Pulse Perspectives

DC Health Benefit Exchange Authority: Private Insurers Submit 293 Health Insurance Policies for Approval to Offer to Individuals, Small Businesses on DC Exchange

Friday, May 17, 2013

Private Insurers Submit 293 Health Insurance Policies for Approval to Offer to Individuals, Small Businesses on DC Exchange

The plans include 259 policies for small businesses and 34 for individual purchasers.

Four major health insurance companies intend to offer nearly 300 different health insurance policies for sale on the DC Exchange Marketplace, a new online portal that will allow individuals, families, and small businesses to shop for coverage that fits their needs and budgets. This robust choice of plans means, for the first time, that residents and employers in the District will be able to compare dozens of plans side-by-side when the Marketplace opens for enrollment on October 1, 2013 for coverage that becomes effective January 1, 2014.

Earlier this month, the four insurers – Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente, and United Healthcare – committed to participating in the Marketplace. Because they sell coverage in today’s market, their participation in the Marketplace ensures all currently insured in the small group and individual markets will not have to change insurers unless they choose to do so.

“This is wonderful news for the residents and local businesses, which will have more choices and better choices than they have today,” said Mayor Vincent C. Gray. “I’m pleased to see our strategy for improving the health and financial security of our residents is working.”

The four insurers have filed a total of 259 small group products and 34 individual products. These include health maintenance organizations (HMOs) and preferred provider organizations (PPOs) health insurance policies. All policies must cover, at a minimum, a set of essential health benefits that include doctor and hospital visits, prescription drugs, pre-natal and maternity care, prevention, lab tests, and vision and dental care for children. A detailed list of plan offerings by insurer is listed below.

“This shows that insurance companies serving the District’s insurance consumers are committed to offering good options for businesses and people here. I thank the insurance companies for their commitment to helping the District’s Marketplace Exchange be successful. As a result, we will have a strong, competitive market where individuals and small businesses will have a wide variety of options when buying high-quality health insurance,” said Mila Kofman, J.D., the Executive Director of the DC Health Benefit Exchange.

Insurers have until May 31 to file their proposed rates with the Insurance Department. Actuaries will review the rates to determine whether they are set at appropriate levels. Once health insurance policies and rates are approved, the Exchange will provide additional information. Many DC residents will be eligible for significant financial help in the form of federal tax credits to reduce the cost of insurance for them.

“For coverage to be meaningful, it must be affordable,” said William P. White, commissioner of the District’s Department of Insurance, Securities and Banking, whose agency is responsible for the rate review process. “Insurers have an obligation to charge premiums that cover the cost of paying claims and maintaining a reasonable reserve to protect against uncertainties. With thousands of uninsured DC residents waiting to gain coverage, it is crucial that 2014 rates are reasonable and justified. We will work with insurers to accomplish that result.”

Health Insurance Policies for the Exchange Filed for Approval With DISB

Carrier	Total Plans	Individual Plans	SHOP Plans
CareFirst BlueChoice, Inc.	50	11	39
Group Hospitalization and Medical Services, Inc. (GHMSI)	27	4	23
Optimum Choice, Inc.	88	0	88
United Healthcare Insurance Company	89	0	89
Aetna Life Insurance Company	12	9	3
Aetna Health Inc.	3	0	3
Kaiser Foundation of the Mid-Atlantic States, Inc	24	10	14
Total	293	34	259

Inova president: Health systems entering ‘new normal’ of fewer patients

May 14, 2013, 1:54pm EDT

Inova president: Health systems entering ‘new normal’ of fewer patients

Ben Fischer

Staff Reporter- Washington Business Journal

Thanks to its profitable suburban locations and strong credit rating, Inova Health System has rarely encountered "business problems" as a non-health care provider might define them. But in a wide-ranging conversation Tuesday, Chief Operating Officer Mark Stauder said times are changing.

Inova’s overall patient load has declined 3.5 percent so far in 2013, year over year, and executives think it’s not a short-term blip. In fact, to a great extent it’s by design, a.k.a. health care reform. Read on for his thoughts on what that means for the system, its patients and business partners.

