Friday, October 28, 2011

Health Insurance Exchange Roundup: October 28

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Fox News: Obama’s Health Care Law Penalizes Marriage, Analysts Say
Maryland Healthcare Commission: Health Care Spending in Maryland’s Individual and Small Group Market
Get Insured: Predicting the Future of Health Insurance
Virginia Public Radio: Employer-Sponsored Health Insurance

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.




Thursday, October 27, 2011

Hear Former HIX Director on the Status of States’ Exchanges

This is your last chance to register for the Health Insurance Exchange Congress and hear Joel Ario, former Director of the Office of Health Insurances Exchanges speak. Joel Ario was the Director of the Office of Health Insurance Exchanges.

His presentation is entitled "The State of the States: Health Insurance Exchange in Various States". It will take place during the event, taking place November 9-11, 2011.  This session will provide you with:
  • • How the political climate within states will affect how they organize their Exchanges
  • • How states are utilizing their innovator grants
  • • Updates on the status of high-populous states that are establishing exchanges
  • • Opportunities regional Exchanges present
For more information about this presentation and the rest of the agenda, download the brochure here and we hope to see you in Baltimore next month!




Wednesday, October 26, 2011

Health Insurance Exchange Roundup: October 26

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Nashville Public Radio: Health Interests Prefer State-Run Insurance Exchange
ASC Review: Kansas Governor's Rejection of $31.5M Health Insurance Exchange Grant Prompts Criticism
Bureau of National Affairs: HHS Doing All It Can to Help States Establish Health Exchanges, Official Says
AM 610: Nebraska- Vs. Federal-Based Health Insurance Exchange
Lansing State Journal: Jack McHugh: Don't rush to create health exchange

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.




Tuesday, October 25, 2011

Health Insurance Exchange Roundup: October 25

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:

AIS Health: Good News for Small Carriers: Exchanges Could ‘Dilute’ Brand
Lawrence Journal World: Brownback’s rejection of health insurance grant continues to spur questions
Becker's Hospital Review: Virginia to Map Out Health Insurance Exchange Framework

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.




Essential Health Benefits: Specific Recommendations and Implications

Our post today comes from guest blogger David Jacobson. He is a consultant for HealthCare Strategic Management – SM. He is a knowledgeable and creative thinker of healthcare reform strategies, and a subject matter expert about Medicaid managed care and the Affordable Care Act including the purchasing Exchange and other reform initiatives. David has over 16 years’ experience and developed Medicaid managed care products for chronically ill, disabled and long term supports and services. 

Specific Recommendations and Implications
Part 1 of this Blog discussed IOM’s overall recommendation for HHS to define Essential Health Benefits. It is a balance of coverage and affordability, and affordability should be a key to support the goals of ACA. This Blog drills-down on the specific recommendations and includes analysis of implications.

Following are IOM committee recommendations and editorial analysis. The detailed recommendation framework was comprised of three major areas. See the IOM report for more specifics.

