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42 Matching News Items

1.  Texas Blue Decision Could Signal Twilight of the Exchange PPO
HealthLeaders-InterStudy Link to more items from this source
July 31, 2015
"Lost in the noise over mega-mergers, one of the biggest carriers anywhere, Blue Cross Blue Shield of Texas, announced plans to stop selling its Blue Choice PPO on and off the exchange in 2016.... This isn't an insurer discarding a poorly performing plan design that failed to sway consumers. The Texas Blue plan has more enrollment in Blue Choice than many insurers have total members."
2.  2016 Health Insurance Premiums: The Reverse Bait-and-Switch
HealthLeaders-InterStudy Link to more items from this source
June 11, 2015
"[It's] important to look between the lines and see which plans are not requesting double-digit hikes for 2016.... The classic 'bait-and-switch' entices consumers to the store with the lure of bargains, but when they arrive they find those items sold out, or are pressured to buy up to a more expensive product.... The insurers requesting big rate increases for 2016 may be doing just the opposite: jacking up the costs of existing products so that narrow-network products, typically featuring care integration, look more attractive."
3.  Jury Still Out on Consumer-Driven Health Plans
HealthLeaders-InterStudy Link to more items from this source
May 30, 2015
"[C]onsumers tend to reduce their utilization of healthcare during their first one or two years in a CDHP, particularly through reductions in prescription drug spending.... [It] isn't clear whether the reductions in services tend to be necessary or unnecessary, and long-term utilization trends are not observable in most studies due to short study periods of only one or two years."
4.  Broad Reach of Cadillac Tax Could Have Significant Impact on Employers
HealthLeaders-InterStudy Link to more items from this source
Apr. 23, 2015
"After analyzing its plan, CalPERS found that if the tax were in place today, its Blue Shield Access+ plan offered through Blue Shield of California in the San Francisco area and the Anthem Traditional HMO plan in Sacramento would both trigger the tax because they cost more than the limit. The purchasing coalition estimated it would pay $3.9 million in excise taxes."
5.  Formulary Exclusions May Be Yesterday's News
HealthLeaders-InterStudy Link to more items from this source
Mar. 11, 2015
"[P]harmacy benefit managers and health plans appear to be turning their attention to contracts that put drug companies on the hook for reimbursing payers if those high-priced drugs do not live up to their promised results. In fact, one senior official of a national PBM ... [said] that the PBM would rather not exclude a drug from coverage ever again, preferring instead to pursue outcomes-based or other contracting terms that would bring payers some form of predictability in their drug costs."
6.  Value-Based Benefit Design and Select Rx Utilization Controls Waned in 2014
HealthLeaders-InterStudy Link to more items from this source
Feb. 13, 2015
"10 years of PBMI data show that, yes, there are higher tiers and copayments for specialty drugs, but cost sharing for these stratospherically expensive drugs has actually dropped, probably because their introduction and subsequent cost inflation has occurred so fast that insurance plans can't keep up with it. Even more surprising, value-based pharmacy benefit design was actually being used less in 2014 than in previous years. More than half (53 percent) of the respondents reported using none of the evidence-based tactics listed in the survey, compared with 43 percent in 2011.... These rather surprising trends away from value-based benefit design probably don't mean that employers are slacking off on encouraging wellness to cut insurance costs. Instead, employers may be finding more effective ways of influencing employees' health choices."
7.  Lower Subsidies Could Lead to Exchange Sticker Shock for Enrollees
HealthLeaders-InterStudy Link to more items from this source
Nov. 24, 2014
"The news that some exchange carriers will offer lower premiums in 2015 was a surprise in many markets. But the biggest surprise could await exchange customers who stick with their existing exchange plan without shopping around. An unintended consequence of lower premiums is lower subsidies, which raises the percentage of premium that enrollees pay for their plan."
8.  California Health Plans on Notice: Drug Lists Will Be Standardized
HealthLeaders-InterStudy Link to more items from this source
Oct. 16, 2014
"[A] new law in California ... will eventually require all plans in California to use a standard formulary.... The new law ... requires the two insurance state regulators ... to devise a standard formulary by Jan. 1, 2017. Within six months after the template is developed, all insurance plans in California, not just those on the exchange, will have to conform to that template and post regular formulary updates."
9.  Eastward Ho! More Pioneer ACOs Turn Their Wagons Around
HealthLeaders-InterStudy Link to more items from this source
Oct. 2, 2014
"Providers are quitting for three main reasons: they're losing money, they're unhappy with [CMS's Medicare Pioneer ACO program] design, and they have a lot more ACO control playing locally than federally.... Providers also cite benchmarks and formulas that don't reflect the unique dynamics of their markets or their patient case mix."
10.  The Maker of Jumbo Jets Tries a Makeover of ACOs
HealthLeaders-InterStudy Link to more items from this source
July 10, 2014
"Within the half year, a large employer and three hospital systems in the Seattle area are launching an unusual accountable care experiment that removes the insurance company middleman. The arrangement is also notable because it will use practically every tactic under way in managed care: health savings accounts, value-based benefits, narrow networks and medical homes. The experiment involving large aerospace manufacturer Boeing Corp. will be closely watched not only for the ACO portion, but also for its everything-but-the-kitchen sink approach to making employees healthier while slowing down the costs of doing so."
