Entries in health plans (63)

Friday
Sep282018

NCQA Health Plan Ratings: What About the 25% With No Rating?

By Clive Riddle, September 28, 2018

NCQA has released its 2018-2019 Health Insurance Plan Ratings. The ratings are a key tool used by stakeholders in evaluating health plans. NCQA tells us they “studied nearly 1,500 health plans and rated 1,040: 445 private (commercial), 418 Medicare and 177 Medicaid” and that “of the 1,040 rated plans, 85 (8%) received a top rating of 4.5 or 5.0 out of 5. Twenty-five (2%) earned the ratings of 1.0 to 2.0.”

The ratings website is searchable by plan type, state, or plan name and can be sorted by ratings (rated on a scale of 1.0 to 5.0). What isn’t readily available is a summary of the number of plans by each rating category, so we compiled one:

What struck us was the 25% of plans studied that aren’t rated. If you’re a plan that likely would get a rating below 3.0, wouldn’t you be motivated to avoid being rated at all? So let’s look at the ratings methodology.  Here’s a summary of NCQA health plan rating methodology, provided by NCQA

“Health plans are rated in three categories: private plans in which people enroll through work or on their own; plans that serve Medicare beneficiaries in the Medicare Advantage program (not supplemental plans); and plans that serve Medicaid beneficiaries. This year’s ratings do not include Marketplace plans because they have not developed sufficient data for analysis. NCQA ratings are based on three types of quality measures: measures of clinical quality from NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®2); measures of consumer satisfaction using Consumer Assessment of Healthcare Providers and Systems (CAHPS®3); and results from NCQA’s review of a health plan’s health quality processes (performance on NCQA Accreditation standards). NCQA rates health plans that report quality information publicly.”

NCQA provides this explanation of plans listed as having partial data:

“Plans with partial data do not receive a rating, but NCQA lists them in the ratings and shows their scores on the measures they report. A plan is considered to have partial data if it: Submits HEDIS and CAHPS measure data for public reporting, but has “missing values” (i.e., NA or NB) in more than 50 percent of the weight of measures used in the methodology. Plans that fall into this category receive an overall rating status of “Partial Data Reported” and their measure rates are displayed as “NC” (No Credit). Refer to HEDIS Volume 2: Technical Specifications for information about missing values. Submits HEDIS data for public reporting but does not submit CAHPS data, or vice versa. Plans that fall into this category receive an overall rating status of “Partial Data Reported” and their measure rates for the dataset they did not submit are displayed as “NC” (No Credit).  Earned NCQA Accreditation without HEDIS data (health plan accreditation standards only) and did not submit HEDIS or CAHPS data for public reporting. Plans that fall into this category receive an overall rating status of “Partial Data Reported” and their measure rates are displayed as “NC” (No Credit).”

NCQA provides this explanation of plans listed as having no data reported:

“Plans that submit results but do not report data publicly, or plans that report no HEDIS, CAHPS or accreditation information to NCQA, are given a rating status of “No Data Reported” and their measure rates are displayed as “NC” (No Credit). Plans that fall into this category and have fewer than 8,000 members are omitted—they are not rated and are not listed in displays related to ratings.”

Based on these explanations, there are plans that legitimately should not be rated. But some of these aren’t included in the above numbers of plans with partial or no data, such as plans with fewer than 8,000 members with no data reported, or Marketplace plans with not enough data history.

But what about the rest? Could there be plans that avoid full data reporting to avoid potentially low ratings? Certainly the small numbers of plans publicly singled out with 2.0 or lower ratings come across looking far worse that the large number of plans listed with partial data or no data reported.

Perhaps NCQA should come up with a way to make the listings of applicable partial or no data reported plans perceived in a more negative manner?

Friday
Sep142018

Post ACA Operating Margins: Health Systems and Health Plans

By Clive Riddle, September 14, 2018

Navigant this week released an eight-page report: Stiffening Headwinds Challenge Health Systems to Grow Smarter, that provides “an analysis of a three-year sample of the financial disclosures of 104 prominent health systems operating 47% of U.S. hospitals,” in which Navigant  “found broad-based and significant deterioration of operating earnings.”

