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Rising Health Plan Rates, Health Plan Consolidation and Competition on the Exchanges

Posted by Susan Donegan on Thu, Aug 25, 2016

We’re reading about health plan changes for 2017 Open Enrollment and the impact of competition on the exchanges. Here’s a summary of interesting news, perspectives and datapoints.

As rates for health plans sold on public exchanges continue to rise higher than expected, causing large insurers to cut and run from this marketplace, brokers and advisers are gathering useful information. Plans in the employer market are borrowing lessons learned from the exchanges in terms of ways to evolve their product designs to be more efficient,” explains Caroline Pearson, senior VP of Avalere. (Employer Benefit Adviser, 8/22/16)

The health insurance market seems to be heading toward more and more consolidation as the major payers Humana and Aetna along with Cigna and Anthem seem to be bent on merging, even though the Department of Justice filed suit to block the deals. More payers are moving outside of the exchanges, the tensions are pointing at some of the faults within the ACA, which may have brought difficulties that stand in the way of keeping revenue stable among top insurers. (Health Payer Intelligence, 8/19/16)

Competition on some exchanges will be diminished next year when three of the nation's largest health insurers — Aetna, UnitedHealthcare and Humana — will sell individual plans in many fewer markets. The departure of several Blue Cross and Blue Shield plans in various states will also hurt. These pullbacks also come on top of the closure of 16 nonprofit co-ops. What's ahead for consumers depends very much on where they live. (NPR, 8/18/16)

Roughly 20 million more Americans have health insurance now than when President Obama’s health care law was passed in 2010. There are still about 24 million adults with no coverage, according to a survey by the Commonwealth Fund, a health research group. That translates to an uninsured rate of about 13 percent, down from 20 percent in 2013. (New York Times, 8/18/16)

Projected Losses on the Exchanges

Tags: ACA, healthcare exchanges, Health plan, HIX

More Psychiatrists Needed

Posted by Laura McMullen on Fri, Jul 22, 2016

Mental health care is in the news almost daily these days. Common story lines are about undiagnosed people, rising substance abuse rates, and the high cost of care. A contributing factor is the shortage of highly trained providers. Psychiatrists ranked seventh in US News and World Reports 2016 Best Jobs list. Psychiatrists are a new entry in the list and represent 15% of the overall demand for the top 10 jobs through 2024. (Take a look at our blog post, Physician Assistants are in Demand, to see the other eight healthcare jobs that were in the top 10.)

More_Psychiatrists_Needed_image.jpgAccording to, “psychiatrists make up approximately 5 percent of all 661,400 physicians and surgeons employed in the U.S. in 2008. This is a rate similar to general surgery, OBGYN and anesthesiology.” In 2011, the Bureau of Labor Statistics estimated there were about 34,000 psychiatrists in the US. The demand for psychiatrists (4,200) represents ~12% of the current industry.  

Like with physician assistants and nurse practitioners, we’re seeing evidence of market demand in provider directories. We used NetMinder to analyze psychiatrist and psychologist populations in six large national behavioral networks and five large national medical networks between March 2015 and March 2016. Here’s what we found:  

    • Significantly fewer psychiatrists and psychologists participate in medical networks than behavioral networks. This reflects the common practice of carving behavioral health out of medical plans. 
    • Psychiatrists are in demand. Behavioral networks added twice as many psychiatrists as psychologists. Medical networks grew more slowly, adding just 5% more psychiatrists than psychologists. The shortage is felt in commercial networks as well as in other care settings. 
  • Each type of network focused on retaining different providers. Behavioral networks retained more psychologists. Medical networks retained more psychiatrists. Psychiatrists can prescribe medication so they fit better in medical plans with pharmacy benefits. And medication management is more lucrative. On average, a psychiatrist who charges for 45-50 minutes of psychotherapy earns $74-$107 less than he or she would for three 15-minute sessions of medication management. The reason may be that insurers figure that psychotherapy, which is time consuming and may go on for months, should be handled by providers who charge less. 

Similar to other jobs on the list that require long and rigorous training, psychiatrists report high compensation, strong job satisfaction, and low unemployment rates. As in past years, the rankings take compensation, flexibility, opportunities for advancement, market demand, amount of stress, and skills or training required into consideration. See the survey methodology here. 

How is the need for more psychiatrists affecting your network? 

Tags: network data, Healthcare, Health plan, best jobs, medical networks

Guest Blog: The Affordable Care Act Part 1 – What’s Ahead for Large Businesses?

Posted by Louis Balbirer on Fri, Aug 29, 2014

Louis BalbirerLouis Balbirer of Kaufman Rossin writes a guest blog post for NetMinder about changes related to healthcare reform. This is the first post in a two-part series discussing opportunities and challenges of the Affordable Care Act for small and large businesses. Material shared here was presented at the C-Suite Breakfast Series event, co-sponsored by Kaufman Rossin and Vistage.

