qotd: Wellmark Blue Cross and Blue Shield placing greater squeeze on patients

Wellmark

September 28, 2016

Wellmark announces individual ACA market changes in Iowa and South Dakota

Wellmark Blue Cross and Blue Shield announced today it will make changes in the individual Affordable Care Act (ACA) market in Iowa and South Dakota.

For the past two years, Wellmark members with individual ACA plans have endured double-digit increases. In addition, Wellmark has lost approximately $99 million over the same time period in the individual market in Iowa and South Dakota.

"Wellmark's mission is to create affordable health insurance for people to access quality health care. And, for the majority of the past 75 years, we've been able to achieve that," said Wellmark Chairman and CEO John Forsyth. "However, it's apparent that continuing to offer plans with broad networks, combined with the rich benefits of the ACA, is not consistent with managing continually rising costs. While we could seek additional premium increases to mitigate rising costs, this is not sustainable for our members' pocketbook."

Iowa changes

In Iowa, Wellmark will narrow its product choices to offer plans that are lower priced and encourage health care delivery by Iowa providers. Specifically, Wellmark will no longer offer gold tier plans nor will the company promote individual under 65 plans that use its Preferred Provider Organization (PPO) network in Iowa.

Wellmark will also continue its plans to introduce a new, simplified HMO plan called Blue Simplicity℠. This plan is like no other on the market today and is designed to help consumers understand the true value of care through simple copay plans – providing members with transparency and predictability of cost as they seek and use medical services.

South Dakota changes

In South Dakota, Wellmark will no longer offer individual Affordable Care Act (ACA) plans effective Jan. 1, 2017.

"Although the ACA has done many positive things, it has also had its challenges and those challenges vary by state," said Forsyth. "Fortunately, in 2017, the ACA gives states the ability to begin addressing those challenges with the goal of stabilizing the individual under 65 health insurance market. We look forward to working with Iowa and South Dakota policymakers on those solutions in the near future."

https://www.wellmark.com/about/newsroom/2016/09/28/wellmark-announces-individual-aca-market-changes-in-iowa-and-south-dakota

===

Comment by Don McCanne

The largest health insurer in Iowa, Wellmark Blue Cross and Blue Shield, is discontinuing their more comprehensive gold tier plans and is discontinuing the promotion of its PPO plans with wider provider networks. They are also introducing a new HMO plan "designed to help consumers understand the true value of care through simple copay plans" (i.e., making them better shoppers by having to bear more of the costs). These changes are compounding the two problems plaguing insurance purchasers today: requiring higher out-of-pocket spending for health care, and narrowing the selection of health care providers covered by the plans.

This is a one-way path designed to keep insurance premiums as competitive as possible. As Chairman and CEO Forsyth states, "continuing to offer plans with broad networks, combined with the rich benefits of the ACA, is not consistent with managing continually rising costs." Insurers are not going to cover more out-of-pocket costs by increasing the actuarial value of their plans (percent of costs they will pay), and they are not going to expand their networks when they can negotiate lower prices by promising provider exclusivity.

Look, as long as we leave these people in charge, we can anticipate that they will engage in strategies that will protect and improve their own market advantage. If we had our own public program, our stewards who work for us would be engaging in strategies that would ensure our access to the health care that we need. There really is a difference. If only for selfish reasons, we should prefer the latter. The fact that it helps everyone else is a bonus.

qotd: Employee health deteriorated under award-winning wellness program

STAT

September 27, 2016

Top wellness award goes to workplace where many health measures got worse

By Sharon Begley

When Idaho's Boise School District receives the workplace wellness industry's highest award Wednesday at a celebration in Atlanta, it is expected to be applauded for helping its 3,000-plus employees and their families improve their health and reduce their risk of illness.

It is "an exemplary program," said Dr. James Fries, an emeritus professor of medicine at Stanford University and member of The Health Project, an industry-sponsored group that makes the annual award. Program participants, he said in an announcement this month, "showed improvements in health behavior," helping Boise save money on medical costs.

Data collected by the company that sold Boise the wellness program and trumpeted the "Koop Award," however, cast doubt on that claim. More key measures of health deteriorated than improved. Self-reported quality of health got worse. And health care costs jumped around in a way that suggests any changes were due at least in part to random fluctuations and possibly employee turnover, not any benefits of the wellness program.

This would not be the first time the Koop Award, named for the late US Surgeon General Dr. C. Everett Koop, stirred controversy. Employees in the wellness program that won in 2015, for instance, collectively achieved a lower reduction in smoking than the national average. More gained weight than lost, more raised their total cholesterol level than lowered it, and more had higher blood glucose levels after participating in the wellness program than before.