 

Navigant reports that from 2015 to 2017:

  • The average operating margin decline for analyzed systems was 38.7%. Not-for-profit system margins fell 34%, while for-profit margins fell 39%.
  • 65% of systems experienced operating income declines totaling $6.8 billion, with the most significant reductions occurring in the U.S.’s fastest-growing regions: West/Southwest and South Central.
  • At the root of these declines were multiyear reductions in the rate of topline operating revenue growth, which fell from 7% (2015 to 2016) to only 5.5% (2016 to 2017), and a failure to contain expenses in line with revenue deterioration. 

Navigant cites these drivers of earnings deterioration:

  1. Weakening demand for such core hospital services as surgery and inpatient admissions, due in part to rising patient cost exposure from high-deductible health plans;
  2. Deteriorating collection rates for private accounts in non-ACA expansion states;
  3. Steady erosion in Medicare payment rates due to the ACA and the 2012 federal budget sequester; and
  4. Failure of health system value-based insurance contracts to deliver sufficient patient volume to offset steep upfront payer discounts and significant hospital population health investments.

Meanwhile on the other side of the post-ACA equation, Mark Farrah Associates this week “released an analysis brief providing insights into mid-year profitability for commercial and government lines of health insurance business. MFA compared second quarter, year-over-year profitability for the Individual, Employer-Group, Medicare and managed Medicaid segments.”

They found that:

  • At the end of second quarter 2018, the average medical expense ratio for the Individual segment was 70.8%, as compared to 77.2% the previous year.
  • Growth in premiums pushed the average medical expense ratio for the Employer-Group segment down to 80.9% for 2Q18 from 81.8% in 2Q17.
  • For Medicare Advantage, premium growth outpaced increases in medical expenses pushing the medical expense ratio down to 85.3% from 86.1% in 2Q17.
  • 2.9% increase in premiums per member per month pushed the medical expense ratio for Managed Medicaid down to 88.6% from 91.0% in 2Q17.

Mark Farrah Associates concludes the current outlook is better than the one Navigant finds for health systems: “At the mid-year point, all four health care segments are signifying improved profitability for health insurers over 2017.  The most significant change is once again in the Individual segment showing improvement over 2017, which ended up being a profitable year for the segment overall.  While this analysis of mid-year segment performance sheds light upon profitability trends for 2018, it’s a wait and see proposition until final financial results are revealed in spring of 2019.”

Friday
May182018

Six Things To Know From Deloitte Research on Health Plan Government Business

Six Things To Know From Deloitte Research on Health Plan Government Business
 

By Clive Riddle, May 18, 2018

 

This week, Deloitte Center for Health Solutions’ Andreea Balan-Cohen, Ph.D., and Maulesh Shukla gave a presentation on Medicare Advantage and Medicaid Managed Care Trends: Deloitte Research in a live HealthcareWebSummit event.

 

The basis for their discussion was Deloitte Center for Health Solutions analysis of financial performance trends in the US fully insured health plans market between 2011 and 2016. This research series was divided into three chapters: Chapter 1, published in December 2017, provided summary observations on overarching developments in the market. Chapter 2, published in March 2018, focused on trends in health plan government programs, specifically Medicare Advantage and Medicaid managed care. Chapter 3, forthcoming later this month, will focus on trends in the commercial individual and commercial group lines of business.

 

Here’s six key findings they shared on U.S. health plans’ government business:

1.     Government programs accounted for a large and growing share of health plan revenue and underwriting gains.

2.     The Medicare Advantage business experienced significant top-line growth and bottom-line volatility, including a notable decline in underwriting performance in 2014 and 2015.

3.     In Medicaid managed care, aggregate plan revenue increased steadily between 2011 and 2016, and underwriting performance grew impressively before retrenching in 2016.

