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Author: Hamoon Hadavand

An interview with Jimmy Lee of Anthem – Part 2

Jimmy LeeAs of January 2017, approximately 27,000 employers have active coverage through SHOP Marketplaces, covering nearly 230,000 individuals. These numbers fall significantly short of the Congressional Budget Office (CBO) estimate that 4 million people nationwide would enroll in coverage through the SHOP Marketplaces by 2017. According to a survey conducted by Mercer, many small employers are considering higher deductibles and correspondingly lower premiums.

In part two of this two-part interview, Anthem’s former President of Consumer Division and SVP of Commercial Segments, Jimmy Lee, offers his perspective on the small group market, and approaches health plans can adopt in order to better serve their small group lines of business.

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An interview with Jimmy Lee of Anthem – Part 1

Jimmy Lee

As of January 2017, approximately 27,000 employers have active coverage through SHOP Marketplaces, covering nearly 230,000 individuals. These numbers fall significantly short of the Congressional Budget Office (CBO) estimate that 4 million people nationwide would enroll in coverage through the SHOP Marketplaces by 2017. According to a survey conducted by Mercer, many small employers are considering higher deductibles and correspondingly lower premiums.

In part one of this two-part interview, Anthem’s former President of Consumer Division and SVP of Commercial Segments, Jimmy Lee, offers his perspective on the small group market, and approaches health plans can adopt in order to better serve their small group lines of business.

SFTN: With FF-SHOP having shut down on 1/1/18 and the uncertainty in ACA, how will this impact the small group segment for health plans?

JL: According to Mercer’s survey, many small employers are considering higher deductibles and corresponding lower premiums. This cost shift to employees often comes through the form of health savings accounts (HSAs) to help employees pay medical expenses. The combination of a high deductible plan and a HSA is a consumer-driven health plan – it puts more accountability on the employee as to where and how health dollars are spent. Survey results show that 10% of employees in companies with between 10 and 50 workers will purchase consumer-driven health plans, while 20% and 37% will purchase these plans in the 50 to 199 employees and 200 to 499 employee segments, respectively. The number of small employers that are self-funded is 15%; much less than the 79% at large companies. However, this number is growing in small groups, with product offering level funded options down to 10 lives.

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What Health Plans Can Do Today to Build Strategies for the Future

In the industry’s era of uncertainty stemming from Washington, D.C. and what the future has in store for healthcare is at the top of everyone’s mind. But, the truth is that no one really knows, and any prediction saying otherwise are merely guesses. This was the general consensus at this years’ 2017 TAHP Managed Care Conference.

Despite this uncertainty, we can focus our attention on what is more certain; what health plans can do today to build strategies for the future. According PwC Health’s report, The health insurer of the future: Consumers’ advocate, providers’ parter, there are three primary areas where health insurers can make choices now to be positioned for a more prosperous future:

  • shift towards value-based care
  • consumer-focused initiatives
  • the advancement of technology

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