By January 1, 2015, large businesses will need to decide if they are going to extend coverage to their employees or pay the annual fee for declining to “play.” For businesses, understanding their obligations under the Affordable Care Act (ACA) now and in the coming months is more important than ever.

The ACA was the topic of the most recent C-Suite Breakfast Series. A panel of experts discussed the impact of the Affordable Care Act on small and large business.

Panelists included:

What are some opportunities for large businesses?

Companies with more than 50 full-time equivalent employees are considered large businesses under the healthcare law. Large businesses are subject to many rules under the ACA that do not apply to small businesses.

The Affordable Care Act presents several opportunities for large businesses related to the insurance coverage options they provide to their employees.

  • The opening of the Small Business Health Options Program (SHOP) marketplace to businesses with 50-100 full-time employees in 2015 will offer employers additional insurance plan options.
  • According to the panel discussion, quality of insurance coverage and healthcare is expected to increase for employees at large businesses.
  • The delay of the Employer Shared Responsibilities Provisions until January 1, 2015, for businesses with more than 100 full time equivalent employees, allows employers more time to strategically position themselves to provide insurance in order to avoid associated penalties. Qualifying businesses with 50-100 full time equivalent employees have until January 1, 2016, to comply with the provisions.
  • Businesses that choose to participate in health insurance plans can use benefits as a recruiting tool to potentially attract higher-quality candidates than those who choose to pay the fees associated with not providing coverage.

What has the Affordable Care Act made more challenging for large businesses?

Large businesses have a greater responsibility than small businesses under the Affordable Care Act. A number of deadline changes have made the roll-out of the healthcare law even more confusing for large employers. Added expenses, additional reporting and mandatory coverage for all full-time employees are further complicating the process for large employers.

The following challenges face large businesses under the healthcare law:

  • Reporting responsibilities for large businesses mean added infrastructure is needed. In 2015, large businesses must start reporting on whether insurance was provided to employees, what type of coverage was offered, and some companies may be required to report on the value of the insurance provided to each employee on his or her W-2.
  • Guidance and regulations continue to evolve, making it challenging to plan and comply with the law.
  • Cost of insurance has increased (in most cases) due to plan design limitations and fees or taxes imposed by the Affordable Care Act.
  • Insurance rates may increase for employers if plan participation is low.
  • Employees may not be able to keep their current insurance plans due to ACA mandates.
  • Large companies that do not offer affordable coverage may be subject to penalties of up to $3,000 per subsidized employee.

What’s ahead for business owners?

Large businesses need to decide if they are going to pay or play by the January 1, 2015, deadline.

“When we talk about next steps, I recommend that companies prepare for the compliance and reporting requirements,” said panelist Alexis DeLuca. “Inevitably, whether a large business chooses to pay or play, they’re likely going to end up with a larger reporting burden than they planned for.”

According to DeLuca, businesses should take steps to ensure they are ready to comply with the changes as they roll out. Investing in the infrastructure needed to accurately report, capturing the required data and planning ahead for annual assessments of health insurance options by contacting an insurance broker or a tax advisor will help large businesses manage the impact of Affordable Care Act.

Louis Balbirer, CPA, is a director of tax services with Kaufman Rossin, one of the top CPA firms in the U.S. He has 20 years of experience providing tax and accounting services to clients and can be reached at

Tags: NetMinder, health insurance, Affordable Care Act, insurance broker, healthcare reform, ACA, healthcare exchanges, Health plan

Join Me at World Congress!

Posted by Aaron Groffman on Wed, Feb 20, 2013

World Congress logoHealth plans, insurance carriers and brokers will convene March 13-15, 2013, to learn how to leverage ancillary and voluntary products to increase their competitive edge and meet the needs of a consumer-driven market.

The World Congress 3rd Annual Leadership Summit on Ancillary Products and Voluntary Benefits will take place in Orlando and feature industry-leading speakers from CIGNA, United Healthcare, VSP Visioncare, Integrated Benefits Institute, Prudential, Blue Cross and Blue Shield, Health Plan Week and more. Session topics include meeting consumer needs, health reform, member acquisition, public and private healthcare exchanges, business innovations and other issues affecting the healthcare industry.

Join me on March 14th as I present “Using BIG Data to Get BIG Results in Ancillary Benefits.” We will explore the following ideas:

  • What’s big data? Does it apply to healthcare?
  • Learn how other carriers are using their big data to create competitive advantages.
  • Teach your sales and network teams to leverage big data to get big results.

If you'd like to attend the World Congress, be sure to register with promo code TAU676 and save $400 off of your attendance fee! (Discount is not valid toward government rates.)

I would love to see you in Orlando. Will you be attending the summit? 

Tags: dental insurance, Ancillary benefits, Vision insurance, Managed Care, Specialty Benefits, Ancillary Products, Voluntary Benefits, Benefit Design, Benefits Consultants, Insurance Brokers, Health plan, World Congress





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