State Employee Benefit Plans Provide Insight Into Overall Group Benefit Trends

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By Clive Riddle, July 20, 2017


The Summer 2017 edition of Data, Segal Consulting’s publication providing research findings on public sector employee benefits, presents findings from their 2017 State Employee Health Benefits Study. As states are one of the largest employers, and their benefit decision making is directly impacted by policy makers, monitoring the pulse of state employee benefit plans provides insight into benefit trends for group coverage as a whole.


Andrew Sherman, Segal’s National Director of Public Sector Consulting, tells us “health benefits have become more important to state leaders as the cost of coverage outpaces overall inflation, placing budget pressure on health plan funding and underscoring the need for ongoing cost-management efforts. Examining what other states offer can be helpful for these leaders when they make difficult decisions about potential changes in coverage.”


The 23-page issue exclusively presents their study which involved a review of the websites for all 50 states and the District of Columbia in the fourth quarter of 2016, capturing medical, prescription drug, vision and dental plan information, as well as wellness and tobacco-cessation programs, including 105 PPOs/POS plans, 83 HDHPs/CDHPs, 149 HMOs/EPOs and five indemnity plans.


One insight from the study was “there are stark geographic discrepancies to where it is offered. According to the study, 13 Southern States offer HDHP/CDHPs, compared to just two in the Northeast. They are offered in eight states in the Midwest and seven in the West.” This equates to 22% of the states in the Northeast, 76% in the South, 67% in the Midwest and 54% in the West offering consumer driven plans.


Single premium increases averaged 8% for HMO/EPO plans, 10% for PPO/POS plans and 14% for HDHP/CDHP plans. The average single monthly premium was $780 for HMO/EPO plans, $713 for PPO/POS plans and $563 for HDHP/CDHP plans. Single deductibles averaged $194 for HMO/EPO plans, $483 for PPO/POS plans and $1,997 for HDHP/CDHP plans.


For the prescription benefit, single copayments averaged $9 for generic, $29 for brand formulary, $53 for brand non-formulary, and $101 for specialty drugs.


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition


Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:


Millions More Uninsured Could Impact Health Of Those With Insurance, Too

Much has been written lately about how individuals’ health could suffer if they lose insurance under the health proposals circulating in the U.S. House and Senate. But there is another consequence: creating millions more people without insurance could also adversely affect the health of people who remain insured. Kaiser Health News. Friday, July 14, 2017


Senate Republicans Unveil New Health Bill, but Divisions Remain

Senate Republican leaders on Thursday unveiled a fresh proposal to repeal and replace the Affordable Care Act, revising their bill to help hold down insurance costs for consumers while allowing insurers to sell new low-cost, stripped down policies. The New York Times

Friday, July 14, 2017

U.S. Charges 412, Including Doctors, in $1.3 Billion Health Fraud

Hundreds of people nationwide, including dozens of doctors, have been charged in health care fraud prosecutions, accused of collectively defrauding the government of $1.3 billion, the Justice Department said on Thursday. The New York Times Thursday, July 13, 2017


Nursing Homes Move Into The Insurance Business

Around the country, a handful of nursing home companies have begun selling their own private Medicare insurance policies, pledging close coordination and promising to give clinicians more authority to decide what treatments they will cover for each patient.

Kaiser Health News. Thursday, July 13, 2017


Fewer exchange plans available in 2018, CMS says

The Centers for Medicare and Medicaid Services has released what it calls further proof the Affordable Care Act is failing in data showing a 38 percent decrease in the number of health plans available in the individual market for the upcoming open enrollment period compared to this year. Healthcare Finance News. Monday, July 10, 2017


These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Medicaid Patient Satisfaction: High Despite Naysayers and Longer Wait Times

Medicaid Patient Satisfaction: High Despite Naysayers and Longer Wait Times

By Clive Riddle, July 13, 2017


The July 10 , 2017 Research Letter published in JAMA, A National Survey of Medicaid Beneficiaries’ Expenses and Satisfaction With Health Care, and authored by researchers at the Harvard T.H. Chan School of Public Health frames the issue like this”: “some policymakers have argued that Medicaid is a broken program that provides enrollees with inadequate access to physicians. While numerous studies demonstrate that Medicaid increases access to care, the literature has less frequently focused on patient satisfaction among Medicaid enrollees themselves. We analyzed a newly released government survey examining Medicaid beneficiaries’ experiences in the program.”

Co-author Michael Barnett, assistant professor of health policy and management at Harvard Chan School, tells us “the debate on the future of Medicaid has largely marginalized a crucial voice: the perspective of enrollees. Our findings confirm that Medicaid programs are fulfilling their mission to provide access to necessary medical care.”

The authors used the Medicaid Consumer Assessment of Healthcare Providers and System (CAHPS) survey administered by CMS. Here’s their summary of results: “Medicaid enrollees gave their overall health care an average rating of 7.9 on a 0 to 10 scale. Forty-six percent gave their Medicaid coverage a score of 9 or 10, while only 7.6% gave scores under 5. Ratings were similar in Medicaid expansion and nonexpansion states (7.8 vs 7.9; P = .54). Ratings were slightly higher for older adults and dual-eligible beneficiaries, but similar in the fee-for-service and managed-care groups. Overall, ratings ranged from 7.6 to 8.3 across all demographic groups.”

Access was also addressed:  physician access, 84% of enrollees reported that they had been able to get all the care that they or their physician believed was necessary in the past 6 months, and 83% reported having a usual source of care. The mean percentage of beneficiaries able to get all needed care was significantly higher in Medicaid expansion states than in nonexpansion states (85.2% vs 81.5%; P < .001). Overall, only 3% of enrollees reported not being able to get care because of waiting times or physicians not accepting their insurance. Two percent reported lacking a usual source of care because 'no doctors take my insurance.'

This level of patient satisfaction comes despite a study published in the May 2017 Health Affairs: Outpatient Office Wait Times And Quality Of Care For Medicaid Patients which found Medicaid patients were 20 percent more likely than others to wait 20 minutes or longer, with the median Medicaid wait time for Medicaid patients 4.6 minutes past their scheduled appointment time, compared to 4,1 minutes for the privately insured. 18 percent of visits for Medicaid patients has a wait time of more than 20 minutes, compared to 16.3 percent for privately insured patients.

The concern stated with the study is the wait time would impact the Medicaid satisfaction rates measured in the CMS Consumer Assessment of Healthcare Providers and System (CAHPS). Yet the new survey findings would indicate otherwise.

Medicaid satisfaction rates were also measured last summer, under a survey commissioned by AHIP, which found:

·         87 percent were satisfied with their Medicaid coverage and benefits

·         Medicaid managed care plan member had higher satisfaction with their benefits (85 percent) in comparison to those enrolled in traditional Medicaid fee-for-service programs (81 percent);

·         9 percent) said they are dissatisfied with their coverage; and

·         83 percent were highly satisfied with their level of access to doctors when needed.


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

by Claire Thayer, July 7, 2017

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

GOP leader says he'll rework health bill, but offers Plan B

Senate Majority Leader Mitch McConnell says he plans to produce a fresh bill in about a week scuttling and replacing much of President Barack Obama's health care law. But he's also acknowledging a Plan B if that effort continues to flounder.

AP News

Friday, July 7, 2017

States Move To Tighten Medicaid Enrollment, Even Without A New Health Law

No corner of the health care system would be harder hit than Medicaid, the federal-state health insurance program for the poor, if Republican leaders in Congress round up the votes to repeal major portions of the Affordable Care Act.

NPR News

Thursday, July 6, 2017

CMS won't delay controversial managed care requirements

The CMS is moving forward with controversial provisions from the mega managed-care rule that expands federal oversight over Medicaid programs after refusing several states' requests to delay implementation.

Modern Healthcare

Thursday, July 6, 2017

Should GOP Health Bill Prevail, Say Bye-Bye To Insurance Rebates

If Senate GOP leaders have their way, the check may not be in the mail. Many consumers collected unexpected rebates after the Affordable Care Act became law, possibly with a note explaining why: Their insurer spent more of their revenue from premiums on administration and profits than the law allowed, so it was payback time.

Kaiser Health News

Wednesday, July 5, 2017

What Tax Breaks? Those Promised In GOP Plans Go Mostly To Top 1%

There’s much talk on Capitol Hill about the tax cuts included in the Republican health plans, but unless you are a frequent user of tanning beds or have personal wealth that puts you in the top 1 percent, you might not feel much effect from them.

Kaiser Health News

Wednesday, July 5, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Healthcare 2017 Viewed Through Brokers’ Lens

by Clive Riddle, July 7, 2017

With the onset of the ACA at the start of this decade, if one asked how brokers would view the world of healthcare seven years later, some would have answered “who cares – they will become irrelevant.” But flash forward to 2017 and here they are, continuing to play the role they have always played, even though the landscape has certainly shifted. Despite disintermediation, public exchanges, technology and a host of other challenges, brokers remain at bat, swinging away.

BenefitsPRO has just released they annual broker survey, with responses from 350 brokers representing the spectrum of industry sectors. One might have thought brokers of all people, would firmly be in the camp of ACA repeal, 50% “would like to see the ACA retained and repaired, while 28 percent prefer a gradual repeal and replace, and 22 percent want it repealed and replaced immediately.”

One insight is that brokers business has evolved so that the public exchange market isn’t a material part of their business. When asked, “how have state exchanges’ struggles impacted your business,” 48% said there was no effect, 35% replied it hurt a little or significantly, and 17% said it helped a little or significantly.” The individual market has gravitated away from brokers, with 34% not involved, 37% reporting minimal demand, and less than ten percent stating “enrolling individuals on the public exchange is worth the effort.” Private exchanges aren’t a dominant force at this point, as “nearly 6 in 10 of those responding say they do not have a private exchange partner for enrollment and benefits administration.”

While technology has facilitated some disintermediation, brokers continue to attempt to enhance their value offering a personal touch that online tools can’t offer. The survey report noted that 53 “percent of respondents say meeting in a group setting at the worksite is the primary enrollment technique, while 36 percent cited one-on-one meetings in the workplace. However, 39 percent say their top method is using an electronic enrollment tool independently.”

But losses of individual and other health insurance market share have been offset by growth in the voluntary benefit sector, with 57% identifying with the statement that “they will use voluntary benefits to offset anticipated commission losses from health insurance this year.”

Looking toward the future, consolidation looms large, just as in all other healthcare sectors, as “27% expect their organization to acquire or merge with another broker/agent organization,” while 14% “ look for another broker/agent to acquire their organization” and “14% also say their company will leave the health insurance brokerage business.”

Brokers focus for the future includes 84% “promoting ancillary insurance coverage,” 58% “promoting health plan consumer engagement and health and wellness programs,” 43% “promoting third-party consumer engagement and health and wellness programs, while 53% will be concerned about the threat of “the new wave of disruptive companies entering the industry.” A particular innovation they are concerned with is payroll companies with direct benefits distribution, with 57% viewing this a concerning.