iLoveBenefits: Industry News Blog

I can get my $1 Coke and my $1 dollar burger, but where’s my $1 salad?

80% of consumers say they wish “doing healthier things didn’t cost so much”

According to a recent consumer survey by Cigna:

  • 75% fear health costs could ruin prospects for secure retirement.
  • 44% worry health costs will limit ability to pay for child’s college.
  • 42% of consumers note hospitalization as their number one health cost concern.
  • 19% of consumers note health costs for a spouse or partner as their number one health cost concern.
  • 16% of consumers note costs of medications as their number one health cost concern.

Note: “Health and Financial Well-being: How Strong Is the Link?” was conducted electronically via a panel by MRops Data Collection from August 7 – 21, 2014 with 1,847 women and men 25-64.

The health of a community is much more than health care

Everyone’s destiny is health care. We have poured billions into the clinical side of health care. We have made huge progress in what we can do to improve outcomes for people. The issue of disparate impact in health care is a vexing one. We are beginning to observe that Socio-Economic Status is a huge predictor of health and health care. We need to do more than simply pour money into health care. We need to pay attention to health and the contributors to health including education, jobs, nutrition, safety and many other factors. Here is a story that is beginning to identify these issues. We need to do more at the community level. We need to build consensus among the many stakeholders in the community — all of whom play vital role in the health of a community.

Report: Physicians should address patient social issues to improve outcomesPhysicians should address social issues, such as housing and access to healthy food, as part of efforts to improve quality outcomes and reduce costs, according to a Manatt Health Solutions report commissioned by The Commonwealth Fund. One option for funding social support services may come through patient-centered medical homes, the report said. Medscape (free registration) (6/13)

Will ACOs replace health insurers?

Consider the author. . .

Posted on April 19, 2012 by AHIP Coverage


Ever since Accountable Care Organizations (ACOs) have come into existence some have speculated that these entities could eventually replace health insurers altogether.   What often gets overlooked in these discussions is the critical role that health plans play in the delivery system and how the programs and support they provide are essential to making ACOs and other new payment models work.

Here are several reasons that ACOs will never replace health insurers:

First, health plans are in a unique position in that they see a patient’s entire interaction with the health care system.  Doctors and hospitals are limited to their direct interaction with the patients that come through their doors and information that patients tell them.  Health plans on the other hand see the whole picture.  Health plans have information on whether the patient is filling his/her prescription or getting care in another setting.  This information is critical to diagnosing patients correctly and helping to ensure they are getting the best care possible.

Second, rather than ACOs replacing health plans, the experience in the private sector demonstrates that health plans and the support they are able to provide to clinicians are essential to making ACOs work.  An article in the September issue ofHealth Affairs found that not all providers are equally prepared to enter into accountable care arrangements and that flexibility and the technical assistance and support of health plans is key to the success of these arrangements.  Unlike the Medicare ACO program which takes a one-size-fits-all approach, health plans are able to tailor these initiatives based on the readiness of providers and are able to offer assistance in a number of critical ways, such as helping to coordinate care and providing physicians with detailed, real-time data on how their patient population is doing.

Finally, if doctors and hospitals were to take on all of the responsibilities of health insurance they would then be subject to all of the numerous rules and regulations that govern health insurers today.  These include laws and regulations governing marketing, reserves, claims payment, underwriting, disclosure, and all of the new health insurance regulations included in the ACA, such as caps on administrative costs and regulation of premium rates.  It is not likely that doctor’s offices and hospitals will want to take on all of these responsibilities.  Even more, providers don’t have any experience managing risk – something health plans have been doing for decades.

Health plans do far more than just administer health insurance benefits and pay claims.  Too often policy discussions ignore all of the things health plans are doing to improve care and reform the delivery system – things that other stakeholders don’t have the ability, infrastructure, or incentive to do.  These include:

Read more here: http://www.ahipcoverage.com/2012/04/19/will-acos-replace-health-insurers/