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UnitedHealthcare Plans to Expand Exchange Presence

Posted by Laura McMullen on Tue, Aug 12, 2014

UnitedHealthcare is betting that the health insurance exchanges are sustainable for the long-term, Kaiser Health News reported in July in a post titled Biggest Insurer Drops Caution, Embraces Obamacare.

What’s behind this decision?

  • understandingtheaca resized 600The marketplaces look viable, even without some of the government safeguards like risk-sharing and reinsurance support that will end after the first few years.
  • The pricing is clearer. With six months of claims experience from millions of people, UnitedHealthcare believes they can accurately rate their products.
  • The regulations are in place. Many of the pending lawsuits have been decided.
  • Consumer behavior is more certain. Even with all of the delays and challenges during the initial implementation of the federal exchange, millions of transactions have been completed and UnitedHealthcare believes “there’ll be some shopping, even though people don’t have to shop,” according to Jeff Alter, head of UnitedHealthcare’s employer and individual insurance division. “The natural consumer play of an exchange is going to cause a shopping experience.”

Does UnitedHealthcare’s entry change anything about your exchange strategy? Is this an attractive market for starting or expanding an insurance company?

Tags: health insurance, Affordable Care Act, healthcare reform, ACA, healthcare exchanges, consumer choice, Obamacare, insurance companies

More Health Systems Becoming Payers

Posted by Aaron Groffman on Thu, Sep 05, 2013

More than 20 percent of hospitals and health systems in a recent survey said they are planning to launch a health insurance plan by 2018.

Another 34 percent of respondents said they already own health plans. The June 2013 survey was conducted by by the Advisory Board Co., a Washington, D.C.-based research and consulting firm, and included more than 100 U.S. hospitals and health systems.

Health insurance exchanges, the aging boomer population, increasing cost and reimbursement pressures and an industry-wide move toward population health are driving many health systems’ decisions to become payers, despite the risk of that move in the continually changing healthcare industry.

North Shore-LIJ Health System, a Long Island, NY-based hospital system, plans to offer its health plan called CareConnect on the state health insurance exchange beginning October 1st.

Providers that offer health insurance typically offer a narrow network composed of their own hospitals and affiliated physicians. But in order to be successful, a network must include enough facilities and physicians to provide access and member convenience. Therefore, some health systems are joining forces to create health plans with stronger networks than either could offer on its own.

For example, Piedmont Healthcare and WellStar Health System, two Atlanta-based systems, are partnering on a health plan called the Georgia Health Collaborative that will offer commercial and Medicare Advantage products starting in 2014.

If you were starting a health plan, how would your network compare to your competitors?

Tags: network growth, network providers, health insurance, Affordable Care Act, Healthcare, Healthcare, healthcare reform, health reform, healthcare benefits, Obamacare, health insurers

Heard About Your Customers May Already Be Using It.

Posted by Aaron Groffman on Wed, Jan 02, 2013

describe the imageIf you haven’t already been to, I suggest you visit. The U.S. Department of Health and Human Services (HHS) introduced the website as a way for consumers to shop for health insurance, and businesses are also using it to research group plan options for their employees. includes information from hundreds of insurers about thousands of coverage plans in all 50 states. This tool can be especially useful for small businesses looking for cost and coverage estimates for small groups and options for in-network versus out-of-network benefits, deductibles and co-pays.

HHS launched the site about a year ago under the requirements of the Affordable Care Act. Users can submit basic information about the type of insurance coverage they need (for an individual or group of up to 50 employees) to generate a list of results with estimated costs and advanced filtering options.

What does this mean for brokers and payers? Consumers and business owners are hungry for information and they have the tools to start the research phase of the buying process on their own. However, as they move further down the sales funnel, they would benefit from the guidance of an experienced insurance professional who is knowledgeable about the available benefit options and able to provide more accurate pricing as well as a competitive network adequacy assessment.

So, have you been to How do you think consumers and businesses will use it?

Tags: health insurance, Affordable Care Act, Healthcare, insurance broker, healthcare reform, health reform, Obamacare, employee benefits, benefits advisor

Affordable Care Act Makes Strategic Benefits Advisors More Important Than Ever

Posted by Aaron Groffman on Wed, Dec 12, 2012

I recently attended a presentation by Beverly Beattie, president and CEO of Selden Beattie Benefit Advisors, Inc. Beverly addressed an audience of entrepreneurs and small business owners and explained the impact of the Patient Protection and Affordable Care Act on the increasingly complex and competitive employee benefits marketplace.  While many in the industry assume that brokers will become marginalized as a result of healthcare reform, I came away from the presentation believing that a strategic benefits advisor is more important than ever.

Businesses have many decisions to make over the next 12-24 months as the healthcare reform law is implemented. For example, businesses with 50 or more employees have to decide if they will “pay or play.”  Will they opt out and pay penalties or offer employee health insurance when the new rules go into effect in 2014? Many employers who do not currently offer health insurance may decide to do so after performing a cost-benefit analysis – which, of course, is good news for insurers.

It’s important for health care companies to identify those brokers and advisors in their distribution channel who are truly strategic (versus transactional), because I believe these will be the best sources for the new business opportunities that are certain to result from the complexities and changes of healthcare reform.

Tags: Affordable Care Act, Healthcare, insurance broker, healthcare reform, health reform, Obamacare, benefits advisor





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