Crains Article on Broker Commissions Cuts

by admin | Nov 12, 2012 | Health Care Reform, Health Exchanges, Individual Exchanges, PPACA, SHOP Exchanges, Small Business Group Health, State Exchanges

Crains Brokers’ Commissions Face Uncertain Future. A quick comment on our quote in Crains “Crains Brokers’ Commissions Face Uncertain Future” today. Insurers are indeed cutting back on services resulting in cost containement measures such as layoffs, outsourcing and significant broker commissions cuts.

A significant negative development is the NYS decision to not allow licensed Agents/Brokers in the Individual Exchange. Many States such as Massachusettes, the inspiration for Health Care Reform, use a Connector which is an Exchange or an independent state agency that helps Massachusetts residents find health insurance coverage and avoid tax penalties. Instead NYS will allow Agents/Brokers to only work in the Commercial Exchange known as SHOP. HealthPass is a good pre-cursor of the SHOP Exchange offering Small Businesses a Defined Contribution Health Plan of full options form Health Insurance, Dental, Vision to Term Life Insurance and Disability.

The Individual Exchange will work with an “Assitor” or “Navigator”. In NYS Government and Non-Profit Agencies will comprise the “Navigator” which will only be allowed to operate in the Individual Exchange. By design an income subsidy will only pass through this Individual Exchange an not on the SHOP Exchange. Example: a $50,000 Family Household of 4 can get approximately 80% credited.

The Federal Gov has already spent $2.2 Billion on State Exchanges. And this figures does not include remaining States as there are only 19 States working on an Exchange for 2014. The Exchanges will be built up for 2 years and then must be fully independent by 2016. If 88% of small groups coverage purchased by Brokers acc. to Bostons Wakely Report in research study- Role of Producers and Other Third Party Assisters in New York’s Individual and SHOP Exchanges the distribution infrastructure is already there. Access to care is not the difficulty in finding a plan its the very cost of the plan! Why then does NYS decide to spend on building up new infrastructures? AgentsBrokers can easily outreach and council to uninsured as well. In fact many small businesses such as construction, consulting services and dining have many uninsured that an Agent/Broker already has a relationship with.

Despite all this and the rapid changes in reshaping health care we remain optimistic and look forward to taking on a greater role in health care reform.

With more choice, our groups and their employees will need more direction, allowing brokers to take on more of a consultative role. Healthcare plans are not a simple purchase and one plan doesn’t fit all. By delivering the latest cutting-edge benefits technologies, continued consumer focus approach and leveraging our long time relationships with Benefits/HR/Payroll partners our role will be pivotal in being part of the solution.

Pulse Nov 2012 Quote MMS

New Summary of Benefits Coverage Notice

by admin | Sep 13, 2012 | Health Care Reform, PPACA

New Summary of Benefits Coverage Notice Summary of Benefits Coverage Sample Summary of Benefits Coverage Sample Reminder: New SBC Notice Requirements Take Effect Soon

After a six-month delay in the original effective date, group health plans (including grandfathered plans) will soon need to comply with a new requirement under Health Care Reform to provide a summary of benefits and coverage (SBC) so that employees can more easily compare insurance options.

The new SBC notice requirements are effective for plan years and open enrollment periods beginning on or after Sept. 23, 2012. If you need a refresher, the following are some key points for group health plans:

An SBC must be provided to plan enrollees at specific times, such as upon application for coverage and at renewal, as well as upon request.
Insured group health plans can satisfy the requirement if the issuer provides a timely and complete SBC to the participant or beneficiary.
Combining information for different coverage tiers, different cost-sharing selections (such as levels of deductibles and copayments), and different add-ons to major medical coverage (such as FSAs, HRAs, HSAs, or wellness programs) into one SBC is permissible, provided the appearance is understandable.
SBCs may be provided either as a stand-alone document or in combination with other summary materials (for example, an SPD), if the SBC information is intact and prominently displayed at the beginning of the materials and in accordance with the SBC timing requirements.
The SBC must comply with certain appearance and format requirements and must use terminology understandable by the average plan enrollee; an SBC template along with instructions and related materials that may be used to satisfy the notice requirements, is available online.

