” Kerr said, adding his pitch that an exchange is great for new agencies just starting out.
...
In fact, Kerr thinks exchanges will become so popular, that they will come to rule the industry.
“I think that the exchange concept will replace traditional distribution,” Kerr said. “I do believe that wholesalers and MGAs will need to either affiliate with an exchange or become one in-and-of themselves. The difficulty there is the land grab is on, and either you’ve built the model and you’ve grabbed your piece of real estate or you haven’t, and first mover’s advantage.”
http://www.insurancejournal.com/news/west/2012/01/26/232823.htm
Hat tip: Insurance Journal (with video embed of interview)
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