by Leila Morris – Medicare Accountable Care Organizations (ACOs) have improved patient care while saving hundreds of millions of dollars, according to a report by the Centers for Medicare & Medicaid Services (CMS). ACOs in the Pioneer ACO Model and Medicare Shared Savings program generated over $372 million in total program savings for Medicare ACOs. The encouraging news comes from the second year of perform
ance of 23 Pioneer ACOs and 220 Shared Savings Program ACOs. They also improved significantly on almost all measures of quality and patient experience this year. The report also notes that health care prices are rising at their lowest rates in nearly 50 years, Medicare spending, per beneficiary, is falling, and employer premiums for family coverage grew just 3% in 2014. That increase is tied with 2010 for the lowest on record back to 1999. For more information, visit http://www.hhs.gov/news.
Health Comparison Site for Wal Mart Customers
DirectHealth.com is launching “Healthcare Begins Here,” an in-store program designed to educate customers on health insurance options. DirectHealth.com will access to health insurance information and enrollment support. DirectHealth.com also manages relationships with licensed insurance agents, enabling customers to compare coverage options and enroll in a Medicare plan or public healthcare exchange plan through online, phone, and in-store services.
LIFE SETTLEMENTS
Seniors Are Using Life Settlement to Cover Medical Expenses
There has been a steady shift in the use of life settlement proceeds to help with medical expenses, said Alan Buerger, CEO and co-founder of Coventry. “The downturn of the economy combined with the rise in healthcare costs is a major reason people are selling their policies. A number of the largest insurance companies have left the long-term care insurance market or have significantly raised rates for these policies, placing seniors in dire straits when faced with immediate long term care needs,” he explained. For more information, visit www.coventry.com.
IN CALIFORNIA
Orange County Insurance Agent Arrested
Eric Lee, 64, of Orange County was arrested Friday by the Department of Insurance and charged with 20 felony counts, including grand theft and providing false or misleading information to an insurer. The alleged scheme netted him over $1.4 million in fraudulent commissions. This case is being investigated and prosecuted under the Life and Annuity Consumer Protection Program (LACPP). The Department of Insurance began its investigation after an audit revealed that many of Lee’s policies failed to have any premium payments after the first policy year. Investigators say Lee directed policyholders to complete applications with false or misleading information. Also, policyholders did not have the money to pay for the insurance policies being written. Lee is being prosecuted by the Orange County District Attorney’s Office with bail set at $1,403,897. He must prove that bail funds are not coming from money he got through his scheme.
Sports Injuries Land Many Californians In the ER
Over 300,000 Californian athletes visit the ER annually, which is a rising financial risk for families as high deductible health insurance grows and health coverage shrinks, according to a Sun Life Financial report. More Californians participate in each of five sports – baseball, basketball, softball, soccer, and volleyball – than do residents in any other state. The report reveals the following sobering statistics:
• A household has a 50% chance of having an emergency room injury within five years when a family member participates in football, ice hockey, or soccer.
• Injuries from seven popular sports lead to average ER medical costs of $3,000 to $4,000.
• Football, which has the highest sports injury rate at 8.5%, leads to over 60,000 California ER visits this year, second only to basketball. Soccer is expected to generate over 40,000 California ER visits this year.
• Increasingly popular high deductible health insurance plans have average deductibles of $4,000 for a family deductible and $2,000 for an individual.
• Accident insurance can fill widening gaps in medical insurance coverage. Beginning in 2018, a 40% excise tax will be imposed on the value of health insurance benefits exceeding a certain threshold. The estimated thresholds are $10,200 for individual coverage and $27,500 for family coverage. Employers are starting to phase out medical coverage that would be subject to the tax.
One doctor, who was interviewed for the survey, reports a disturbing number of people who refuse essential emergency care because of medical costs. He says that agility training can prevent injury by increasing the ability to anticipate an accident. For more information, visit http://bit.ly/ZleIGi.
CARRIER OUTLOOK
Low Interest Rates Remain Leading Insurance Industry Concern
The low interest rate environment is at the forefront of insurers’ concerns, according to a survey by A.M. Best. Companies have a wide array of asset allocation strategies to stave off declining portfolio yields, most of which involve some trade-off of liquidity and credit quality. Forty-seven percent of companies have more liquidity today than they did during the financial crisis of 2007 to 2008 while 45.2% say they have the same amount. For a full copy of the report, visit http://www3.ambest.com/bestweek/purchase.asp?record_code=229377.