The U.S. Department of Labor has released three sets of Frequently Asked Questions (FAQs) which address a number of issues relating to the SBC notice requirements. The FAQs also make clear that, during the first year of applicability of the new SBC rules, penalties will not be imposed on plans that are working diligently and in good faith to provide the required content in an appearance that is consistent with the final regulations.

Summary of Benefits Coverage Sample

Doctor Shortages-covered but less access?

by admin | Aug 30, 2012 | group health insurance, Health Care Reform, PPACA

Doctor Shortages-covered but less access?

With increase in demand and already shortages of Doctors the Obamacare – Affordable Care Act will put significant severe strains on patient access.

According to todays WSJ article – John C. Goodman: Why the Doctor Can’t See You “Here is the problem: The health-care system can’t possibly deliver on the huge increase in demand for primary-care services. The original ObamaCare bill actually had a line item for increased doctor training. But this provision was zeroed out before passage, probably to keep down the cost of health reform. The result will be gridlock.”

The Department of Health and Human Services, estimated the minimum number of primary care physicians to ensure “adequate supply” at 60 to 80 per 100,000 population. By 2020 an estimated 45,000 new PCP would ne needed 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.

The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.

“Take preventive care. ObamaCare says that health insurance must cover the tests and procedures recommended by the U.S. Preventive Services Task Force. What would that involve? In the American Journal of Public Health (2003), scholars at Duke University calculated that arranging for and counseling patients about all those screenings would require 1,773 hours of the average primary-care physician’s time each year, or 7.4 hours per working day.”

In 2014 an expected 30 Million people will be added The expected wait time would increase form 3 weeks to about 2 months. The 2 month estimate is a approximately how long it takes to schedule a check up in Boston which had enacted universal healthcare 5 years ago. Furthermore, the positive measures to encourage preventive care such as healthy screenings and well-care will only add to the gridlock.

“When people cannot find a primary-care physician who will see them in a reasonable length of time, all too often they go to hospital emergency rooms. Yet a 2007 study of California in the Annals of Emergency Medicine showed that up to 20% of the patients who entered an emergency room left without ever seeing a doctor, because they got tired of waiting.” Be prepared for that situation to get worse even with Urgent Care Centers.

“A New York Times survey of dermatologists in 2008 for example, found an extensive two-tiered system. For patients in need of services covered by Medicare, the typical wait to see a doctor was two or three weeks, and the appointments were made by answering machine.However, for Botox and other treatments not covered by Medicare (and for which patients pay the market price out of pocket), appointments to see those same doctors were often available on the same day, and they were made by live receptionists.”

As with any economic model the shorter supply of provider will drive up costs. Aside form provider fees increasing, those who can afford concierge service and pay $2,000-$4,000 may be able to get same day services and easy access but for most Americans with insurance will be waiting longer to see their Doctors. The irony is that people with coverage will have limited access to care.

Aetna and Hunterdon HealthCare Partners Forge New Accountable Care Relationship

by admin | Jul 18, 2012 | Health Care Reform, PPACA

Aetna and Hunterdon HealthCare Partners Forge New Accountable Care Relationship

Hunterdon Healthcare employees and Aetna members in 5 NJ counties will benefit from new ACO committed to higher quality more coordinated care

HARTFORD, Conn.–(BUSINESS WIRE)–Aetna (NYSE: AET) and Hunterdon HealthCare Partners today announced a new accountable care agreement that will improve the quality and cost of patient care, helping members and plan sponsors save money. Hunterdon Healthcare is establishing an Accountable Care Organization (ACO) to deliver a better patient experience, and aims to improve the quality of patient care while reducing the overall cost of care.

“Becoming an ACO not only supports our mission to deliver better access to primary care and specialist physicians, but will allow us to better provide integrated healthcare to improve the health of our community.”

