iLoveBenefits: Industry News Blog

What provider network does your health plan offer?

Over 60% of health insurers have changed network strategy since 2014, with 53% using tiered and 42% using narrow networks, according to a recent report. Source: “Journey to Value: The State of Value-Based Reimbursement in 2016,” McKesson, June 2016, http://mhsinfo.mckesson.com/rs/720-XWV-189/images/McKesson-Journey-to-Value-State-of-VBR-2016.pdf

July 11, 2016 | Categories: Benefits,healthcare,insurance | Tags: , , , | Comments (0)

The Evolution has Begun

Survey: Teens and Digital Health Information

Northwestern University recently conducted a national survey regarding teens and their approach to digital health information. Here are some key findings from the report:

  • 84% of teens have gotten health information online.
  • About a quarter (21%) of teens have used digital health tools (mobile apps, digital games, wearables).
  • 32% say they have changed their behavior due to digital health information or tools.
  • A third of teens turn to the Internet when a health issue arises to check symptoms and diagnose themselves.
  • 1 in 10 teens say they get “a lot” of health information from social networking sites.
  • Fitness (42%) and nutrition (36%) are the top health issues teens research online.

Source: Northwestern University, June 2015

What is the effect of narrow networks on premiums?

The Urban Institute and RWJF released a new report that suggests narrow networks aren’t the only tool available to reduce premiums and maintain access to highly ranked hospitals.  The report concludes that “almost all insurers offer plans that include in their networks access to many highly ranked hospitals.  Moreover, all hospitals in the cities we examined were in at least one Marketplace plan’s networks. Finally, the size of networks was not necessarily tied to premiums.  Though narrowing networks generally led to more competitive and lower premiums (and certainly lower than if the same insurer had a broader network), some plans with broad networks had low premiums and some with narrow networks had high premiums.  Insurer market share and negotiating power can influence premiums independently of network size.”

After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know

Getting needed care is difficult by itself. Understanding what you will need to pay daunting. But making decisions about getting in network care is often well understood by patients. However, there are many care decisions that patients don’t make, are unable to make and are often made for them. This NYT article illuminates the practices that many patients encounter.

There needs to be public policy that sets forth the following: For an elective procedure, if a patient selects an in network hospital and an in network surgeon or primary care doctor then all other providers not selected by them must be handled, for insurance coverage purposes, as if they were in network as well…

“He was blindsided, though, by a bill of about $117,000 from an “assistant surgeon,” a Queens-based neurosurgeon whom Mr. Drier did not recall meeting.

. . .

In many other countries, such as Australia — where, as in the United States, people often rely on private insurance — it is seen as a patient’s right to be informed of out-of-pocket costs before hospitalization, said Mark Hall, a law professor at Wake Forest University.”

Read more here: http://mobile.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=1&referrer

A few insights into what consumers consider in their health plan choice

According to a recent survey:

  • Overall, 51% prefer a health plan that costs more money but allows them to see a broader range of doctors and hospitals
  • Overall, 37% prefer a plan that is less expensive but limits the range of providers they can visit
  • Among those who are either uninsured or currently purchase their own coverage, 54% prefer cheaper narrow network plans, while 35% prefer more expensive plans with broader networks
  • Among those who currently get their insurance through an employer, 55% prefer a more expensive plan with a broader network, while 34% prefer a cheaper narrow network plan

Source: “Kaiser Health Tracking Poll: February 2014,” The Henry J. Kaiser Family Foundation, February 26, 2014, http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-february-2014/

International care issues similar to those in the US

Many countries face similar health and health care concerns. The United States, aside from the absolute cost of care, is not that different in its search for improvements in health, health care, innovation and the rapidly rising rates of health care costs. Here is a sample from across the globe as reported by the Commonwealth Fund.

Australia

Prices of Generic Drugs Reduced Under Australian Government Reforms

The price of more than 1,000 different generic drugs was reduced in April as part a series of reforms to the Pharmaceutical Benefits Scheme, an Australian government program that provides subsidized prescription drugs to all residents. [Read more]

Canada

Legislation to Regulate the Price of Generic Drugs Introduced in British Columbia and Ontario

The government of British Colombia has introduced legislation to reduce the price of generic drugs after a failed price regulation deal with the pharmacy industry. [Read more]

Doctors Now Able to Use Mobile Devices to Access Patient Records

Doctors and other authorized health professionals can now use mobile devices to access their patients’ records for hospital visits, treatments and procedures, and tests and hospital lab results at 28 hospitals across the Hamilton region and other parts of southern Ontario. [Read more]

France

Agreement Signed to Strengthen Role of Pharmacist in France

Three unions representing pharmacists in France signed an agreement with the national health insurance plans to strengthen the role of pharmacists in improving the quality of medication management and providing support for patients. [Read more]

Netherlands

Dutch Patients to Pay for Out-of-Network Care

Health Minister Edith Schippers announced that health insurers will no longer be required to cover medical bills in full if patients go to a provider who is outside their health insurance network. [Read more]

New Zealand

Asthma New Zealand Launches New Smartphone Application

A new application for smartphones allows asthma patients in New Zealand to better monitor their health. [Read more]

United Kingdom

U.K. Health Secretary Underscores Importance of Empowering Local Groups

In response to concerns that the National Health Service (NHS) Commissioning Board Authority will increase its own responsibilities, the U.K. Health Secretary Andrew Lansley recently emphasized the importance of decentralizing power in the NHS in a letter to the chairman. [Read more]