An excellent baseball-playoff themed edition of the Health Wonk Review is at Wing of Zock, hosted by Jennifer Salopek – be sure to head over and check it out. This article by Jason Shafrin should be of interest to anyone who has been paying attention to all the talk about ACOs lately. I have been generally impressed with what I’ve read regarding the potential cost savings and improved efficiency that ACOs will hopefully provide. However, although health care reform has focused quite a bit of energy on the creation of ACOs, it is far […]
Archives for September 2012
Colorado Kaiser Permanente Recognized By HHS For Hypertension Control
Nationally, more than half of hypertension cases are not under control (36 million uncontrolled cases out of 67 million total cases). In 2008, Kaiser Permanente members in Colorado had a 61% control rate, and that number has climbed to 82.6% thanks to an intensive effort on the part of Kaiser Permanente to continually work with patients to control hypertension. Sebelius said that Kaiser Permanente’s efforts have proven that “… by making high blood pressure[…]
An Idea That Beats “Skin In The Game”
David points out that healthcare isn’t like a shopping spree at the mall. He believes “… that patients actually just want to get better and that they will be willing to forego expensive services and products when it makes sense to do so.” I agree. And David links to a study that found evidence-based decision aids can indeed […]
Health Wonk Review – Football Is Here Edition
Welcome to the Health Wonk Review Football edition because, well, it’s September and that means football season is here! And… we’ve got Peyton Manning!!!
Every time I read a post by Amy Berman on the John A. Hartford Foundation’s blog, I’m blown away[…]
AG Announces Settlement With Colorado Discount Medical Benefits Plan
Last spring I wrote about the lawsuit that was filed by the Colorado Attorney General against Consolidated Medical Services, LLC. Consolidated Medical Services was a discount plan (ie, not health insurance but a cheaper substitute that wouldn’t provide much in the way of benefits if a person needed medical care) run by Joseph Benedetto. The Colorado discount medical benefits plans were, according to Colorado Attorney General John Suthers, “… fraudulent, frequently failing to pay patients’ claims as promised.” However, the focus of the lawsuit was the manner in which Benedetto and his LLC went about recruiting affiliate salespeople. According to the AG press release, “Consolidated Medical Services recruited individuals, many of whom are elderly, to market “medical benefits programs” that were advertised as valid substitutes for traditional health insurance.” Salespeople were charged start-up fees and monthly hosting fees in order to sell the discount medical benefits, and virtually none of them made enough money selling the product to recoup the fees they had paid. Only about three percent of the 12,800 affiliates who were recruited between 2008 and 2011 made any money at all selling the discount plan, and most of the few who did make money earned less than they had paid in fees.
Attorney General Suthers’ office announced today that a settlement has been reached with Joseph Benedetto and Consolidated Medical Services, LLC. Benedetto must […]
More About Colorado’s Kaiser Permanente Benchmark Health Insurance Plan
Yesterday’s article about Colorado selecting a benchmark health insurance plan for individual and small group policies sold starting in 2014 has raised a few more questions and I wanted to clarify some details.
This publication from the Colorado Division of Insurance, the Health Benefit Exchange and the Governor’s office is an excellent resource and answers a lot of frequently asked questions. It was released earlier this summer, before the Kaiser small group plan was selected, so it includes details about all nine options that were considered as possible benchmark plans. The Kaiser small group plan that was ultimately picked as the benchmark is listed on page 11 as option A, under “one of the three largest small group plans in the state”.
The 2011 Colorado health insurance plan description for the Kaiser policy is here if you’re interested in the plan specifics. We had a question from a reader who wondered whether chiropractic care would be covered, but it’s listed as “not covered” on the plan description form (item number 30). It’s important to note that cost sharing details like deductible, coinsurance and copays are not part of the benchmark program. The concept of benchmark here only applies to the benefits provided by the Kaiser Permanente health insurance plan. The deductible on the Kaiser health insurance plan is $1200, but that DOES NOT mean that all policies will have to have a $1200 deductible in 2014. In order to be sold in the exchanges, health insurance plans will have to cover at least 60% of costs in order to qualify for a “bronze” designation. And there will also be silver, gold and platinum ratings, so there will still be plenty of variation in terms of cost sharing.
If Colorado had not selected a benchmark plan, HHS would have picked one for us. HHS would have […]
Colorado Selects Kaiser Permanente As Its Benchmark Health Insurance Plan
Last December, HHS made it clear that they were giving states a lot of flexibility in determining what plan would serve as the benchmark for the state’s “essential benefits” for individual and small group health insurance policies that would be sold starting in 2014.
After months of consideration, Colorado has selected Kaiser Permanente’s small group plan as a benchmark. This is the largest small group plan in the state, with almost fourteen thousand members, and was selected by a group of officials from the Colorado Division of Insurance, the Governor’s office, and the health benefits exchange. The Division of Insurance will be taking comments until next Monday before making a final announcement, and you can contact them by email (ehb@dora.state.co.us) if you’d like your comments to be considered.
The Kaiser plan covers services in the ten areas that are required by the PPACA (ambulatory patient services, emergency care, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription medications, rehabilitative services, lab work, preventive care/disease management, and pediatric care), which means that it will serve as a benchmark for services in those areas without the DOI having to add additional coverage minimums. In addition, the Kaiser plan was generally considered to be a good balance between comprehensive coverage and affordable coverage. It’s not the most comprehensive policy out there (the much maligned “Cadillac plans” offer more benefits), but it provides […]