11.  UnitedHealthcare's Reversal on Drug Copay Coupons
HealthLeaders-InterStudy Link to more items from this source
Apr. 15, 2014
"Last month, UnitedHealthcare went out on a limb with its decision to prohibit the use of copay coupons at retail settings for its commercial book of business ... Now, it appears the limb broke, and the company has essentially decided to backtrack.... Employers may have ... cried foul. They're footing the bill, after all, and they may fear member disruption and backlash.... UnitedHealthcare is not afraid to rock the boat, so this issue will not go away."
12.  Looming Healthcare Tax Lights a Fire Under Corporate America
HealthLeaders-InterStudy Link to more items from this source
Mar. 13, 2014
"The nation's largest employers are leading the trend toward consumerism, relying increasingly on employees to share more of the costs and manage expenses at a time when household budgets and family to-do lists are stretched to the limit. Fortunately, corporate benefit directors have been gearing up to guide employees through the process of being smarter consumers of healthcare while also helping them to stay as healthy as possible."
13.  Healthcare Reform Continues to Roil U.S. Managed Markets as the Number of ACOs Nearly Doubles and State Exchanges Create Clear Winners and Losers
HealthLeaders-InterStudy Link to more items from this source
Feb. 27, 2014
"Even though large businesses cannot put their employees into the state exchanges until 2017, millions of small-business employees could go into the exchanges between 2015 and 2017. Meanwhile, several million more individuals who had been uninsured will gain benefits. ACOs fundamentally shift the risk of patient health and costs to providers. They also represent a potential consolidation of power among a more select group of decision-makers -- something that is likely to have a tremendous impact on prescribing habits and medication therapy management."
14.  Pioneer ACOs' First-Year Results Leave a Lot of Room for Improvement
HealthLeaders-InterStudy Link to more items from this source
Feb. 6, 2014
"Altogether, the Pioneers produced savings of about $147 million, a drop in the bucket for the entire Medicare budget, and certainly much less than the amount spent to develop the infrastructure to support the ACOs. Officials with [CMS] -- which is managing the Pioneer and the Medicare Shared Savings Program (MSSP) ACOs -- said some progress is better than none, and the program will take time to produce more significant savings."
15.  Bigger Footprint Could Be Saving Grace for CO-OPs
HealthLeaders-InterStudy Link to more items from this source
Jan. 9, 2014
"Some crafty maneuvers worthy of the nation's private-sector insurers may give CO-OPs staying power and a number of them are looking at expansion in 2015. Early enrollment figures for one CO-OP signal that a multi-state approach might be the way to go.... If those expansions take hold, there's a high probability of further moves into other states to position themselves as true regional players."
16.  Explaining the ACA to the Public: What We Have Here Is a Failure to Communicate
HealthLeaders-InterStudy Link to more items from this source
Dec. 5, 2013
"What other completely predictable 'surprises' await us as the ACA careens toward its full enactment? What other headlines will come rolling out as the reforms unfold? ... Narrow networks will exclude desired physicians, hospitals.... Providers will see a lot of bad debt.... Many will fail to sign up."
17.  November 30: D-Day for Health Insurance Exchanges
HealthLeaders-InterStudy Link to more items from this source
Nov. 11, 2013
"Why Nov. 30? That's the self-imposed deadline set by Obama officials for having HealthCare.gov functioning 'smoothly' for the vast majority of users. But it's not an arbitrary date, a neat spot on the calendar that rolls off the tongue in speeches and media reports. Nor is it a reasonable amount of time to correct what we now know are widespread problems embedded in the site's core program, not mere technical glitches in need of a reboot. In fact, Nov. 30 holds important and long-term implications for consumers, payers and providers."
18.  In Victory for Drug Manufacturers, Copay Coupons Will Be Allowed on Exchanges
HealthLeaders-InterStudy Link to more items from this source
Nov. 4, 2013
"The anti-kickback statute forbids copay coupons in Medicare, Medicaid and Tricare. [This author had written] that because exchange plans are in a grey area -- they are commercial, but provide federal subsidies to most enrollees -- they would likely not qualify for copay coupons. But [HHS Secretary] Sebelius says otherwise.... The issue may not be entirely settled.... [T]he Pharmaceutical Care Management Association plans to challenge the HHS determination on copay coupons."
19.  The Sam's Club Approach to Healthcare
HealthLeaders-InterStudy Link to more items from this source
Oct. 21, 2013
"[E]mployers and insurers across the country are increasingly relying on narrow networks to control the costs of insurance coverage.... But narrow networks and their discounted rates are not enough to hold down healthcare costs. Employers and insurers are also negotiating with providers for fixed, transparent prices, which allow them to budget for the costs of coverage."
20.  State-Run Exchanges Fare Better in Enrollment's Early Days
HealthLeaders-InterStudy Link to more items from this source
Oct. 9, 2013
"At Kynect (Kentucky's exchange), a few quick questions about age, family, household income and tobacco use lead to a menu that lets consumers sort plans by premium, deductibles, out-of-pocket maximums, and metal tiers, and allows for searches by hospitals and providers.... In its first five days, Kynect screened 142,242 people for eligibility. In its first week, Kynect had 22,000 applications started and nearly 15,000 completed. More than 200 small businesses are also in the application process."
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