Healthcare Council – 1Q Meeting Recap
The Healthcare Council kicked off its 2013 quarterly meeting schedule on Friday where members gathered to hear from a panel of speakers on the challenges and opportunities of building new avenues to coverage in 2014 (click here for the meeting handout framing the discussion). The meeting, hosted by MCHC, also featured Congressman Peter Roskam (IL- 6th District), the Chief Deputy Whip for the U.S. House of Representatives, who led off the meeting agenda with an update on federal activities around the debt ceiling, sequestration, and the upcoming expiration of continuing appropriation authority on March 27. Congress has already delayed action on the debt ceiling until May 29, but action on the budget sequester will be a bigger battle in the coming weeks as the White House and Congressional Republicans square off over the spending cuts (see following story for more on the federal sequester, Congressman Roskam’s comments and the upcoming budget battle).
The remainder of the meeting turned towards a discussion of coverage options in 2014 and more specifically, how those “on the ground” are building and designing plans to fit the mold of the Affordable Care Act (ACA) while addressing key challenges that will inevitably accompany this ” brave new world of coverage” moving forward. Kevin Scanlan, the President & CEO of MCHC and the Chairman of the Formation Board for the new Land of Lincoln Health Consumer Operated and Oriented Plan (CO-OP) started the panel discussion with an overview of the new CO-OP, which was approved by the US Department of Health and Human Services in late December. CO-OPs are a function of the ACA, which initially authorized upwards of $6 billion to provide low-interest administrative and solvency loans to organizations across the nation to establish and operate a non-profit mutual insurance company to offer qualified health plans (QHPs) on the new public health insurance exchanges. Land of Lincoln Health was the last CO-OP awarded by HHS before funding was eliminated for the program as part of the fiscal cliff deal in early January.
The late award announcement for Land of Lincoln Health affords a short timeline for execution of action items necessary for the assembly of plan and product offerings ahead of the October 1 enrollment date for coverage on the new health insurance exchange, but according to Mr. Scanlan, the vision of Land of Lincoln Health is one that will be highly attuned to consumers’ needs, leveraging the partnerships MCHC has already established with providers around the state and the health information connectivity afforded through MCHC’s regional health information exchange to improve member health and outcomes.
The blurring line between provider and insurer, while not an outright assertion by the panel, was also underscored by Katie Galle, an Administrative Analyst for Meridian Health Plan – a physician-owned managed care company – that is one of the state’s partners in its Medicaid-Medicare Alignment and Care Coordination initiatives. Ms. Galle discussed the continuity of coverage issues that will likely surface in managing care for a population that is likely to experience a lot of churn between Medicaid, employer-sponsored coverage, and the exchange citing the state-option for a Basic Health Plan; an ACA-related provision that attempts to address continuity of coverage between Medicaid eligibility and the exchange. HHS has issued guidance and rules to attempt to address coverage “bridges” for individuals susceptible to eligibility fluctuations, but BHP proposed rules are not anticipated until later this year or early 2014.
David Lindgren, the Product and Compliance Manager with Flexible Benefit Service Corporation (Flex), addressed new coverage avenues that are evolving beyond that of any direct mandates from the ACA, including that of the private exchange. Several companies have rolled out different models for private exchanges in recent months, including Flex, which offers a new InsureX Solution aimed at offering employers – particularly smaller employers who may not currently offer coverage to their employees – a defined contribution approach to their benefits while giving employees an efficient way to select a plan that works for their specific needs. Plan offerings on the private exchange must be ACA-compliant, but do not have to meet the same requirements imposed on carriers offering plans and products on the public exchange (e.g., carriers offering plans on the exchange have to offer certain metal tier plans and are prohibited from creating price differentials between offerings on and off the exchange).
The panel discussion was capped off by Joshua Keepes, Regional Director – State Advocacy for America’s Health Insurance Plans (AHIP), who also emphasized the increasing need to build a coverage system that relies on greater coordination between the points of access for coverage with access points of care. While the ACA eliminates long-standing barriers to entry for health insurance for many individuals (like pre-existing condition exclusions), the system also faces a new set of barriers with respect to the affordability of coverage in 2014; a challenge that is complicated by richer benefit standards, health underwriting changes, and new taxes and fees. Mr. Keepes outlined some of the ways carriers are addressing cost issues, including promoting greater transparency and moving away from fee-for-service payment models to global payment/pay-for-outcomes models, but noted that legislative changes are also necessary to address the affordability barrier to coverage, including medical malpractice reform and the elimination of a new health insurance tax on fully-insured plans.