  • Policy Foundation that included stewardship of limited resources under an Ethic dimension
  • Summary of Criteria for the: 1) aggregate package, 2) specific components, and 3) defining and updating the specific components
  • Eight recommendations addressing in the six categories that address:
    • o Establish initial EHB: Reality will be in the specifics of how HHS interprets and applies the IOM guidelines. The IOM strongly recommended effective public deliberation and the process will need to make tough a-political decisions to define EHBs that will support affordability. A challenge will be the level of benefits for the chronically ill and disabled segment. This segment may need special consideration such as targeted programs and effective risk-adjustments that can actually attract health plans with care management expertise. Additionally, the EHB needs to consider Medicaid benefits to support continuity of care for enrollees that switch between subsidized and Medicaid plans (bubble population).
    • o Foundation for updating with monitoring and research: Establishing data standards is a valuable component in order to have information to evaluate performance and outcomes to improve the system. This will increase administrative costs in the short-term and, when done right, can reduce cost and improve outcomes in the medium term. Useful and actionable data is essential to reforming the system.
    • o Allow for State innovation: This component is needed in order for states to continue to design programs for the local market and be a laboratory for innovation. However, it will also create challenges to maintain actuarial neutral benefit designs and avoid an onerous waiver process like what states currently face for Medicaid.
    • o Update the EHB with evidence-based information and explicitly consider costs:A challenge here is that new treatments may initially lack sufficient evidence-based data. Additionally, cost neutrality presents the challenge of comparative effectiveness and politicizing the process when choices need to made about what benefits to add or change. It will be important to maintain affordable premium price-points and avoid political influence driving the cost up or complaints of rationing.
    • o HHS strategy to address rising costs across all sectors: As noted above, this is critical for the success of ACA and American healthcare in general. To highlight, the recommendation is across all sectors which can help minimize pushing the financial bubble around the system between payers and providers.
    • o Create a National Benefits Advisory Council (NBAC): This needs to be kept non-partisan. The ACA says that the council would be staffed by HHS and appointed through a non-partisan process.
The next step is for HHS to conduct listening sessions and the IOM report targets the definition of the initial EHB package by May 1, 2012. The sooner the better due to the implications of EHB and the ever narrowing window to implement ACA. The next steps will be an intense process and fortunately the IOM committee proceeded in the right direction and recommended a solid framework to support the ACA.

Contact David at: djacobson@healthsm.com




Monday, October 24, 2011

Health Insurance Exchange Roundup: October 24

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Kaiser Health News: Can A Small Business Insurance Marketplace Take Root In Florida?
Richmond Times Dispatch: Virginia officials to meet about setting up health-insurance exchange
Las Vegas Sun: Report finds high numbers of Nevadans lack health insurance
Baltimore Business Journal: Maryland seeks bids to build health insurance enrollment system

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.




US Healthcare rate climbed in 2011 but at a slower pace

The average cost of healthcare services covered by commercial services and Medicare grew 5.73% from August 2010 to August 2011.  This is the lowest growth rate in six years, however still outpaced the overall inflation rate of 3.1% according to the CPI Index.  According to Health Leaders Media, the cost of hospital and professional services rose, but it is believed to be a result of  rising employment and wages.

David M. Blitzer, chairman of the Index Committee at S&P Indices, said in the report, stated:
"As the summer of 2011 ended, we continued to observe the recent trend of a deceleration in the annual growth rates of Medicare costs and a sustained acceleration in the annual rates of commercial healthcare costs.....With this month's data, the Medicare index is almost one-fourth of its peak annual rate of +8.02% recorded in November 2009. This is a very sharp deceleration."

At the 9th Annual The Medicare Congress, Centers for Medicare & Medicaid Services will be on hand to present, "Strengthening Medicare – Better Health and Lower Costs for Medicare Beneficiaries," identifying the problems posed by the increasing cost of Medicare.  For more information about the event, download the brochure here.

Why do you think the average cost of healthcare had a lower rate of growth in 2011?




Friday, October 21, 2011

Health Insurance Exchange Roundup: October 21

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
The Detroit News: Health care cost-cutting touted
Progress Illinois: Health Exchanges Still In The “Studying” Stage
The Lund Report (Oregon): Oregon’s Health Exchange Gets a B- in National Study
ASC Review: North Dakota Lawmaker Touts State-Run Health Insurance Exchange Over Federal Intervention
Green Bay Press Gazette: Wisconsin Senate limits abortion funding

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.




Thursday, October 20, 2011

Health Insurance Exchange Roundup: October 20

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Associated Press: North Dakota GOP lawmaker pushes health insurance exchange
Connecticut News Junkie: Protesters To Board: Add More Members Or Scrap The Exchange
Heartlander: Arkansas Governor Temporarily Halts Insurance Exchange
Mackinac Center for Public Policy: NFIB: 'No Rush' on Creating Obamacare Exchange


The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.