How is health care utilization at Inova this year? Let me step back and talk a little bit about Inova’s perspective on the evolution on what’s happening within health care today. We think this is really a beginning of a new normal, or a tipping point in the change within health care. For decades, this country has lived in a fee-for-service environment, and over the last several years, we are moving towards a value-based health care system, moving away from volume and moving toward value.

I think this is exemplified in the federal government’s movement around [accountable care organization] demonstration projects. I think it’s exemplified in employers making significant changes in their health plan design around consumer-based health plans, around high-deductible health plans and really encouraging patients and families to share in the cost of health care, so it becomes a very personal decision around the consumption of health care. For many decades, individuals and families have been insulated from the cost of health care, and we think that’s changing now with new health plans that employers seem to be adopting at a very very rapid pace.

With that evolution, with those changes, we actually believe we’re at a tipping point and we’re going to see consistently lower volumes over time. And that’s consistent with moving away from a fee-for-service environment and moving toward a value-based environment where physicians are being more cautious about ordering tests, [and] individuals and families are being more cautious about using health care, especially services that are elective.

Is Inova seeing fewer patients in real time, or do you mean over the coming years? We measure things in what we call equivalent admissions, and that’s a combination of inpatient care, observation care and outpatient testing. First quarter, we’re down about 3.5 percent, year over year. And that’s pretty consistent with what we’re reading from (publicly traded health care companies) Health Management Associates, Universal Health Services other national providers, including commercial health care businesses such as Johnson & Johnson, Abbott Laboratories or St. Jude Medical. I think we are seeing a tipping point in national health care across the country, and we believe this is just the beginning of that future trend.

Local and state governments have long counted on health care to lead their economic development efforts. Are they overestimating its future? This is Mark Stauder‘s opinion, this is not Inova’s opinion, this is my opinion, but my sense is that overall utilization across the country and in this region will trend down over time. And the only offset is going to be if population growth grows faster than the utilization declines. And I think given the state of this economy across the country, I think there will be very few markets where populate grows enough and quick enough to offset utilization decline.

What about the aging of the population? That’s another trend, but you’ve got to realize that the federal government is really [incentivizing] and asking providers to come together, hospitals [to] come together and form [accountable care organizations], to really manage for that triple aim: higher quality, higher service, lower utilization and lower costs. So even in the Medicare population the national focus is on that triple aim.

Do you believe Virginia will expand Medicaid? We are very hopeful and very supportive of expanding the Medicaid program. The state legislature voted to have a two-step model: medicaid reform and then Medicaid expansion, as it’s reviewed and affirmed by the bipartisan commission. We’re very hopeful. We think it is the right public policy to have everyone covered, and everyone insured to make sure we’re driving wellness, we’re driving prevention and driving health.

Is Medicaid expansion a material factor in the performance of your hospitals, or do you approach this as a general public policy position? Inova is the largest nonprofit health care provider in Northern Virginia, and we’ve got a mission to take care of everybody. Today, we provide $350 million in charitable services to underinsured and uninsured patients at cost. So clearly, if the state decides to reform and expand Medicaid, there will be funding for a portion of that group of patients that is currently receiving charitable services or free services as part our nonprofit mission. From a public policy perspective, we believe we can have a healthier population if everybody’s insured.

How’s development of your cancer center? Things are moving ahead briskly. We’re going through the site development, the architectural development, its going to be about 250,000 square feet of cancer services, cancer research and academic services, and we hope to have the planning done here and the drawings complete, and we hope to begin construction in 2014. And hopefully then we’ll occupy in late 2016 or early 2017.

What about the required certificates of need? Will those be difficult? That’s moving in parallel. No, this region needs a significant comprehensive cancer program. This will be the dominant comprehensive cancer program in the northern Virginia/D.C. region. And with the population aging, you know, cancer is going to continue to be one of the most significant diseases we’re going to have to deal with, and that’s where our genomic research and clinical trials will hopefully discover new and productive approaches in prevention and cancer management.

