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

Hamoon Hadavand

Hamoon Hadavand

Senior National Account Executive at Softheon
Hamoon is an industry expert in the healthcare payer market. He is responsible for Softheon’s strategic payer partnerships, strengthening existing client relationships, and identifying new market opportunities. Over his career, he has held several senior sales and business development positions within information technology and healthcare.
Hamoon Hadavand

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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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Three States Bar Issuers from Increasing Rates

Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

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UPDATE: On October 26th, North Dakota’s insurance commissioner announced that Sanford Health Plan will return to ND’s individual exchange for 2018, but only in 5 counties. Sanford’s Executive Vice President, Kirk Zimmer stated that the move was due to the Trump administration’s decision to cut off insurer subsidies.

Though the start of the 2018 Open Enrollment Period (OEP) is only a week away, there is unprecedented uncertainty around the Exchanges and federal funding established by the Patient Protection and Affordable Care Act (ACA). Despite this, three states have decided to hold their ground and block issuers from increasing member premiums for 2018.  

With rumors that the White House was considering ending cost-sharing reduction payments, many health insurance carriers increased their 2018 premium rates to account for the loss of government funding. Since the official decision to end the payments on October 12, even more health plans have raised their rates through an informal offer by the Department of Health and Human Services (HHS), allowing carriers to adjust their premium rates right up until OEP 2018 on November 1st (1).  

While insurers in all 50 states, plus D.C., have requested the approval of rate hikes, the insurance commissioners of Minnesota, North Dakota, and Vermont have unilaterally declared that they will deny any such request by insurers participating in their exchanges. They reason that the effect would be too severe with such little time until OEP 2018 begins on November 1st, justifying that their purpose is to protect consumers though whatever measures they can take. 

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‘HELP’ May Have Arrived For ACA Exchanges

Jen Eyring

Jen Eyring

Communications Manager at Softheon
Jen Eyring is the Communications Manager at Softheon. Prior to this role, she focused on creating instructional documentation for Softheon’s five core solutions and their corresponding operating procedures. She has also acted as a Product Manager for our Foundry solution. Jen holds a BA in Writing, Rhetoric, and Technical Communication from James Madison University and is working toward her MA in Strategic Communication at American University.
Jen Eyring

After failing to reach an agreement at the end of four senate committee hearings last month, Senators Lamar Alexander (R – Tenn.) and Patty Murray (D-Wash) have found common ground and announced a bipartisan deal ‘in principle’ yesterday.

The agreement reinstates the cost sharing reduction payments President Trump ended last week and increases flexibility for states. During a Rose Garden press conference yesterday, Trump called the deal a “short-term solution” that would last for a year or two.

“It’ll get us over this intermediate hump,” Trump said.

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End of CSR May Signal Beginning of Troubles for Issuers & Members

Jen Eyring

Jen Eyring

Communications Manager at Softheon
Jen Eyring is the Communications Manager at Softheon. Prior to this role, she focused on creating instructional documentation for Softheon’s five core solutions and their corresponding operating procedures. She has also acted as a Product Manager for our Foundry solution. Jen holds a BA in Writing, Rhetoric, and Technical Communication from James Madison University and is working toward her MA in Strategic Communication at American University.
Jen Eyring

Capping off his executive order last week, President Trump stated that his administration will immediately stop making cost sharing reduction (CSR) payments, a move that is expected to drastically increase premiums, the federal debt, and the number of bare counties.

Late last Thursday, Trump tweeted “The Democrats ObamaCare is imploding. Massive Subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!” promptly ending the reimbursement of CSR payments. Health Insurance companies are legally required, through the ACA, to provide these silver plans for households with incomes below 250 percent of the federal poverty line.

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President Trump Signs Executive Order on Health Care

Matt Cummings

Solutions Architect at Softheon
Matthew is a Solutions Architect at Softheon. He works closely with Product and Development teams to design products and solutions to help Health Plans and other entities to excel in the marketplace. He received his bachelor's degree in Applied Psychology and Business Management from Stony Brook University in Stony Brook, New York.
What Happened?

President Trump on Thursday, signed an executive order directing the Departments of Treasury, Labor and HHS to consider loosening rules controlling the issuance of health coverage by groups and businesses as well as the duration of short-term that don’t currently meet ACA rules[1].

“With these actions, we are moving toward lower costs and more options in the health-care market…”, Trump said during the signing ceremony in the Roosevelt Room in the White House.

Supporters of the executive order say that it will help to improve access, increase choices and lower costs for healthcare. Sen. Rand Paul (R-KY), who worked closely with the President on the order called it, “The biggest free market reform of healthcare in a decade”.