Wednesday, October 19, 2011

Health Insurance Exchange Roundup: October 19

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:

The Associated Press (Illinois): Group calls for action on insurance exchange
Milwaukee Public Radio: Lawmakers Hoping to Block Health Care Reform in Wisconsin Propose Constitutional Amendment
California Healthline: As Health Jobs Grow, a Prescription for Smart Growth

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.




See who’s attending the Health Insurance Exchange Congress

Even if the federal government overturns the Affordable Care Act, many states are still moving forward with establishing their own Health Insurance Exchanges. Utah and Massachusetts have exchanges while New York, Oregon, Vermont and West Virginia are pursuing state legislation to establish their own. Your best bet to learn what’s going on is to attend the Health Insurance Exchange Congress taking place November 9-11, 2011, in Baltimore, Maryland. Join us and align your company's strategies with the state's progress to ensure you benefit from state sponsored Insurance Exchanges. Because regardless of the federal government's ruling, states are still moving forward and you don't want to miss out on the estimated 24 million new eligibles.

Who can you meet when you attend the 2011 conference?
AARP * Aegis Sciences Corporation * AmeriChoice * Amerigroup * AmeriHealth Mercy * Aon Hewitt * Brier Law Group * Cambiare * CareContinuum, Inc * CDPHP * Colorado Access * Consumer Reports * Deltek * Dominion Dental Services * Enroll America * Essex Woodland * Express Scripts Inc * Health Partners * Health Plan of San Mateo * HHS * HMS * Independent Insurance Agents & Brokers of America * JP Morgan * Massachusetts Health Insurance Connector * Medicaid Health Plans of America * MedSolutions * Microsoft Corporation * Molina Healthcare * Monroe Plan * National Association of Health Underwriters * National Association of Medicaid Director * National Foundation of Independent Bus* National Governors Association * National Committee for Quality Assurance * Network Health * Optimetra * State of Oklahoma * State of Utah * Summit Solutions Unlimited * Transamerica Life & Protection * University of Arizona Health Network * WellPoint *

For more information on the event, visit the webpage to download the brochure.




Tuesday, October 18, 2011

Health Insurance Exchange Roundup: October 18

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Savannah Now (Georgia): Carter: Making health insurance mandatory
Associated Press: Rhode Island Community Forums to hold discussion on state's health insurance exchange
Dallas Morning News: Texas receives 'incomplete' on health insurance exchange report card
The Intelligencer: West Virginia Insurance Plan Promising
Gazette News (Maryland): Program could reduce by half those without health insurance, state official says

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.




Essential Health Benefits – IOM process recommendations: Part 1

Our post today comes from guest blogger David Jacobson. He is a consultant for HealthCare Strategic Management – SM. He is a knowledgeable and creative thinker of healthcare reform strategies, and a subject matter expert about Medicaid managed care and the Affordable Care Act including the purchasing Exchange and other reform initiatives. David has over 16 years’ experience and developed Medicaid managed care products for chronically ill, disabled and long term supports and services. 


Affordability is key to ACA Essential Health Benefits

Essential Health Benefits (EHB) of the Affordable Care Act (ACA) require a balance between coverage and cost, and affordability was weighted heavily by the Institute of Medicine (IOM). The IOM committee introduction said “If you don’t control costs, the goal to increase coverage will be undermined” when they released the anxiously awaited recommendations to the Department of Human and Health Services (HHS) on October 7. The recommendations are for the guidelines and criteria for HHS to specify the EHB package. The EHB packages will be offered through purchasing Exchanges and have far reaching impacts on the success of the ACA. More than 68 million people are expected to meet EHB requirements.

The regulations received intense public interest during the IOM development process and there were several hundred people on Friday’s teleconference meeting. The website with the full report became blocked on Friday afternoon as a surge of people retrieved the report.

To put this in context, the principal reason for ACA is to enable people to purchase health insurance and cover more of the population. This is supported by subsidized plans for low and moderate income individuals and small employers that is sold through a purchasing Exchange.