Will you pursue National Cancer Institute designation? That’s something that’s under study at this time.

Inova has committed or spent more than $1.7 billion to rebuild its hospitals, install a major new computerized patient record system, launch its Translational Medicine Institute and the cancer center. Will this pace of development and spending continue, or have we reached the downside of a cycle? I think we’re continuing to invest in the region, to continue to be the significant leader in health care provision, new clinical services, and innovation within the Northern Virginia region. Everything we’re investing in, we believe is going to be accretive long term. Patients are seeking new accommodations, they’re seeking wellness, comfort-oriented confidential environments for receiving health care services. Information technology is critical — we’re really in the information management business, and our clinical effectiveness is only as good as our information systems. We believe that these are all fundamental elements of maintaining building, and evolving a world-class health care system.

But is more coming? We’re just continuing to focus on kind of this new normal. We don’t have any major announcements we’re planning. We’re continuing to think through the evolution of health care, and making sure we are a world-class provider of health care services, that we are integrating, that we’re leveraging our intellectual knowledge within the system.

Are you still working to acquire doctors’ practices as a strategy? We are careful and thoughtful about physician acquisition. We are acquiring practices — primary-care practices and select subspecialties. I would say it’s a thoughtful, careful and measured approach.

How many primary-care doctors do you have employed now? We have about 50 physicians. In Northern Virginia, our medical community is still probably 85 percent private-practice physicians. Again, I think our physicians have had a very good place to practice here, and I think they’re satisfied working in small groups, and that’s worked well for them.There’s a number of different alignment approaches. No. 1 is the traditional medical staff relationship, No. 2 is an employment model. and No. 3 is a narrow-network partnership model, which we are currently developing called Signature Partners. That is a model to begin to take risk together, to enter relationships with insurance companies together and to manage care together without necessarily requiring employment.

Ben Fischer covers health care and law.

DISB Press Release: Rehabilitator for D.C. Chartered Health Releases Fourth Status Report

For Immediate Release May 17, 2013 Contact: Mike Flagg, (202) 442-7756 michael.flagg Rehabilitator for D.C. Chartered Health Releases Fourth Status Report

Uber wars threaten to reignite over new regulations

Uber wars threaten to reignite over new regulations

By Mike DeBonis, Updated: May 17, 2013

Six months after city officials and Uber settled conflicts over regulation of the app-based transportation service and jointly declared peace in our time, conflict again threatens to erupt — this time, over new sets of regulations being considered by the D.C. Taxicab Commission that Uber claims could severely impact its business.

Regulations passed last week by the commission — the same one requiring all city taxicabs to accept credit-card payments — also include requirements that payments be processed through “payment service providers” that are integrated with the cab’s on-board meter system. That requirement, Uber said in a May 3 letter to the commission, “is not practical for a software-only company like Uber.”

Uber CEO Travis Kalanick said Thursday that the new rules, “as far as we can tell, require us to shut down Uber Taxi” — the part of the Uber app that hails a traditional taxi cab rather than the luxury black cars the company is best known for. The rules, he said, would require Uber to associate with payment providers who are integrated with the taxi hardware in order to maintain Uber’s model of processing payments entirely via smartphone app.

And Kalanick says another set of regulations now in development affects the sedan service in significant ways — including a ban on cars weighing under 3,200 pounds, which he says would encompass most “eco-friendly” vehicles. Also troublesome, he says: a requirement that companies would have to share ride data with the commission for analysis and planning purposes, creating what he feels is a “substantial privacy problem” for Uber customers.

“Do you trust the D.C. Taxicab Commission with your whereabouts?” he asked.

The company has submitted comments on the taxi regulations to the commission, with comments on the sedan regulations likely forthcoming. Company reps have also taken their case direct to D.C. Council members, who have a limited to nonexistent role in the rulemaking process.

