May 2010 Archives

How will the new health care reform law affect the current slow movement toward consumer-directed health plans? Will the economics of the post-reform world encourage employers to offer them? Does it make sense to provide them as an option in state health exchanges? Or are they a thing of the past that will disappear altogether as coordinated care models emerge?

Last year, the prevalence of these plans grew, as 15 percent of employers with 10 to 499 employees offered them, compared to 9 percent a year earlier, according to a survey conducted by the employer consultant Mercer. Among larger employers with over 500 workers, Mercer found that the prevalence of consumer-directed health plans remained constant at 20 percent.

What does the future hold for consumer-directed health plans?

5 responses: Larry C. McNeely II, Paul B. Ginsburg, Michael F. Cannon, Paul Fronstin, John C. Goodman

Insurers beginning in January will have to spend 80-85 percent of collected premiums on medical services and quality improvements, and there's an enormous looming question (subscription) about what should count toward meeting the requirement.

Should disease management or nurse hotlines count, for example, even though there are administrative costs involved? How much proof must there be of a direct connection between activity and quality improvement?

Exactly how much leeway should insurers have? And are the new medical loss ratio levels fair and achievable, especially in the individual insurance market, where carriers have to pay brokers?

Sen. Jay Rockefeller, D-W.Va., last week warned that some insurers already are gaming the system to get around the rules. A recent Commerce Committee report found that the insurer WellPoint has announced it has started reclassifying such expenses as nurse hotlines, disease management, and clinical health policy as medical rather than administrative expenses.

Rockefeller wants to require insurers to demonstrate that expenses improve health care quality based on the definition of quality-improving activities in the "existing research on health care quality that the Agency for Healthcare Research and Quality has performed in consultation with non-governmental entities."

5 responses: Karen Davis, Paul B. Ginsburg, Karen Ignagni, Gail Wilensky, Janet Trautwein

What is the most effective use of new health care reform money to promote prevention and wellness? Should the emphasis be on reversing the obesity trend? Encouraging immunizations? Diet and exercise?

The new law establishes a prevention and public health fund for research and health screenings and immunization programs. There would be $7 billion through 2015, and $2 billion a year after that. Also, a grant program would support the delivery of evidence-based and community-based services aimed at prevention activities, reducing chronic disease rates and addressing health disparities.

By September, health plans will have to cover preventive services recommended by a new U.S. Preventive Services Task Force, without charging patients any cost sharing. But which preventive services are the most important to include under that requirement?

7 responses: Sen. Tom Harkin, D-Iowa, Marilyn Werber Serafini, Christine Ferguson, Grace-Marie Turner, Kenneth E. Thorpe, Jack Lewin, John C. Goodman

How significant are the findings from Medicare actuary Richard Foster that the new health care reform law will expand insurance to 34 million people but actually raise health care spending by about 1 percent before potentially saving money after the first decade? Is this a problem, and was it unexpected?

Foster also forecast that reductions in Medicare spending could force 15 percent of hospitals into the red, and send up to 50 percent of seniors who get their health care through Medicare Advantage plans back into the program's traditional fee-for-service coverage. The projections don't account for the law's tax on high-cost health care plans.

What could Washington or states do to achieve quicker savings?

8 responses: Grace-Marie Turner, John Sheils, Ralph G. Neas, Uwe Reinhardt, John C. Goodman, Uwe Reinhardt, Karen Davis, David Cutler