Specifying the EHB is a tremendously difficult task due to the competing goals of comprehensiveness and affordability, many trade-offs, and diverse public interests. It’s a balance of wallet and heart. If EHB is too expansive, then it will be too expensive and there will be less consumer uptake. If it is too limited, individuals will not get access to the services they need and outcomes will suffer. The IOM created a multi-stakeholder committee and obtained extensive public input to set the parameters and guidance.

The IOM recommendations are a solid point of departure and reference point for HHS, even if it seems vague in spots. The IOM committee recognized that benefit packages need to be affordable to obtain the necessary level of enrollment and we also have limited resources. They viewed it as a ‘market basket” to know what you can spend and spend it carefully rather than a filling up your shopping cart with as much as you can. A committee member said: “Everyone cannot have everything they want. “

This raises tough questions about the level of benefits, especially for chronically ill and disabled. Special consideration, programs, and rate adjustments will be required for high-risk individuals.

The IOM suggested benchmarking the average covered benefits and premiums for small employer health plans. They were also required to add benefits to reflect the ten categories specified by the ACA. This will increase the cost and create pressure to limit benefits in order to meet premium price-points.

The IOM approach is to start with what we have and then readily adjust as we learn how the Exchange market works. This is a prudent way to begin – progress over perfection – and let the free market do its work. This allows the opportunity for increased consumer take-up rates which will allow a broader selection mix and the ability of Exchanges to learn, adapt and grow. It would allow states and/or insurers to offer additional plans with enhanced benefits vs. overly specific regulations.

Certainly, ACA and healthcare reform will not be successful with the right Exchanges and EHBs alone. Other changes are needed to address the high cost and quality variation in the American system. For instance, other critical success factors include benefit design (i.e. cost-share), administration (i.e. care management), and network requirements. Reform must also address improvements to delivery and payment, risk-adjusted rates for insurers, health information technology, and informed and engaged consumers.

Stayed tuned for Part 2 of this Blog: Specific Recommendations and Implications next Tuesday, October 25.  Contact the author at djacobson@healthcaresm.com.





Monday, October 17, 2011

Health Insurance Exchange Roundup: October 17

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Montgomery Adviser: Market for health insurance in Alabama the least competitive in U.S.
Associated Press: West Virginia still pursuing health insurance exchange
NPR: A Tale Of Two Health Plans: Romney Versus Obama
Washington Post: Some states seek flexibility to push health-care overhaul further

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.




Nebraska waiting to create their health insurance exchange

Until there is a clearer picture on what the federal health insurance exchange looks like, Nebraska Department of Insurance Director Bruce Ramge has told the state it is best to wait before any recommendations can be made as to build a state run health exchange.  They are also waiting to see what the Supreme Court states as to the constitutionality of the Affordable Care Act.

The Insurance Journal reports that Omaha Sen. Jeremy Nordquist, the Chair of National Conference of State Legislature’s Health Committee, stated: “We lose nothing by moving forward and enacting legislation. If we sit on our hands and the court upholds the law, we’re going to be way behind the game, potentially to the point where the federal government says, ‘Nebraska, you’re not ready. We’re going to run the exchange for you.”

Chiquita Brooks-LaSure, Director of Coverage Policy, Office of Health Reform (OHR), Department of Health and Human Services, will be at the Health Insurance Exchange Congress this coming November to discuss, "Spread Excellence throughout the System: Better Care for Patients and Better Health for the U.S. Population," looking at how a health insurance exchange can be a benefit to those who are covered.  For more information on the event, download the brochure here.

Do you agree with Nebraska's actions?  What are the advantages and disadvantages of waiting until the Supreme Court rules on the Affordable Care Act?




