Health Republic NJ Shutting Down
Health Republic NJ Shutting Down
In yesterday’s surprise announcement, NJ regulators will be shutting down Health republic NJ for 2017 “because of its hazardous financial condition”. This marks the demise of the second Metro area healthcare co-op with the same name-sake Health Republic but different managed healthcare co-op, see Health Republic NY Shutting Down Nov 30.
Since Obamacare’s rollout in the fall of 2013, 16 co-ops that launched with money from the federal government have collapsed. Now, just six co-ops—Wisconsin’s Common Ground Healthcare Cooperative; Maryland’s Evergreen Health Cooperative; Maine Community Health Options; Massachusetts’ Minuteman Health; Montana Health Cooperative; and New Mexico Health Connections—remain.
In a bizarre twist of fate or unintended Affordable Care Act design flaw small affordable startups not only have to gain new client footholds but also support large
established companies “with sicker patients”. Start-ups, by contrast, with much lower rate of diagnosed sick patients essentially pay into this tax. This tax is part of the risk adjustment program intended to stabilize Insurers who took on sicker patients and spread this risk. While some correctly blame too low pricing and some miscalculated business decision-making the inherent extra tax doomed the majority of the original 16 co-ops.
Health Republic in fact grew steadily and made money the first 9 months of 2015. However, HRNJ lost 17.6 million end of 2015 and is choking off at this $46.3 million payment to the government through the risk adjustment program. This is considered one of the 3 R’s of the reinsurance program – risk corridor, reinsurance and risk adjustment that were intended to level the playing field. The first “R”—“reinsurance”—subsidizes insurers that attract individual customers who rack up particularly high medical bills. The second—“risk adjustment”—requires insurers with low-cost patients to make payments to plans that share the benefits with those who insured higher-cost ones. And the third, called “risk corridors,” is a program to subsidize health plans whose total medical expenses for all their Obamacare customers overshoot a target amount.
The co-ops received less money than they initially anticipated last year under Obamacare’s risk corridor program, which resulted in the collapse of at least five co-ops and a $5 billion class action lawsuit filed
by 6 state’s co-ops – ” Oregon-based insurer Moda Health Plan Inc., Blue Cross Blue Shield of North Carolina, Pittsburgh-based Highmark Inc., and the failed CoOportunity Health, which was based in West Des Moines, Iowa, and Health Republic Insurance Co. of Oregon, which was based in Lake Oswego.”
From Politico’s “Obamacare’s sinking safety net”:
“The risk corridor program, however, has been an unmitigated debacle. In December 2014, the Republican Congress voted to prohibit the Obama administration from spending any money on the program, decrying it as a bailout for the insurance companies. Sen. Marco Rubio, then thought to be a leading GOP presidential contender for 2016, was particularly vocal in pillorying the program.
Unlike all those symbolic “repeal Obamacare” votes, Congress actually succeeded in blocking those risk corridor payments, and it hit Obamacare hard. Insurers filed claims seeking $2.9 billion, but under the limits imposed by the GOP there was less than $400 million available to make good on those payments. The end result: insurers initially received only 12.6 cents for each dollar they had counted on. Many of the new Obamacare co-op plans that went out of business blamed their collapse in part on the fact that they’d been counting on the full payments to keep them solvent.”
Regrettably, in a Presidential year no one wants to touch this burning hot potato. Perhaps NJ’s handling of this pressure cooker and taking 2017 off may be the best course of action after all.
As of Monday, September 19, 2016, the portal for Health Republic Insurance will be shut down, as they are no longer accepting new business for the year.
The New Jersey State Department of Banking and Insurance has also provided a list of FAQs related to the shutdown and how it affects individuals, small employers, brokers and providers. For more information, click here.
As always, our team is here to assist you and to help you grow your business.
Hurricane Sandy Recovery Assistance Resources. Department of Small Business Services (SBS) and the New York City Economic Development Corporation (NYCEDC), is coordinating a set of services to assist small businesses in recovering from Hurricane Sandy.
Below is an outline of available programs & relevant contact information:
For small- to mid-sized businesses that have experienced business interruption
An emergency loan for businesses will be available, patterned after similar programs deployed in past emergencies. Loans will be capped at $10,000. Please click this link to contact an NYC Business Solutions Account Manager or call 311 and ask for NYC Business Emergency Loan.
Federal Aid Programs for State of New York Disaster Recovery Loans are available up to $2 million for business property losses not fully compensated by insurance, and for small businesses, small agricultural cooperatives and most private, non-profit organizations of all sizes that have suffered disaster-related cash flow problems and need funds for working capital to recover from the disaster. More information can be found at www.DisasterAssistance.gov, or 1-800-621-FEMA (3362). Information from the Federal Small Business Administration on disaster recovery assistance is also available at www.sba.gov.
For mid- to large-sized businesses that need to undertake rebuilding
An emergency sales tax letter from New York City Industrial Development Authority (IDA) will be available allowing businesses to avoid payment of New York City and New York State sales taxes on materials purchased for rebuilding. IDA will also waive all fees and, while following State law, look to streamline its normal procedure. This program is expected to offer economic benefits to reconstruction projects costing $500,000 or more. Please contact Shin Mitsugi at firstname.lastname@example.org for further information on this program.
For any business that is temporarily displaced from its space
Short-term “swing” office space at Brooklyn Army Terminal available free of charge for the next 30 days. NYCEDC has approximately 40,000 square feet of warehouse space at the Terminal that can be used for this purpose. Please click this link to contact an NYC Business Solutions Account Manager or call 311 and ask for NYC Business Solutions.
For any business in need of other emergency assistance
The SBS Business Outreach Team and Emergency Response Unit’s Large Scale Response Team will be deployed after the storm to help all impacted small businesses. This team is currently on-call for any storm-related business inquiries and is closely coordinating with the NYC Office of Emergency Management. Please click this link to contact an NYC Business Solutions Account Manager or call 311 and ask for NYC Business Solutions.
Federal Aid Programs for Disaster Recovery
Click here for information from the Federal Small Business Administration on disaster recovery assistance.
- State of New Jersey – The state website has a Hurricane Sandy resource center with emergency hotlines, updates from the power companies and how you can volunteer.
If you would like to help those hurt by this storm, here are a few ways:
Visit www.redcross.org, call 1-800-RED CROSS (1-800-733-2767), text the word REDCROSS to 90999 to make a $10 donation, or mail a contribution to a local Red Cross chapter or the American Red Cross, P.O. Box 37243, Washington, D.C. 20013. The Red Cross is providing food and shelter to storm victims.
Visit salvationarmyusa.org, text the word STORM to 80888 to make a $10 donation, confirming the donation with the word, “Yes.” The Salvation Army is providing food and shelter to storm victims.
Visit www.humanesociety.org to support the group’s pet rescue team.
Visit www.redcrossblood.org to find the nearest blood drive site. The Red Cross said more than 360 Red Cross blood drives were canceled due to the storm.
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 CareTeamSM 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.
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.
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(Source: Business Wire )