“We are excited to bring our industry-leading technology and care management capabilities together with Hunterdon’s quality-driven team to offer highly coordinated and comprehensive care management to members in New Jersey,” said John Lawrence, president, Aetna New Jersey market. “Beginning this summer, 8,000 Hunterdon Healthcare employees and Aetna members will receive health care in this new patient-focused, accountable care model.”

An ACO is a group of health care providers who coordinate care and are accountable for cost, quality and patient satisfaction for the health care they provide.

“In the past several years, the healthcare industry has changed with the demands of health care reform. The industry trend is shifting from paying for services, regardless of patient outcomes, to paying for care that delivers better value, quality and patient satisfaction. Collaborating with Aetna will help Hunterdon Healthcare deliver better care at a better price. We think patients will see direct benefit from this approach,” explained Robert P. Wise, president and CEO, Hunterdon Healthcare.” Jeffrey Weinstein, executive director for Hunterdon HealthCare Partners added, “Becoming an ACO not only supports our mission to deliver better access to primary care and specialist physicians, but will allow us to better provide integrated healthcare to improve the health of our community.”

About the Hunterdon HealthCare Partners ACO

Under the new ACO agreement, 2,200 members in the Hunterdon Healthcare employee benefits plan, and approximately 5,700 fully insured Aetna members who live in Hunterdon, Mercer, Warren, Morris and Somerset Counties will be served by the ACO. Aetna members served by this new model are ones who primarily received care from Hunterdon Healthcare’s providers in the last 24 months, as well as those who seek care from Hunterdon Healthcare physicians following the start of the agreement.

Hunterdon Medical Center, more than 225 affiliated primary care physicians and specialists, and the affiliated ambulatory surgery, radiology, hospice, and other Hunterdon Healthcare facilities and providers will all be part of the ACO. Working together, and supported by a full suite of Aetna health information technology and care management capabilities, the providers will become part of a coordinated health care network and receive notices of any treatments and medications the patient may be receiving. As a result, the patients will receive an enhanced level of coordinated care in addition to the member benefits of their current Aetna plan.

Aetna and Hunterdon HealthCare Partners are implementing a payment model that will change the way Hunterdon Healthcare is reimbursed for care. Under the ACO agreement, Hunterdon Healthcare will be paid based on achieving certain quality, efficiency and patient satisfaction measures, which are designed to:

improve the patient’s health care experience through greater care coordination and patient engagement;
improve the health of populations; and
reduce the cost of health care by aligning payment with quality, patient outcomes and value.

The measures include, but are not limited to:

the percentage of Aetna members who receive recommended preventive care and screenings, such as increased cancer screenings, flu shots and other vaccinations;
improved management of patients with chronic conditions such as diabetes, heart failure and asthma;
reductions in hospital readmission rates; and
reductions in Emergency Room visits by improving primary care access hours.

Aetna’s Technology Support

To support the full success of the ACO, Aetna will implement the following integrated technologies and capabilities for Hunterdon HealthCare Partners:

health information exchange technology from Medicity, a wholly-owned subsidiary of Aetna, to enable the secure, two-way exchange of health information across a patient’s entire care team, including hospitals, physicians, labs, pharmacies and other ambulatory services;
point-of-care clinical decision support services and the Active CareTeam^SM desktop-based workflow tool to track, monitor, coordinate and report on patient health outcomes from ActiveHealth Management a wholly-owned subsidiary of Aetna; and,
reporting tools that will help Hunterdon Healthcare providers evaluate how they are performing against their targeted clinical and financial outcomes.

About Hunterdon HealthCare Partners

Hunterdon HealthCare Partners was created by physicians and the Hunterdon Healthcare System, the parent organization of the Hunterdon Medical Center. The partnership’s goal is to provide the residents of Hunterdon County and the surrounding areas better access to integrated care delivered through their network of primary care and specialist physicians. For more information, contact Jeffrey Weinstein at Weinstein.Jeffrey@hunterdonhealthcare.org.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 36.1 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services and health information technology services. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.