Friday, October 14, 2011

Health Insurance Exchange Roundup: October 14

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
MSN Money: Nebraska insurance head needs data on exchange cost
Superior Telegram (Wisconsin): Democratic bill seeks health insurance market
Baltimore Business Journal: Baltimore-area brokers may win work in new health insurance market
St. Petersburg Times: New state health exchange could become precursor to implement federal health care law
MSNBC: Rhode Island seeks federal aid for health insurance exchange

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage




Thursday, October 13, 2011

Health Insurance Exchange Roundup: October 13

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
The Washington Examiner: Nebraska insurance head needs data on exchange cost
Montgomery Adviser: Report: Alabama's health insurance market least competitive in U.S.
Times News Magic Valley: Town Hall Will Focus on Health Exchanges
News Review (Nevada): State of health

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage




Wednesday, October 12, 2011

Health Insurance Exchange Roundup: October 12

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Bloomberg Business Week: Rhode Island seeks federal aid for health insurance exchange
Bloomberg Business week: Arkansas insurance officials look at health exchange
Wyoming Tribune: Wyoming lawmakers favor more study on health exchange
Arkansas News: Insurance chief: May be too late for state-run health exchange
Public News Service: Indiana on Healthcare Reform: Take the Lead, or Wait for Feds?

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage




Tuesday, October 11, 2011

Health Insurance Exchange Roundup: October 11

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Boston Globe: RI seeks federal aid for health insurance exchange
Chicago Tribune: Coalition wants consumer voice on health exchange
California Healthline: Counties Weigh Public Plan as Option in State Health Benefit Exchange
Billings Gazette: Gov. Mead supports health insurance exchange
Idaho Statesman: Idaho small-biz group wants insurers' hands out of health exchange

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage




Could four conditions help doctors save Medicare money?

Logo Source: Med City News
The American Medical Association recently sent a request for Medicare to start paying doctors for four tasks that will allow Medicare to save more health care money in the long run by encouraging patients to get their questions answered before they go to the emergency room.


Health Leaders Media reports the four tasks that they have requested for reimbursement are:

  • -Responding to calls from patients at least seven days past doctors visits
  • -Education and training to help patients better manage their health
  • -Management of coagulataen drugs
  • -Reimbursement for team coordination when patients aren't

Barbara Levy, MD, chairperson of the AMA's Specialty Society RVS (Relative Value Scale) Update Committee, issued the following in a recent release:
“When treating patients with chronic conditions, such as heart disease and diabetes, physicians provide many services that are currently not recognized or compensated by Medicare. Not only will payment for these services save Medicare money in unnecessary office and emergency room visits......potential savings in Medicare Parts A and D will also offset upfront payment for non–face-to-face services."

At the 9th Medicare Congress, the panel Strengthening Medicare – Better Health and Lower Costs for Medicare Beneficiaries a group of panelists will be discussing the latest changes to Medicare and how better coordinated care can save the industry money.  For more information, download the agenda here.

Do you agree with Levy's statements? Could reimbursing doctors for time spent doing the four things listed above save the Medicare organization more money in the long run?




Friday, October 7, 2011

Health Insurance Exchange Roundup: October 7

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Westfair Online (Connecticut): M.D.s propose plan in new health exchange
Wall Street Journal: Panel Urges Affordable Health Plans
Bloomberg Business Week: Arizona governor defends health exchange request
News-Medical.net Funding issues affecting health exchanges, community health centers
Mackinac Center: Obamacare Exchange: The People or the Insurers?

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage




Thursday, October 6, 2011

Health Insurance Exchange Roundup: October 6

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
The Capitol (New York): Health Insurance Exchanges Stall In State Senate
Tulsa World: Health-care mandate costly and complex, business leaders tell legislators
The Lund Report (Oregon): Insurance Exchange Must Consider Needs of Tribal Communities
Courier News (Arkansas): Beebe seeks GOP cover on health care
State Paper (Nebraska): Heineman says health exchanges will wait for U.S. Supreme Court decision

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage




Preliminary Agenda now available for the Medicare Congress

Save the Date! Join us February 6-8, 2012 at the Loews Portofino Bay Hotel in Orlando, Florida for the 9th Annual Medicare Congress, the premiere Medicare event featuring today's health plans discussing tomorrow's solutions. Last year we had more than 150 attendees from across the country, representing California, Arizona, New York, Illinois, Texas, and Washington, DC to name a few.