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Despite Challenges and Inefficiencies, SHOP Empowers Businesses to Obtain Coverage

Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

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In accordance with its goal of reducing the country’s uninsured rate, The Affordable Care Act (ACA) established the Small Business Health Options Program (SHOP) to create a small business insurance marketplace. SHOP’s purpose was to provide small businesses with unprecedented access to health insurance coverage for their employees, which was traditionally difficult due to their limited size. By setting up an exchange specifically for small businesses separate from the group and individual markets, SHOP tried to reach out and empower businesses that did not have the means to obtain coverage previously.  

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Graham-Cassidy: A Closer Look

Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

Latest posts by Sean Kirschner (see all)

There is a major effort in Washington to push healthcare reform through before the end of the September.

The new bill drafted by Sen. Lindsey Graham (R-SC) and Sen. Bill Cassidy (R-LA) is appropriately known as the Graham-Cassidy bill. It is lauded by its sponsors as a proposal to return power to the states after the centralization of the ACA. Under the Graham-Cassidy bill, money made available for Medicaid Expansion effort and health plan subsidies would be pooled and allocated to states as block grants, which the states can then use to build their own health care plans. The block grants will be based on the number of individuals with incomes between 50-138% of the Federal Poverty Line (FPL) in the state, but this is only initially. Starting in 2024, enrollment levels will also be factored in to determine the level of funding available through the grants. Block grants are only provisioned through 2026, though, with nothing legislated to take their place after that year.

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Bipartisan Effort Concedes as Republicans Race a Ticking Clock

Jen Eyring

Jen Eyring

Communications Manager at Softheon
Jen Eyring is the Communications Manager at Softheon. Prior to this role, she focused on creating instructional documentation for Softheon’s five core solutions and their corresponding operating procedures. She has also acted as a Product Manager for our Foundry solution. Jen holds a BA in Writing, Rhetoric, and Technical Communication from James Madison University and is working toward her MA in Strategic Communication at American University.
Jen Eyring

After four hearings and 20 testimonies hoping to find a bipartisan common ground to stabilize the individual health insurance market, an agreement could not be reached.

“During the last month, we have worked hard and in good faith, but have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted,” said Senator Lamar Alexander (R-TN), chairman of the Senate Committee on Health, Education, Labor, and Pensions (HELP). 

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Senate Committee Seeking Bipartisan ‘HELP’ to Limit Premium Increases for 18M Americans Next Year

Jen Eyring

Jen Eyring

Communications Manager at Softheon
Jen Eyring is the Communications Manager at Softheon. Prior to this role, she focused on creating instructional documentation for Softheon’s five core solutions and their corresponding operating procedures. She has also acted as a Product Manager for our Foundry solution. Jen holds a BA in Writing, Rhetoric, and Technical Communication from James Madison University and is working toward her MA in Strategic Communication at American University.
Jen Eyring

Premiums will go up 20%, the federal debt will go up to $194 billion over 10 years to pay for the higher premiums, and 5% of people will be living in bare counties after 5 years.

Those are the consequences of not passing a bill to “create a more personalized healthcare plan,” according to Senator Lamar Alexander (R-TN), chairman of the Senate Committee on Health, Education, Labor, and Pensions (HELP).

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Senate Hearings Day 4: Senate Hears from Health Care Stakeholders

Jen Eyring

Jen Eyring

Communications Manager at Softheon
Jen Eyring is the Communications Manager at Softheon. Prior to this role, she focused on creating instructional documentation for Softheon’s five core solutions and their corresponding operating procedures. She has also acted as a Product Manager for our Foundry solution. Jen holds a BA in Writing, Rhetoric, and Technical Communication from James Madison University and is working toward her MA in Strategic Communication at American University.
Jen Eyring

Opening the 4th and final Senate Committee on Health, Education, Labor, and Pensions (HELP) hearing, Senator Lamar Alexander (R-TN) summed up the hearings so far as focused and bipartisan. 

“I think they’ve been refreshing for most of the members of the senate who are hungry for that sort of opportunity to see if we can work together to get a result,” Senator Alexander said.  

Today, the witnesses included 5 healthcare stakeholders:  Dr. Manny Sethi, President of Healthy Tennessee, Dr. Susan Turney, CEO of Marshfield Clinic Health System, Inc., Robert Ruiz-Moss, VP of Anthem’s Individual Market Segment, Christina Postolowski, Rocky Mountain Regional Director of Young Invincible, and Raymond Farmer, Director of South Carolina Department of Insurance.

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