4.     The largest Medicare and Medicaid plans by national revenue captured a disproportionate and growing share of industry underwriting gains.

5.     Medicare Advantage performance variation widened beginning in 2014; smaller plans and newer entrants experienced substantial headwinds.

6.     Medicaid managed care markets exhibited widening performance variation at the company and state levels beginning in 2014.

 
Thursday
May172018

Medication Nonadherence: Data and Analytics Can Make an Impact

By Claire Thayer, May 16, 2018

Over two-thirds of hospital readmissions are directly due to medication nonadherence.  Many factors contribute to patients not taking their medications, including fear of side effects, out-of-pocket costs, and misunderstanding intended use.  Interventions targeted at understanding the underlying causes on nonadherence are critical to improving chronic disease outcomes.  Successful interventions include: educating patients on purpose and benefits of treatment regimen, reducing barriers to obtain medication, as well as use of health IT tools to improve decision making and communication during and after office visits. 

This weeks’ edition of the MCOL infoGraphoid, co-sponsored by DST Health, explores how data and analytics can provide insight to drive behavior change to improve adherence.

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Friday
May112018

The Disconnect with Consumers and Health Plan Costs

The Disconnect with Consumers and Health Plan Costs
 

By Clive Riddle, May 11, 2018

 

eHealth this week released a new eleven page report: Costs and Consequences in the ACA Market: A Survey of Individual and Family Health Insurance Consumers, presenting findings from more than 1,700 consumers who purchased their ACA-compliant plans via eHealth that included:  (1) “Consumers’ idea of a fair price is hard to find in today’s market;” (2) Policyholders aren’t willing to pay extra for key ACA benefits;” and (3) “Voters are bringing health care frustrations to the mid-term elections this fall,” (66% said it was one of their top three issues.)

 

Consistent with a number of previous studies, there is a significant disconnect between consumers sense of where healthcare prices should be in the market, and what they actually are. Health reports that the average individual monthly premium cost during the last open enrollment was $400,  Only 3% surveyed felt $400+ was a fair price. Only 9% felt $300+ was fair. Only 25% felt $200+ was fair. So what is fair? 38% felt premiums should be $100 or less. Another 36% felt $200 or less was fair.

 

The disconnect carries over consumer sense of the value of specific benefits. 61% want mental health benefits, 60% want maternity care and 55% want birth control coverage (which are all ACA required), but only 25%, 24% and 16% respectively, want to pay for them. Even emergency room benefits experience this disconnect: 80% want the benefit and 54% are willing to pay for it.

 

ACA compliant HDHPs are prevalent in the ACA marketplace, and continue to gain the large group environment as well. Benefitfocus this week released a new eleven page survey report: The State of Employee Benefits 2018 - Industry Edition that examined benefit trends for four sectors: education, health care, manufacturing and retail, with an emphasis on examining the impact of HDHPs in each sector.

 

Benefitfocus found that regarding HDHP prevalence by sector:

·         Education: 50% of employers offer HDHPs compared to 23% in 2016.

·         Healthcare: 73%% of employers offer HDHPs compared to 56% in 2016.

·         Manufacturing: 88%% of employers offer HDHPs compared to 54% in 2016.

·         Retail: 76%% of employers offer HDHPs compared to 55% in 2016.

·         All Industries: Healthcare: 70%% of employers offer HDHPs compared to 58% in 2016.

 

When large employers offer other type plans and HDHPs side by side (many employers do not offer both), the HDHP employee enrollment rates by sector were: Education: 34% (30% in 2016); Healthcare: 27% (23% in 2016); Manufacturing: 29% (46% in 2016); Retail: 40% (27% in 2016) and All Industries: 35% (40% in 2016).

 

What would drive such different results by sector? Employee premium HDHP contributions compared to last year decreased 27% in Education, increased 4% in healthcare, increased 46% in manufacturing, increased 20% in retail, and increased 4% overall for all industries.

 

So just as in the individual marketplace, much comes down to price, even though there is a disconnect in the value that price reflects.