Photos/Multimedia Gallery Available: http://www.businesswire.com/cgi-bin/mmg.cgi?eid=50342381&lang=en

(Source: Business Wire )

Also See: NYU Beth Israel Hospital Merger and ACO

Union Plans and Obamacare

by admin | Jul 16, 2012 | COBRA, Health Care Reform, individual health insurance, PPACA

The Con Ed lockout this Summer couldn’t come at a more heady time. I’m not referring to the obvious temperature swelter but more to the employee health benefits that are at the back bone of virtually every recent Labor dispute. With the Con Ed dispute, Management’s has acquiesced on the health insurance . “Con Ed did accede to “public pressure” on Sunday by reinstating health insurance for the 8,500 members of Local 1-2 of the Utility Workers Union of America, a company spokesman said. The workers have been collecting unemployment benefits for two weeks but had to pay for their own prescription medicine and doctor visits because the company cut off health coverage when the old contract expired, at midnight June 30.”

Interestingly, Unions are major stakeholders in Healthcare as their benefits have been traditionally rich incentives attracting to workers. However, with A.C.A. (Affordable Care Act) otherwise known as Obamacare their health programs are very much in danger of additional taxation or member withdrawal. Unions estimate these provisions will raise the cost of health coverage by an additional $1,000 a year. In fact, a Union members may fare better on the Individual Mandated Exchange with projected individual direct insurance dropping 70% things will open up. A lower/middle income member will likely qualify for an additional discount credit. A more affordable health plan just may be a possibility.

There are other reasons the Individual Health Plan may be better:

Unions as other self insured group must now comply with added benefits for preventive care, maternity care, Age 26 dependent care, pre-existing condition waivers.
No Annual Limits on essential benefits by 2014
No Lifetime Limits
No more mini-med plans – discount health plans are prohibited. The movie John Q , based on a true story, where a father is told his son’s transplant will not be covered based on th elicited mini-med plan covering him up to $20,000. Large companies such as McDonald’s have also sponsored mini meds.
Cadillac Tax – By 2018 a 40% excise tax on health plans that exceed $10,200(single) and $27,500 (family).

The original Cadillac Tax was pushed back by the behest of Unions to 2018 from the original proposed 2014 date. Most Unions with generous health care packages would not be complaint within that time frame.

However, not all is grim for Unions. HHS has issued waivers to 1,625 plans covering 3,914,356 individuals were exempt from these mandates through 2014. According to Heartland “More than half of the approximately four million individuals receiving waivers are union members, including 82.9 percent of those covered in the most recently updated list of waivers.”

With current administration posts coming from Union there wouldn’t be much surprise if these allowances continue. Would it be that bold to predict for Union Members in 2014 will be allowed to use their Individual Exchange income tax credits for their Union benefits packages? Small businesses may not be as lucky.

Individual Mandate Upheld

by admin | Jun 28, 2012 | Health Care Reform, individual health insurance, Obamacare, PPACA, Tax

At 10 AM today the Supreme Court in a 5-4 decision upheld the Patient Protection and Affordable Health Care Act’s individual mandate as constitutional.

The text of the opinion, in National Federation of Business vs. Sebelius, Case Number 11-393, is available here.

Imposition of a tax “leaves an individual with a lawful choice to do or not do a certain act, so long as he is willing to pay a tax levied on that choice,” Roberts says. “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”

According to Footnote 11, which is on page 44 of the slip opinion: Those subject to the individual mandate may lawfully forgo health insurance and pay higher taxes, or buy health insurance and pay lower taxes. The only thing that they may not lawfully do is buy health insurance and not pay the resulting tax.With this decision finalized, New York State (and the rest of the country) can now move forward with implementing the law. We embrace the much-needed clarity and looking forward to working with our clients moving ahead.Millennium Medical Solutions Corp will be planning health care seminars to review the decision and overview to help understand the impact on employers, plan benefits, and providers. We welcome your suggestions on specific topics or questions you want us to focus on. Please join us!

Our office will continue to monitor events and inform our members of any other important news.

Imndiv Mandatae requirement_flowchart_3