EMPLOYEE BENEFITS
Voluntary Participation Rates Vary
Participating rates for voluntary benefits vary from 2% to 42%, according to an Eastbridge survey. But the average is around 20%, which is slightly below study results in 2011. The report also reveals the following:
1. Participation is higher for smaller cases than for larger cases.
2. Dental and vision products have the highest participation rates among all voluntary products.
3. Participants say that personalized enrollment kits improve persistency. They also say that the right sequencing of products in an enrollment can make a difference in the participation results.
For more information, visit www.eastbridge.com.
NEW PRODUCTS
Safe Harbor Term
Phoenix is offering Phoenix Safe Harbor Term Life and Phoenix Safe Harbor Term Life Express. Phoenix Safe Harbor Term Life includes riders that can provide accelerated death benefits in case of chronic illness, critical illness, or terminal illness. It also offers a waiver of premium in case of unemployment. An optional accidental death benefit rider is available for an additional premium. It is available in 10-, 15-, 20- and 30-year term periods to insureds from age 18 to between 50 and 80 at the time of issue, depending on the term length and tobacco use. For more information, visit www.phoenixwm.com and www.saybruspartners.com.
Savings Calculator for Self-Funded Employers
SurgiPrice is offering a transparent, bundled bid medical and dental platform for surgeon fees, anesthesia fees, and facility fees. A dedicated patient advocate works with consumers from start to finish. For more information, visit https://www.surgiprice.com.
Private Exchange Solution
Connecture is offering On Ramp, a full service, private health insurance exchange solution and benefit portal. On Ramp includes the shopping, enrollment, quoting, sales, benefit administration and member engagement capabilities. It can be customized to each client and configured to people in every health insurance segment, including those in the individual, group, under 65, Medicare, and retiree markets. Users answer questions to get personalized plan selections. It offers additional benefits including wellness programs and ancillary insurance offerings, such as dental, vision, life, disability and more through an online benefit store. It includes an out-of-pocket calculator, a drug price comparison tool, quoting and sales administration tools, and integrated benefit administration. For more information, visit www.connecture.com.
Dental Benefits
Brighter Dental has developed the Proactive Remittance Organization (PRO), a technological evolution of the PPO model. Brighter says that the cloud-based dental benefit platform simplifies employer self-insurance and reduces costs dramatically. It offers pricing transparency, more efficient claims processing, and integrated communications between patients and providers. It also offers a dental shopping platform in which dentists compete based on cost, quality, and convenience. The new communications and claims payment software makes plan administration more efficient and less costly. For more information, visit https://www.brighter.com.
ACA Compliance Tool
ADP is offering ACA compliance solutions for organizations with at least 1,000 employees in the United States. ADP Health Compliance combines Software as a Service (SaaS) with rigorous managed services staffed by ACA experts who can help to enable compliance while managing all of the complex regulatory requirements. For more information, visit www.adp.com/healthcompliance.
Fixed-Indexed Annuity with Long-term Care Benefits
OneAmerica launched Indexed Annuity Care, the first fixed-indexed annuity that can provide benefits for long-term care (LTC) expenses. Consumers can pay a single premium to get Indexed Annuity Care, which offers built-in leverage for qualifying LTC expenses, such as assisted living, home care, adult day care, respite care, hospice care, and nursing home care. Consumers can add an optional lifetime LTC insurance rider benefits to the contract – with premiums that are guaranteed never to increase. Owners of Indexed Annuity Care can get income-tax free withdrawals and benefits for qualifying LTC expenses, thanks to provisions of the Pension Protection Act (if funded from after-tax premium sources). For more information, visit www.OneAmerica.com.
Decision Support Retiree Health Benefits
Towers Watson is offering a decision support service that will help early retirees determine whether they are better off using a subsidy from their former employer or taking a tax credit from the federal government. For more information, visit towerswatson.com.
Private Exchange
Genius Avenue has launched Genius Benefits. Employers can offer an alternative to public exchanges for part-time and non-benefit-eligible employees. Licensed benefit counselors provide guidance and information to employees over the phone. Genius Benefits also includes voluntary benefits, such as dental and vision, supplemental insurance coverage, identity theft protection, telemedicine, pet insurance, and discount and savings programs. There is no payroll deduction administration because premiums are billed to the employee’s credit card or debit card. For more information, visit www.geniusavenue.com.
EVENTS
Premium Financing Webinar
Succession Capital Alliance is holding its Advanced Premium Financing webinar Wednesday, October 22, at 11:00 am PST. It will cover the evolution of premium financing as well as how to close a case, handle common objections, and identify prospects. To sign up, visit https://www1.gotomeeting.com/register/958385392.