Did you know that in 2011 only 3 Medicare health plans received an overall rating of 5 stars? With over 500 Medicare health plans nationwide, the question remains, how did these 3 conquer all? Learn from the highly ranked plans on how they achieved their high scores and hear directly from the federal officials on how to excel on your RADV audit, improve your Star Rating, and remain profitably despite reimbursement costs.
What's new for 2012?

Three New Full Day Summits
  • • State-of-the-Art Medicare Compliance Summit
  • • Medicare Pharmacy Benefit Management Summit
  • • ICD: 10 Payer Implementation Summit
Three New 100% Case Study Tracks
  • • Medicare Marketing and Member Retention
  • • Complex Care Management that Delivers Clinical and Financial Results
  • • Medicare Reimbursement & Revenue Enhancement
Download the preliminary agenda to see what's in store for 2012.




Wednesday, October 5, 2011

Health Insurance Exchange Roundup: October 5

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Wyoming Tribune Eagle: Health insurance exchange could bypass Legislature
Idaho Statesman: Businesses weigh in on health exchange
Omaha World-Herald: Wait-and-see plan urged for exchange
Jacksonville Journal-Courrier: Uninsured may soon have coverage
Michigan Live: Legislators set to begin work on creating state health exchange
Insurance News Net: Ritze Notes Growing Opposition To State-Run Health Exchanges

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage




The State of Managed Care

In a report from the Kaiser Family Foundation, the found that in 47 out of 50 states, the Medicaid programs are run by Managed Care, and in 2010, there were 54 million who were covered by the program.  Thirty-six of those programs were run by contracted managed care providers.  However, many of those eligible have problems accessing the care available, especially dental, mental health and pediatric services.

Even with those setbacks, the benefits of the system are huge.  The Managed Care System results in:
  • -Improved Accountability
  • -Restructured delivery system
  • -Ensured access to those eligable
  • -Better ability to measure quality
The main concern arises when 14 million extra patients are eligible for managed care under the Affordable Care Act.  How can states and plans work together to increase access to care?





Tuesday, October 4, 2011

What does the Massachusetts Health Insurance Exchange look like?

This week's feature from the Heath Insurance Exchange podcast has Glen Shor describing the Massachusetts Exchange.  To hear more from this podcast, we invite you to download the exclusive Health Insurance Exchange Podcast.

Here is an exceprt from this exclusive podcast:

Please explain what your state’s Exchange looks like.
Glen Shor: We actually operate two Exchanges at the Massachusetts Health Connector, one for our subsidized program, Commonwealth Care and the other for our unsubsidized program, Commonwealth Choice. The overriding purpose of each of these Exchanges is to make it easier for people who might have formerly had problems finding affordable coverage to find affordable coverage and thereby find and secure their way into the ranks of the insured.


Commonwealth Care is a state subsidized health insurance program covering about 160,000 people. We offer state subsidies that help make health insurance affordable for adults up to three times the poverty level who don’t have access to affordable employer- sponsored health insurance. They have a choice of five private health plans and half of them pay premiums to contribute to the cost of their coverage.

For Commonwealth Choice, we are a very active market organizer. We offer six standardized health plans for adults and an additional four more for young adults, among seven soon to be eight health insurance carriers. We try to structure a shopping experience that allows people to choose and compare benefits on an apples-to-apples basis and thus find the coverage that best suits their needs and their budgets.


Finally, I should note that we also make policy decisions related to implementation of Massachusetts adult health coverage mandate.


Join Glen Shor of the Massachusetts Health Exchange at the Health Insurance Exchange Congress where health plans, states and the federal government are addressing the opportunities and challenges presented by the implementation of Exchanges.  This event will take place November 9-11, 2011 in Baltimore, Maryland.  For more information on his presentation rest of the program, visit our webpage.




Monday, October 3, 2011

Health Insurance Exchange Roundup: October 3

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Log Cabin Democrat (Arkansas): Sides at odds on health insurance exchange grant
Cincinnati.com: Health market to cost $19M+
MPR News: Showdown coming in Minnesota over health exchanges
Kaiser Health News: Vermont Edges Toward Single Payer Health Care

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage