Entries in health plans (32)

Monday
Dec012014

Future of Provider-Sponsored Health Plans and Managing Risk

By Cathy Eddy, December 1, 2014

Deloitte Consulting conducts an enterprise wide risk assessment with Presbyterian Health Services annually and the information is leveraged by the health plan.

Health systems are looking at their range of options for the future – most with an eye for making the transition from fee-for-service to value-based reimbursement. These options include shared savings programs, bundled payments, accountable care organizations, some form of capitation or global payment and for some, starting or growing a health plan. These options involve varying levels of risk.

As the lines blur between payers and providers, it is important for health systems to carefully evaluate their strategies and their partners to be successful in the future. It will also mean doing business differently and navigating through the major challenges that have been driven by marketplace dynamics and health care reform.

Many organizations have identified provider-sponsored plans as a “hot topic” and are trying to identify the keys to success with this model. As systems move to value-based reimbursement, a health plan can act as both a catalyst and an accelerator for change.

For almost 20 years, the Health Plan Alliance has been working with integrated delivery systems that have health plans. These are the systems that stayed with the vertical strategy when many of their colleagues sold off or closed down their insurance arms. The health systems that stayed committed to owning a health plan are now at a strategic advantage in many ways:

  • They have a vehicle to understand and manages risk
  • Health plans have the infrastructure to manage populations 
  • A closer link to the marketplace 
  • Better understanding of managing care 
  • Ability to gather and analyze quality data for the populations served 
  • A driver for more clinical integration 

What are some of the key considerations for systems to consider when owning a health plan or partnering with one?

  • What are the populations you want to serve – commercials, exchanges, Medicaid Advantage, Medicaid or duals? These all have different risk challenges 
  • Do you have the financial resources to fund a start-up and maintain the risk-based capital requirements? 
  • Do you have or can you acquire the expertise to run a successful plan? 
  • Does it make sense to partner with another health plan or payer?
  • Are you willing to make the delivery system changes need to manage risk? 
  • Are your physicians organized to take on risk and support quality measures of a health plan? 
  • Are you organized to manage the care of a population along the healthcare continuum?
  • Are you thinking about direct contracting with large employers in your marketplace?

The members of the Health Plan Alliance have a wealth of knowledge about how integrated delivery systems are managing risk. Last month, our Fall Retreat addressed the various levels of risk that a health plan manages – governance, product lines, physician alignment, clinical integration, financial and business continuity.

If you weren’t able to attend this meeting, you can find the presentations on our website and you can request a video recording of the meeting.  Managing multiple levels of risk will continue to be a challenge for health systems in the future, especially those that have made the strategic investment to own a health plan. 

Friday
Oct102014

Study on Health Plan Shopping – Reluctants, Premiums and Defaulters

By Clive Riddle, October 10, 2014

Vitals – who provide a consumer health information platform including doctor ratings and reviews, has released a study on health plan shoppers in open enrollment season, and lumping many of the shoppers into three categories: (1) The Reluctant; (2) The Premium; and (3) The Defaulter. Vitals study was based on their August online survey of 1,000 adults.

The big takeaways from their survey?

  • 80 percent of respondents said they were not planning to switch their insurance this year.
  • More than 1 in 5 are dissatisfied with their plan.
  • Nearly one-third said they were unhappy with the value for cost of their plan.
  • 27 percent were unhappy with customer support services
  • 9 percent were unhappy with the lack of quality network doctors and hospitals

So what the heck are Vitals’ trio of Reluctants, Premiums and Defaulters?

Vitals classifies Reluctants as age 30-44 with no dependents and household income under $25k, who are satisfied with their plan provider network but not the plan value. Vitals says “the Reluctant doesn’t want to buy insurance and isn’t satisfied with their plan – if they even have one. They’re more likely to have an HMO to keep costs down, but still say they’re not getting a good value for cost. Over 1 in 4 will switch their health plan during open enrollment this year. Their main gripe: Cost. They index higher for cost increases over the past year and report being surprised more by health care costs this year, compared to last year.”

Vitals classifies Premiums as age 45-60 with dependents and household income over $100k, who also are happiest with the network and unhappiest with plan value. Vitals tells us “the Premium is most likely to have Cadillac-like coverage for their health care. They index higher for employer-provided health care and PPO-type plans, which offer the most flexibility. Premium shoppers are most likely to say they’re happy with their health insurance – only 5 percent will switch during open enrollment! And they uniformly agree they have adequate access to medical care.”

Finally, Vitals classifies Defaulters as any age adult (but often age 60+) with no dependents and household income of $50 - $99k. They define the Defaulter as someone “on cruise control and typically doesn’t review or change their plan from year to year.”

Friday
Sep192014

Humana Study on Workplace Wellness: It’s not just ROI

By Clive Riddle, September 19, 2014 

Humana has just published a 22 page report Measuring wellness: From data to insights which based on their study conducted by the Economist Intelligence Unit, examining “why companies implement workplace wellness, how data influences these programs and identifies obstacles that inhibit program participation.” The study surveyed 225 U.S.-based executives and 630 full-time employees from organizations with workplace wellness programs. 

Beth Bierbower, President of Humana’s Employer Group Segment, tells us “It’s interesting to validate that employers now view ROI as an important, but not exclusive or even primary measure of a wellness program’s success. Employers are now seeing that employee health is important beyond health care costs, it has profound impacts on productivity, retention, workplace engagement and morale.” The report states that instead of asking about ROI, “perhaps the question should be, ‘do we improve health at a reasonable price’ as opposed to ‘do we save money by doing so.’” 

Here are some key findings highlighted from the study:

  • Nearly 70 percent of executives consider their organization’s wellness program to be cost effective, even though not all of the outcomes are measurable.
  • While 86 percent of executives say improving employee health as an indirect driver of productivity, morale and engagement is their top reason for implementing a wellness program, cost factors are still important, including reducing employee health care costs (66 percent) and controlling medical claims (48 percent).
  • About 30 percent of employees rate subsidized gym memberships, onsite health and wellness facilities, and budgeted wellness activity time during business hours, as the three most important services that would motivate participation.          
  • 64 percent of employees have used fitness devices to monitor health and capture data, but only 19 percent use them regularly.         
  • Two-thirds of executives feel data collection and interpretation is the biggest challenge confronting effective workplace wellness.         
  • 53% of survey respondents say their organization collects health-related employee data as part of its wellness program
  • The biggest disconnects between executives and employees regarding their perceptions of obstacles to employee participation in wellness programs, were in regards to the statements: “Employees don’t perceive health and wellness as a high priority” (30% of executives agreed vs. 2% of employees); “Employees are concerned that personal information will not remain confidential (43% of executives agreed vs. 27% of employees); and “Employees distrust employer motives” (24% of executives agreed vs. 11% of employees.)     
Thursday
May012014

Humana Study Measures Claims Costs and Absence Rate by level of Wellness Program Engagement

By Clive Riddle, May 2, 2014

Humana has released findings from their HumanaVitality Health Claims and Productivity Impact Study of Humana employees. HumanaVitality is a joint venture between Humana Inc. and Discovery Holdings, Ltd. That serves 3.5+ million members and “is a data-driven wellness and rewards program that motivates members to make healthier life choices.”

Humana touts that “the two-year study found improved health, as shown through lower health care costs and fewer unscheduled absences, among employees who actively participated in the HumanaVitality program.”

Here’s their specific findings:

  • Unengaged members in both years averaged $53 more per month spent on health care claims than members who were engaged in HumanaVitality both years.
  • The largest impact on health care costs was on members with lifestyle-related chronic conditions like high blood pressure or diabetes. Engaged members with these conditions had 60 percent lower health claims costs than unengaged members with these conditions.
  • Another way of stating this: Unengaged members with lifestyle-related chronic conditions had 101% higher claims costs than the total population, while engaged members with these chronic conditions had 41% higher claims costs than the total population
  • Unscheduled absences were 56.3 percent higher among unengaged members in both years than engaged members
  • Members who were unengaged the first year but engaged the second year had 29% higher unscheduled absence and an average of $28 per month in claims costs than members who engaged both years

Humana shared this about the study methodology: “This study was performed on a cohort of Humana associates that were on a Humana employee medical health plan for a full 12 months in at least two consecutive plan years over the study period. The study was conducted by Humana actuaries for the following time period: Baseline Year (July 2010 – June 2011), Year 1 of the HumanaVitality program (July 2011 – June 2012) and Year 2 of the HumanaVitality program (July 2012 – June 2013). Only Humana employees were included in the study; individuals with high cost claims (>= $ 150,000 in the Baseline Year, Year 1 or Year 2) were removed from the sample. The final sample size was 13,046 members in the Year 1 analysis and 16,296 members in the Year 2 analysis.”

Friday
Mar282014

March Brings Three Different Slices of Health Plan Consumer Experience Ratings

by Clive Riddle, March 28, 2014

This month, three annual proprietary consumer experience studies have yielded separate slices of the health plan consumer experience. J.D. Power, Temkin Group and Saatmetrix have all weighed in, and each shed favorable light on Kaiser Permanente, among other plans.

J.D. Power released results from their eighth annual Member Health Plan Study, in which they provide member satisfaction index rankings by region. Their 2014 Member Health Plan Study is based on responses from more than 34,000 members of 136 commercial health plans across 18 regions in the United States. The study was fielded in December 2013 and January 2014.  

J.D. Power ranks satisfaction on a 1,000 point scale. Satisfaction is highest among health plan members in the California and Michigan regions (in a tie); the Indiana-Illinois and Mid-Atlantic regions (in a tie); and the East South Central and South Atlantic regions (in a tie). Satisfaction is lowest in the New England, New York-New Jersey and Southwest regions. 

Top ranked plans by region, according to the J.D. Power study, were compiled in healthsprocket, in these regional lists:

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Southern United Stated

  • Kaiser Foundation Health Plan (784) ranks highest among health plan members in the South Atlantic region (which includes Georgia, North Carolina and South Carolina) for a fifth consecutive year
  • AvMed Health Plans and Humana (in a tie at 690 each) rank highest among health plan members in the Florida region, AvMed ranks highest in the Florida region for a third consecutive year
  • Cigna (689) ranks highest among health plan members in the East South Central region (which includes Alabama, Kentucky, Louisiana, Mississippi and Tennessee)
  • Aetna (677) ranks highest among health plan members in the Texas region

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Eastern US

  • Kaiser Foundation Health Plan (732) ranks highest among health plan members in the Mid-Atlantic region (which includes Maryland, Virginia and Washington, D.C.)
  • Capital District Physicians Health Plan (727) ranks highest among health plan members in the New York-New Jersey region
  • Geisinger Health Plan (705) ranks highest among health plan members in the Pennsylvania region for a third consecutive year
  • Tufts Associated Health Plans (681) ranks highest among health plan members in the New England region (which includes Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont)

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Midwestern US

  • Health Alliance Plan of Michigan (711) ranks highest among health plan members in the Michigan region for a seventh consecutive year
  • Dean Health Plan (703) ranks highest among health plan members in the Minnesota-Wisconsin region
  • Medical Mutual of Ohio (697) ranks highest among health plan members in the Ohio region
  • Health Alliance Medical Plans (692) ranks highest among health plan members in the Indiana-Illinois region
  • Wellmark Blue Cross Blue Shield of Iowa (680) ranks highest among health plan members in the Heartland region (which includes Arkansas, Iowa, Kansas, Missouri, Nebraska and Oklahoma)

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Western US

  • Kaiser Foundation Health Plan ranks highest among health plan members in the California region for a seventh consecutive year, with a score of 756
  • Kaiser Foundation Health Plan (732) ranks highest among health plan members in the Northwest region region (which includes Oregon and Washington)
  • Kaiser Foundation Health Plan (703) ranks highest among health plan members in the Colorado region for a seventh consecutive year
  • SelectHealth (698) ranks highest among health plan members in the Mountain region (which includes Idaho, Montana, Utah and Wyoming) for a fifth consecutive year
  • Blue Cross Blue Shield of Arizona (675) ranks highest among health plan members in the Southwest region (which includes Arizona, New Mexico and Nevada

Temkin Group pronounced the health plan industry “mediocre” and bestowed the highest customer experience rankings to Kaiser Permanente and Humana respectively, in releasing results from their fourth annual ranking of companies based on a study of 10,000 U.S. consumers that “examines the quality of the customer experience delivered by 268 organizations across 19 industries: airlines, appliance makers, auto dealers, banks, car rental agencies, computer makers, credit card issuers, fast food chains, grocery chains, health plans, hotel chains, insurance carriers, Internet service providers, investment firms, parcel delivery services, retailers, software firms, TV service providers, and wireless carriers.”

Bruce Temkin, managing partner of Temkin Group, tells us "consumers give pretty bad ratings to most health plans, as this entire industry needs a customer experience makeover.  Overall, the health plan industry averaged a 56% rating in their study and tied for 17th place out of 19 industries.

Temkin ratings by plans included in the survey were:

  1. Kaiser Permanente (68%)
  2. Humana (63%)
  3. Medicare (62%)
  4. TriCare (62%)
  5. United Healthcare (59%)
  6. Blue Shield of California (58%)
  7. Aetna (57%)
  8. Health Net (55%)
  9. CIGNA (54%)
  10. Anthem (BCBS) (53%)
  11. CareFirst (BCBS) (48%)
  12. Medicaid (45%)
  13. Highmark (BCBS) (44%)
  14. Empire (BCBS) (42%)
  15. Coventry Health Care (41%).

Temkin noted that Humana (+12 points), Blue Shield of California (+7 points), and United Healthcare (+5 points) improved the most between 2013 and 2014. Coventry Healthcare (BCBS) (-18 points), TriCare (-9 points), Empire (BCBS) (-7 points), and Highmark (BCBS) (-6 points) declined the most since 2013. Kaiser Permanente with their 68% rating, was in 109th place overall out of 268 organizations across 19 industries. Humana, with a rating of 63% placed 160th overall. Coventry Health Care (BCBS) was in last place across all 268 companies in the ratings with their score of 41%.

Satmetrix Systems released results for their 2014 Satmetrix® Net Promoter® Benchmarks which measure and rank customer loyalty more than 219 brands across 22 U.S. industry sectors, including financial services, insurance, technology, online services, retail stores, electronics, travel and hospitality, and telecommunications. The Satmetrix Net Promoter Benchmark rankings are based on survey responses from more than 24,000 U.S. consumers nationwide who indicated they had significant experience with a company's products or services in the previous 12 months. A company's Net Promoter Score is based on customers' likelihood to recommend the company's product or service. The score is the percentage of customers who are promoters, rating the company 9 or 10 on a 0 to 10 point scale, minus the percentage who are detractors, rating 6 or lower.

The Satmetrix study for the health insurance sector followed these nine companies:

  • Aetna
  • Anthem
  • BlueCross BlueShield of Florida
  • BlueCross BlueShield of California
  • Cigna
  • Humana
  • Kaiser
  • Medicare
  • United Healthcare

Like J.D. Power and Temkin, Satmetrix found Kaiser Permanente to be a dominant force, leading the health insurance category for the fourth consecutive year  and “improving to an all-time high [Net Promoter Score] score of 40 points. The provider rated highest on a number of important key loyalty drivers, as patients appreciated its service features, company reputation and the feeling that Kaiser Permanente acts in their personal best interest.” Kaiser’s score was 23 points higher than the industry average. Like Temkin, Satmetrix ranked Human in second place: “with a score of 32 points, Humana saw significant improvement from 2013, moving up 14 points to beat out last year's second place finisher, Medicare (27 points).”