Uber D.C. general manager Rachel Holt and company lobbyist Jon Bouker met with D.C. Council member Mary M. Cheh (D-Ward 3), the transportation company chairman, on Wednesday to discuss the company’s concerns. David Grosso (I-At Large) said he’s also gotten involved and is considering introducing emergency legislation if the matter isn’t resolved in the rulemaking process. “I have a draft ready to go, but I’m not going to put anything in till we work through this,” he said.

Cheh said she’s hoping the council can stay out of it. “I think whatever their concerns are … we’ll get them resolved,” she said, adding that she is not pleased that Kalanick has yet again gone public with his displeasure with the city’s regulatory efforts: “I do wish they would at least give me a chance to sort this out.”

Taxicab Commission Chairman Ron M. Linton was more direct, saying he would not let the rulemaking process be taken hostage by Uber’s threats. Other companies, he said, have offered similar comments which will be considered by the commission in due course.

“As regulators we don’t negotiate with individual parties when we’re dealing with regulations that affect multiple parties,” he said. “We’re not trying to twist anyone here. We have a process, a system which allows us to monitor and protect the consumer that makes sure everything is done under the law.”

Update, 8:20 p.m.: In case there was any doubt, yes, Uber is now rallying its customers to oppose the regulations, something that has proven quite successful for them in the past.

Linton added this statement:

There is nothing in the proposed Modern Taximeter System regulations that would require Uber or any other digital reservation system to shut down. As a matter of fact, no other digital reservation service providers have indicated any plans to cease operations. The regulations have been designed to prevent potential credit card fraud. All data transmitted is done anonymously without identifying anyone. It is patently false that fuel efficient vehicles would not meet the sedan class regulations. As examples both the Camry Hybrid and Avalon Hybrid would comply with the standards. The provisions to be implemented are what Uber agreed to last year when the DC City Council passed the Taxicab Innovation Act. Without the regulatory protection the DC market would be open to unscrupulous operators who would be able to engage in widespread credit card fraud. If Uber follows through on their threat to shut down it would be their decision and not the result of any regulation.

Also, I’ve obtained an e-mail sent Tuesday to Bouker, Uber’s lobbyist, from a city hall lawyer who acknowledged “there is merit to Uber’s concern” and expressed willingness on the part of Linton and other officials to work with the company to address them.

“We’re eager to continue conversations on this issue and reach a solution that works for everyone,” wrote Barry Kreiswirth, senior counsel to City Administrator Allen Lew. “As Ron has previously stated, he is prepared to call a special meeting of the Commission for May 24 in order to vote on the changes on an emergency basis, so the quicker we can get these issue resolved the better. … The District values the innovation Uber and companies like it have brought to District sedan and taxi service – and the great service it’s provided to District residents.”

Unclear how that degenerated into today’s accusation that the city is “burdening DC tech startups with anti-consumer, anti-innovation regulations.”

CareFirst, other insurers back in D.C. Council’s crosshairs

May 15, 2013, 2:52pm EDT Updated: May 15, 2013, 3:19pm EDT

CareFirst, other insurers back in D.C. Council’s crosshairs

Ben Fischer

Staff Reporter- Washington Business Journal

D.C. Councilman David Catania, I-At large, an influential voice on health care issues, plans to introduce legislation forcing insurance regulators to take a closer look at large hikes in health insurance premiums.

When the full D.C. Council considers a controversial proposal to mandate use of a new health insurance exchange, Catania intends to propose an amendment requiring public review of exchange plans with rate hikes that exceed medical inflation rates.

His amendment, still being drafted, would require a 30-day public comment period and a public hearing for qualifying rate hikes, as well as an affirmative decision from the D.C. Department of Insurance, Securities and Banking.

Under current law, the department has some latitude in how it decides to review rates and often lowers them before approval, but rate hikes are deemed approved after 60 days if the department hasn’t taken action.

Catania cast his proposal as an olive branch to business groups that fear extraordinary growth in their health insurance premiums if they are forced into the exchange.

"The issue is how do we go forward in a way that eases some of the concerns raised — that are legitimate — about the unknown in terms of price increases, yet still be faithful to the Affordable Care Act," Catania said.

