health insurers

Trend: Insurers creating more HSAs as industry grows

Anne Zieger — Mon, 15 Dec 2008 10:55:03 -0500

The money coming from the "health/wealth" market is expected to increase over the coming years: some experts predict the market could reach $40 billion in the next five years.

So it's little surprise that the biggest health plans are not hesitating to at least dip their hands into programs like HSAs and health debit cards. Experts predict that over 10 percent of that $40 billion could go to companies who help consumers manage their HSAs, so insurers are maneuvering to be those companies.

As we've reported before here at FierceHealthcare, major health insurers like WellPoint, UnitedHealth Group, and BCBS already have HSA programs, but experts predict that other insurers will jump into the banking industry before long, to get their share of the cash.

To learn more about this trend:
- read this AMNews piece

Health insurers turn to financial services

Anne Zieger — Thu, 23 Oct 2008 10:13:06 -0400

Yesterday, our sister publication FierceHealthFinance told you about the growth in consumer deposits to health savings accounts, the nifty tax-advantaged vehicles consumers can use to pay for the high deductibles on their "consumer-directed" health plans. Not surprisingly, insurance companies have been responding to this trend with some strategic moves of their own.

Apparently, some insurance companies believe it is to reinvent themselves as financial services companies and get out of the sinking ship of traditional health insurance. For example, WellPoint is a health insurance company, right? Well, no. Actually, it has convinced the Federal Reserve Board that its primary business was financial services. Health insurance was just "complementary" to that main business.

WellPoint is just the most recent health insurance-related entity to go into the HSA business. As we've previously noted, CDHPs and HSAs are a growing business in which insurance companies (or is it financial service companies?) stand to earn a lot of money. For example, the Blue Cross Blue Shield Association launched its own HSA-focused "Blue Healthcare Bank" about a year and a half ago, co-owned by 33 BCBS companies. Another case in point is Exante Bank, which was chartered in January 2002 by health plan operating company UnitedHealth Group.

To learn more about health insurers turned money managers:
- Read this L.A. Times piece

Non-profit health plans question for-profit switch by Horizon

Anne Zieger — Fri, 29 Aug 2008 10:00:18 -0400

A group of not-for-profit health insurers and providers have their back up over Horizon Blue Cross and Blue Shield's application to convert its corporate structure to for-profit status. The group, the Alliance for Advancing Nonprofit Healthcare, contends that Horizon hasn't given a good enough reason to justify the conversion.

In its filing with the state, Horizon has said that switching from not-for-profit to for-profit operations will help it obtain greater access to capital, which it plans to invest in information technology, pay-for-performance initiatives and business operations. These investments would exceed the plan's annual $35 million by a projected $20 million to $30 million per year during the next five years.

However, the Alliance, whose members include Henry Ford Health System, Minnesota Blue Cross Blue Shield, Provena Health and the Washington State Hospital Association, isn't buying Horizon's pitch. Its leaders have sent letters to both the New Jersey attorney general and commission of the Insurance and Banking Department, urging them both to closely study Horizon's application. The Alliance's leaders say the officials should question why Horizon can't get the capital it wants while staying a not-for-profit entity.

To learn more about the challenge:
- read this Modern Healthcare article

Related Articles:
N.J. Blue plan files to go for-profit
DC sues area Blue plan, demands it donate millions to community
Horizon BCBS settles with MDs
NJ Blue plan invests $500K in med history tech for hospitals

Harvard, RAND-backed provider payment model to be tested

Wed, 21 May 2008 06:59:57 -0400

An evidence-based healthcare payment model driven by researchers at RAND Corporation and the Harvard School of Public Health will be rolled out in January at four pilot test sites with funding from a $6.4 million grant.

The project, dubbed Prometheus--for payment reform for outcomes, margins, evidence, transparency, hassle-reduction, understandability and sustainability--is funded by the Robert Wood Johnson Foundation. Payments will be built around a total amount to be paid to all providers for a patient's condition. The project includes 12 evidence-based case rates, which included input from health insurers, employers, physicians and others through a not-for-profit collaboration.

The payment scheme will be kicked off in Rockford, Ill., and Minneapolis, with two other sites still to be announced. HealthPartners, a not-for-profit health plan, will run the project in Minneapolis, and employers will test the model with providers in Rockford.

To learn more about the project:
- read this article from Modern Healthcare (reg. req.)

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UnitedHealth's Ingenix faces mounting legal troubles

Mon, 05 May 2008 06:59:58 -0400

A couple of months ago, New York Attorney General Andrew Cuomo rocked the health plan industry when he filed suit against UnitedHealth Group. In the suit, Cuomo argued that UHG was committing consumer fraud in how it sets rates for paying out-of-network physicians, specifically by setting artificially-low rates that leave consumers with big bills. Not only is this a big deal for UHG itself, it's a problem for the health insurance industry as a whole, as several major health insurers also use Ingenix data to set rates.

Now, a consumer is raising the stakes a bit by attempting to get class action status for a suit against Ingenix itself. In the suit, which was filed in Connecticut, plaintiff Jeffrey Weintraub contends that he was defrauded by a conspiracy in which health plans calculate lowball, out-of-network rates using bogus Ingenix data. Weintraub also names UHG, Oxford health Plans, Aetna, Cigna and other insurers in the suit.

Meanwhile, the industry is still waiting for Cuomo to drop the other shoe. While New York's AG has promised to sue Ingenix, he hasn't done so yet. Cuomo has said that he is investigating an "industry-wide scheme perpetrated by some of the nation's largest health insurance companies to defraud consumers."