Such cases reinforce a growing recognition among experts that wellness programs — which constitute an $8 billion a year industry — "don't lead to any visible results," Stanford's Emma Seppala recently wrote in Harvard Business Review. "At best, these initiatives are nothing more than lip service or PR. But at worst, they actually cause more stress."

https://www.statnews.com/2016/09/27/workplace-wellness-award/

===

Comment by Don McCanne

We still hear that employers are adopting wellness programs in order to reduce the future costs of their health benefit programs by making their employees healthier. There could be no better evidence that these programs do not work than the fact that the top award for a workplace wellness program went to an employer whose employees' health deteriorated.

If employers really want to do something about controlling health care costs, they should get on the single payer bandwagon. Not only would that eliminate the hassle and expense of administering their health benefit programs, all of their employees would have health care automatically, and future increases in health care costs would be reduced to sustainable levels.

Any employers reading this who are not yet convinced about single payer would benefit by watching a movie developed by and for the business community, "FIX IT - Healthcare at The Tipping Point":

http://fixithealthcare.com

qotd: What should the candidates tell us about controlling costs?

Modern Healthcare

September 24, 2016

Editorial: Thank you for that question, Lester

By Merrill Goozner

(Question for candidates, proposed by the New York Times): "Health insurance premiums and out-of-pocket costs are rising rapidly. What would you do to control them?"

If I were advising a candidate on how to respond to that question, here's what I'd recommend he or she say:

(Excerpts)

"Thank you for that question, Lester. I understand why many Americans think their insurance premiums are rising rapidly. There's been a lot of attention paid to next year's increases for the individual policies sold on the Obamacare insurance exchanges, which will rise about 9% on average, according to the latest Kaiser Family Foundation survey."

"Employers are forcing individuals to pick up more of the cost of their plans."

"The employer portion of your health insurance is going up just 4% next year on average. That means the family share has to go up more than 5.5% to make up the difference."

"Employers are doing that by putting more of us in high-deductible plans. They're asking more of us to pay higher co-pays and deductibles. They are raising our portion of the premiums."

"So what can we do about it? First, we have to recognize this is a big experiment that has been endorsed by economists associated with both political parties. They say by forcing patients and consumers to have more skin in the game, they will become wiser healthcare shoppers."

"I say, to make that work, we have to have total transparency — in healthcare prices, in insurance prices, in which doctors and hospitals are in health plan networks, in quality ratings, and with good, easy-to-understand information about what constitutes the most effective and cost-effective care. I pledge to work night and day to give consumers the information they need to make smarter choices in the healthcare marketplace."

"And if some people simply can't afford to put money into the health savings accounts accompanying these plans, let's remove some of the tax subsidies given high-income people for their health insurance so we can finance a generous federal match for what lower-income people contribute."

"Let me now turn to what can we do about those rising individual rates for plans sold on the exchanges. The bottom line is we need more people to sign up. The No. 1 reason why rates are rising is that not enough healthy uninsured people signed up for coverage."

"We need everyone who is uninsured to jump into the individual insurance pool."

http://www.modernhealthcare.com/article/20160924/MAGAZINE/309249985/editorial-thank-you-for-that-question-lester

===

Comment by Don McCanne

Merrill Goozner certainly understands the political realities about health policy. To a question on health costs that could be part of tonight's presidential debate, he suggests an answer for the candidates that aligns with the current financing system under the Affordable Care Act. Unfortunately, because of the restrictions he apparently placed on himself, it's a terribly deficient answer.

For the problem of high-deductibles he suggests making patients better shoppers through greater transparency in prices, in network composition and in quality ratings. But that would have almost no impact on making the deductibles and other cost sharing more affordable.

He accepts the dubious concept that health savings accounts should accompany these high-deductible plans, and further suggests that the accounts for lower-income individuals be subsidized. Health savings accounts are strictly an administrative tool that increases the complexity and waste in health care financing. When the accounts are depleted, beneficial health care services are forgone - not a desirable outcome. If you are going to have first dollar coverage built into the HSAs, why not instead save administrative hassles and expenses by building first dollar coverage into the insurance program itself?

For the high premiums of the exchange plans, he suggests enrolling more of the healthy to dilute the risk pool. But the low-lying fruit has been picked. The policy community is beside itself in trying to figure out how to bring more into the exchange plans, while having only negligible success in doing so.

Goozner is certainly highly respected by me and others, but we wish that he and others like him would move beyond feeble patchwork solutions and support a program that would make health care accessible and permanently affordable for all. Of course that would be a single payer national health program - an improved Medicare for all. Goozner understands that we won't hear that from either candidate tonight, but that doesn't mean that we shouldn't be asking for that response.