Catania’s chief of staff, Ben Young, said the councilman’s general goal is to shift intensive rate review from an option to a requirement for rates that grow more quickly than overall medical spending, as defined by the Centers for Medicare & Medicaid Services.

In early 2010, the D.C. Council approved an emergency law prohibiting rate hikes of more than 15 percent, but the la expired and its permanent version includes no bright-line thresholds for more intensive review. The new law, however, does require that the rate hikes be published online and that regulators make sure they are not excessive, inadequate or discriminatory.

"We take this seriously," said Associate Insurance Commissioner Phil Barlow. "We don’t just arbitrarily decide to look at filings or not. We give all filings scrutiny. Some — the filings that affect a lot of people or that have significant rate increases — we give them more."

CareFirst controls about three-quarters of the District’s insurance market. But three other insurance companies are expected to sell through the exchange, including Aetna Inc., Kaiser Permanente and UnitedHealthcare.

A CareFirst spokesman declined comment.

So far, the work to create the insurance exchange has unfolded with relative peace between the District government and insurance companies. Even though carriers are fighting mandatory use of the exchange, the rules are designed to foster maximum participation and flexibility. That strategy reflects the view of Executive Director Mila Kofman, who believes open competition within the exchange will serve to hold down rates.

But bringing up rate review could revive old disputes from several years ago, when rate regulation fever struck after double-digit hikes.

Does the extra review really lead to lower rates?

Georgetown University health policy professor Sabrina Corlette said the public hearings backed by Catania would make D.C. one of the most aggressively regulated jurisdictions in the country. Oregon has a similar procedure.

"I can tell you in Oregon, the folks out there definitely believe that having a public process, and a hearing, absolutely does lead to lower requested rates," Corlette said.

Ben Fischer covers health care and law.

Washington Informer: AmeriHealth Promises Enhanced Care for Residents

AmeriHealth Promises Enhanced Care for Residents

Written by Barrington M. Salmon

Thursday, 09 May 2013 19:06

May 1 marked the first day that AmeriHealth formally took control of the operations of the now-defunct Chartered Health Plan.

On a recent morning, the Northwest offices of AmeriHealth DC buzzed with activity as employees continued to get comfortable with catering to the varied needs of 100,000 of its newest members.

May 1 marked the first day that AmeriHealth formally took control of the operations of the now-defunct Chartered Health Plan (CHP). AmeriHealth officials said they’ve set their sights on ensuring a smooth transition while allaying any fears their new clients might have.

AmeriHealth CEO Michael Rashid echoed the elation he said the staff feels about the transition.

"I’m so excited to be here," he said during a May 1 interview. "What we’ve been doing is transition. We couldn’t be here without the Chartered Health staff. They’re a great staff."

Rashid and several senior staffers said that 150 employees from the Chartered Health Plan were invited to shift over to AmeriHealth.

"We’ve had 30 days to ramp up and during that period, we’ve met with all Chartered doctors and hospitals and 90 percent have agreed to stay with us," Rashid explained. "… It will be a nice marriage. We want to augment what CHP was doing. We’re starting from scratch, turning the page. Huge distractions are off the plate for the employees."

Rashid was referring to the problems that have dogged Charter Health Plan since Jeffrey Thompson, former owner and one of the principals, became embroiled in a federal investigation for alleged campaign finance irregularities. For more than a year, Thompson battled with prosecutors, meanwhile, CHP came under the scrutiny of insurance regulators and city government officials took over the firm and placed it in receivership last October.

Like CHP, AmeriHealth DC will continue to serve low-income residents who’re eligible for Medicaid and other government health programs. AmeriHealth bought the company and inherited Chartered’s 100,000 District residents. AmeriHealth will continue with, and close out CHP’s current contract it has with the city before it commences with its own contract on July 1.

"We’re bringing our 30 years of Medicaid. This is all we do," said Rashid. "We’ll be focusing on understanding the community and Medicare and Medicaid recipients. We’re developing programs geared to the needs of those in the community. We’re trying to connect people to the system."

