iLoveBenefits: Industry News Blog

62% of Exchange Plans Will Be HMOs in 2017



McKinsey & Company recently released an analysis of 2017 exchange plan designs across the U.S.

Here are some key findings from the report:


HMOs will comprise 62% of all plans for 2017.
68% of consumers will have access to competitively priced managed plans only.
The lowest-price silver plan premium will increase 9% for managed plans in 2017.
82% of consumers will have access to both managed and unmanaged plans in 2017.
For unmanaged plans, the lowest-price silver plan premium increase will be 18%.
97% of national plans will be managed in 2017, up from 62% in 2014.



Source: McKinsey & Company, August 2016

HMO Redux ? Have we learned our lessons?

“As the role of primary care expands in the evolving healthcare landscape, there has been increasing discussion about expanding the team, and re-tasking members of those teams to allow everyone to “practice up to their licence.” This is a major part of the patient-centered medical home, and integral to making any such transformation successful.”

Then there is this…

“The patient needs to call and reach my office. A telephone encounter is created in the EHR. Now I have to stop what I’m doing, and “create” a referral to the dermatologist, as if this was some sort of magical, healing, useful thing. More often than not we need to select some benign (or made up) diagnosis (“dermatitis” or “nevus, non-neoplastic”) that will allow the patient to be seen, since we most likely do not know why they are there, and allow the dermatologist to be reimbursed by the insurance company.

It’s not just that I don’t want to do this work, it’s not just that it’s tedious work, but it’s work that no one should have to do. A ridiculous administrative burden has been created that prevents every one of us, no matter the level of our licensure, from being able to do the jobs in healthcare that we are desperately trying to do, and that we desperately want to do.”

So are ACO and patient-centered care just recreating the very reasons that HMOs failed? Of course there are all of the improvements and tools that are now being applied, that didn’t exist in the 1990’s HMO era. But from a public relations perspective, have we learned the lessons of the past on the parts of the physician, the physician’s office and the patient?

What did health care cost in 2012?

Average Annual Premiums for Covered Workers, Single Coverage, by Plan Type, 2012

1. HMO: $5,668
2. PPO: $5,850
3. Click to continue

Source: Kaiser Family Foundation

Projected Health Care Cost Increases for 2010

Editor’s note: Here are the projected cost increases for HMO type coverage for 2010. Note that these numbers are before plan design changes. Design changes generally shift cost to the insured either in the form higher copays, deductibles or a reduction in the coverage itself. So, generally speaking the actual cost increases in premiums will be less when actually implemented for 2010.


HMO Rate Increases Expected to Remain at 11.8 Percent in 2010

According to data released by Hewitt Associates, HMO rate increases by region have stabilized for 2010, with less variation by region relative to the national average HMO increase level. Preliminary* HMO rate increases by region for 2010 are as follows:

  • West: 11.1%
  • Southwest: 14.0%
  • Southeast: 13.2%
  • Northeast: 11.3%
  • Midwest: 12.5%
  • National: 11.8%

*Preliminary HMO Increases are before plan changes, negotiations and terminations; data as of July of each renewal cycle.

Source: Hewitt Associates, July 15, 2009.

July 20, 2009 | Categories: Cost,healthcare,Plan design | Tags: , , | Comments (0)

Health Care — What Washington is Selling

Buyer Beware: When you strip away all the talk, all the bills, is what Washington really selling HMOs of the 21st century? Capitation, patient-centered (around a primary care doctor) care…