To learn more about the case:
- read this Modern Healthcare article

Related Articles:
NY sues UnitedHealth over MD payments
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WellPoint profits fall 25 percent during first quarter

Thu, 24 Apr 2008 06:59:58 -0400

Yesterday it was UnitedHealth Group in the hot seat, and today it's WellPoint. The health insurance giant said that its first-quarter profits fell 25 percent compared with the same quarter last year. The company reported a drop in net income to $588 million for Q1 of this year, compared with $783 million for the first quarter of 2007, driven primarily by rising medical costs. This news comes despite the fact that revenues climbed 3 percent to $15.6 billion from $15.1 billion, and enrollment went up.

With a growing number of health plans reporting that they're losing ground financially, things are beginning to look bad for the sector as a whole. Generally speaking, that's not good for providers; after all, a health plan's first instinct is to clamp down on reimbursement when things look bad. The next few quarters could be scary for providers that don't have serious negotiating muscle.

To learn more about WellPoint's results:
- read this Business Courier of Cincinnati article

Related Articles:
UnitedHealth suffers financial setback
Aetna, WellPoint refuse payment for serious errors
WellPoint links employee bonuses to member health
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Genetic discrimination bill progressing in Congress

Thu, 24 Apr 2008 06:59:57 -0400

After more than a decade of attempts, it looks like Congress might finally pass a bill that would block health insurers from denying coverage to otherwise healthy persons based on their genetic predisposition to come down with a particular disease. The bill, the Genetic Information Nondiscrimination Act, also would bar employers from using genetic info as part of hiring, firing, job placement or promotions. The House approved the bill last year, and the Senate is expected to vote on it this week. The Senate version, however, attempts to make the bill easier on insurers. The changes are a concession to Sen. Tom Coburn (R-OK), who has blocked the bill, arguing that it could impose unintended liability risks.

If this bill passes, it could have important implications for the future of personalized medicine. Right now, some researchers studying gene-specific effects of treatments are finding that some subjects won't participate due to fears that their data will be used in just the fashion proscribed by this legislation.

To learn more about the bill:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
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CA regulators begin broad review of policy cancellations

Fri, 18 Apr 2008 06:59:57 -0400

In a move that could cost health insurers untold dollars, and possibly change the dynamics of the individual coverage market, the California Department of Managed Health Care has begun reviewing thousands of individual policy cancellations by the state's five major health plans. The DMHC will turn over policies dropped by the plans to an independent arbiter, who will determine whether the policies were inappropriately canceled. If the policies were wrongly canceled, the DMHC will require the health plans to reinstate those patients, and what's more, to pay all of the patient's bills incurred while the patients didn't have coverage. Meanwhile, the DMHC is ordering Anthem Blue Cross, Kaiser Permanente and Blue Shield to immediately reinstate 26 patients whose policy cancellations, in its view, were wrong on their face.

This move is perhaps the boldest in a long string of actions the DMHC has taken to prevent the state's health plans from canceling individual policies when individuals incur high medical bills. The DMHC contends that canceling such plans because of innocent mistakes on applications is unlawful.

To learn more about the DMHC's review:
- read this Los Angeles Times article

Related Articles:
BC of California fined $1M for cancellations
Kaiser forced to reinstate coverage
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Kaiser pushes for policy-cancellation rules

Ohio law makes health plans disclose contract terms

Mon, 07 Apr 2008 06:59:57 -0400

A new Ohio law has been enacted that requires health plans to provide significantly more information in their contracts with physicians, as well as change their contracting practices. Among other things, the new law requires such contracts to offer clearer statements of what the insurer will pay for services, provide a summary section outlining key parts of the agreement and provide notice of significant changes to contracts. The measure also imposes a two-year moratorium on "most-favored-nation" clauses, which require physicians to give an insurer the lowest price for its members. Not only that, it limits "network rentals" or silent PPOs, in which health plans get access to other insurers' networks, then pay their doctors the lowest rate they find. Meanwhile, the new law calls for the development of a web-based eligibility verification system that lets physicians know if care is covered, and what portion of charges patients will pay.

To learn more about the new law:
- read this AMNews article

Related Articles:
OH may make health plans disclose fees. Report
New York AG expands health plan investigation. Report
CA accuses UnitedHealth of 'unfair' practices. Article

WellPoint stops paying for never events

Thu, 03 Apr 2008 07:59:58 -0400

Health insurer WellPoint has taken a stand that most other U.S. insurers are likely to follow: It has announced that it, in coming months, will no longer pay for care resulting from serious medical error. WellPoint will start by denying payment for three never events: foreign objects left in patients after surgery, operations on wrong body parts and operating on the wrong patient. It's also refusing payment for hospital-acquired injuries, pressure ulcers, air embolisms, blood incompatibility, catheter-associated urinary tract infections, vascular catheter-associated infections, hospital-acquired injuries and chest infections after CABG. It is, of course, following CMS's lead, which announced last year that it would stop paying for treatment related to certain adverse events.

To learn more about WellPoint's decision:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
By 2008, Medicare won't pay for hospital errors. Report
Others payers may follow CMS's 'no pay' lead. Report
BCBS plans phasing out pay for errors, 'never events.' Report
Business say 'no pay' for major mistakes. Report
Study: Wrong-site surgeries, close calls are common. Report