Rashid said Chartered Health laid a foundation on which AmeriHealth will build.

"Charter is different and it has had relevant programs for is clients. Clients should stay because the future is so bright. We bring best practices and increased resources coming in."

Anne Morrisey, AmeriHealth’s executive vice president and chief operating officer, explained the three top issues the company is focused on.

"We’re making certain that existing members have access to quality care; ensuring that we’re in their communities; and helping them understand the transition," she said. "They’ll have the same benefits and they’ll have the same opportunity to get a similar level of care."

Executive Director Karen Dale said no one’s trying to reinvent the wheel.

"We’re using the care management approach that meets members where they are," she said. "We’ve been working for one and a half years on the total care approach."

That may mean finding out if a diabetic patient has food in his or her refrigerator, checking if they have money for transportation, as well as focusing on and addressing other complex psychosocial issues.

Rashid said AmeriHealth is owned by two Blue Cross plans, which means "patients will be served by Blue Cross which means Cadillac care."

Keeping Chartered Health staff is a non-brainer the executives said, and with the staff on board, continuity continues unabated.

"Clients will be talking to the same people because we’re brought over most of the program," Morrisey said. "We’ve met with them a number of times to bring them on. And we’ve talked to them about the advantages they bring to the marketplace."

She said AmeriHealth is using some Chartered Health staff employed by having them work virtually, assisting staff in other cities.

"The jobs stay here. Obviously, it depends on performance," she said.

Dale said that one of the benefits AmeriHealth brings is a system where everything is integrated.

"We can see families, provide prescriptions and close gaps in care," she said. "Having that integrated system means more and better management."

The executives said a lot of doctors refuse to take Medicaid because the reimbursements are so low and because the onerous paperwork and administrative burden.

"It’s not a D.C. problem, it’s a national problem," said Rashid. "And it’s a rural issue Medicaid numbers are so low. The Affordable Care Act has increased reimbursements. This will attract doctors back."

"Increased prevention will mean an increase in numbers but less doctors."

Dale said the company has worked to reverse the problem.

"We’ve done some things with providers to make it better," she said. "We try to wrap things into one visit and we’ve reduced the administrative burden. We have a provider portal where doctors check eligibility, the status of payments and reduce the time administrative staff would spend on these issues. We have a commitment to providing that level of support."

Dale said AmeriHealth offers doctors incentives to offer extended hours and office hours on weekends.

"If people are going above and beyond, they can get money for that," Dale added.

"The end-game is taking care of clients," Morrisey said. "The capitated rate, incentives and bonuses create a quality health care life for members."

Rashid acknowledged the challenges of providing healthcare to a disadvantaged population.

"We know there are disparities East of the [Anacostia] River. There are higher rates of diabetes, hypertension and childhood asthma," he said. "We plan to leverage our experience and partners, double our teams and dedicate a number of our staff to high-volume pharmacies and practices. Nothing’s changed except the name."

The trio said they plan to leverage their experience, as well as that of their community partners.

"We’ll work with community resource organizations when we need to connect with a part of the community," said Morrisey, a native Washingtonian who was born at the Garfield Hospital in Ward 8. "It’s important to connect to different people who know our membership."

Rashid concurred.

"We’re so big we cannot do it all," he said. "They can reach people we can’t."

He spoke of a church-based program which includes health screenings, information sessions and cooking classes in small settings.

"Then it grows into a thing with 3,000-4,000 women – a health ministry for women," he said. "We have way more power working with community. It can’t happen without the small things we do and build it up."

Rashid said personal contact with clients is the "sweet sauce" of AmeriHealth’s success.

"We try to make it as easy as possible," he said. "We try to do as much as we can to make it easier to serve Medicaid recipients. We’ll call Medicaid recipients, remind them of appointments; we’ll even be in offices to help them explain doctors’ instructions – we’re bringing in resources from outside to improve health care."

"To operate in a vibrant community and only pay insurance claims is not enough. We want people to be healthier, get well and stay well. Building healthy communities, that’s our mission."