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Thursday, November 29, 2012

Exchange Board and staff water down already watered-down affordability and access provisions In a surprise to advisory committee co-chairs, CT Health Insurance Exchange staff submitted four alternative policy proposals at today’s Board meeting – they were adopted virtually intact by the Board. The staff alternatives were contrary to the recommendations adopted Tuesday by the Consumer and Qualified Health Plan Advisory Committees, with Exchange staff at every meeting. One staff change increased the number of options insurers can offer (in response to insurance industry comments); research shows that consumers prefer and make better choices with a limited number of well-vetted options. Another eliminated a secret shopper survey to ensure that the plan’s provider panels are accurate; in a Mercer study of HUSKY plans, shoppers were only able to get appointments with one in four providers on those HMO panels. Staff stated that accountability in secret shopper surveys seem “too adversarial” with insurers. Another proposal reduced the number of essential community providers that plans have to include in their networks, such as community health centers. The last one eliminated even the guidance that the Exchange will develop a plan of some undefined type to eventually, someday move along a continuum toward an active purchasing model. Active purchasing now saves MA exchange consumers millions in premiums by fostering competition and negotiating rates with insurers.
Staff reviewed comments to the draft health plan solicitation. Ten of the 22 comments mentioned were from insurers – half were accepted in the staff proposals, two were not, and three others were not relevant. Five comments came from NCQA, two from unknown sources, four from this consumer advocate (none were reflected in proposals) and one from a provider (was reflected in joint committee proposal).
The Exchange staff also announced they have hired Pappas Macdonnell, a Westport marketing firm with experience in selling corporate insurance and financial products. When asked if they have any experience in marketing to low-income, uninsured populations, one representative noted that he has worked on Democratic political campaigns.
In other news, they have settled on a new name for the Exchange – Access Health. They also have submitted an application for $2.6 million in federal funding for application assisters. They expect to award about 300 grants of about $6,000 each to community organizations to publicize the exchange, help people figure out what assistance they are eligible for, and help them enroll. They have hired three new Exchange staff this month.

The official vote tally for today’s vote to kill active purchasing

Wednesday, November 28, 2012

From Exchange staff: Below lists the results of the votes cast by the Consumer Experience and Outreach and Health Plans Benefits and Qualifications Exchange Advisory Committees with concern to the certification of Qualified Health Plans within the Exchange.-- Note -- a vote to approve is against active purchasing -- Results:
Twenty (20) – Approve Two (2) – Reject Approve
-- Sheldon Toubman Vicki Veltri
Gerard O’Sullivan Anne Melissa Dowling Deb Polun
Marcia Petrillo
Steve Frayne
J. Erlingheuser
Mark Espinosa
Gloria Powell Margherita Giuliano Tanya Barrett
Bonnie Roswig
Mary Fox
Alta Lash
Arlene Murphy
Sarah Frankel
Cee Cee Woods
Dr. Robert McLean Dr. Robert Scalettar Reject
-- Kevin Galvin Deirdre Hardrick

Joint exchange committees voting down active purchasing, cost control

While the votes are reportedly still coming in, it appears that the Consumer and QHP Insurance Exchange committees have voted against active purchasing. With active purchasing, other state exchanges are using the power of numbers, as large employers do, to negotiate better premiums, lower costs and better coverage for their members. MA has saved millions for consumers in their state with active purchasing. While the committees’ language includes a symbolic nod to possible future negotiation, it is far weaker than current state law. Reportedly, through a procedural maneuver, Exchange staff and committee co-chairs agreed to link all the proposals in one vote. Providers on the committees were picked off by adding back requirements that their organizations be included in network standards. Reportedly consumers lost votes we would have had if active purchasing had had a fair vote. All meetings this week and negotiations over language were conducted in secret. A critical negotiation session happened by conference call, but the public was not allowed to listen in. (The public was told to come to the LOB, from 6 to 7pm Monday to hear the call. However the building closes at 5:30.) This secrecy would not be allowed if the Exchange was part of state government – there are laws about that. But as a quasi-public entity, they can make their own rules. It is ironic as 50% of the Board members are public officials (71% if you count spouses and retirees), and all their millions in funding come from taxpayers. Exchange staff also incorrectly argued that they had to have this issue decided in time to release the health plan solicitation next month. However, state RFPs rarely release specifics on how they will score bids with the RFP release. Why would you? Now the HMOs know that as they prepare their premium bids, that the sky is the limit. We will post the vote tally as soon as we get it.

Just 6 days to comment on exchange health plan solicitation

Saturday, November 24, 2012

Stakeholders had only six days to comment on the 40 page health plan solicitation from the CT Health Insurance Exchange – and it’s already over. Stakeholders in CA and MD had months to comment, with multiple drafts, meetings and opportunities to craft better proposals. The CT Health Policy Project’s initial comments centered on active purchasing, network adequacy, and the proposed “iterative process”. MA’s Connector has used active purchasing to save consumers millions in premiums – CT should do the same. When consumers are required to purchase coverage in the exchange, they must be able to get an appointment with a provider. HUSKY secret shoppers were only able to get appointments with 1 in 4 providers on the health plan lists. Using the standards from HUSKY contracts, thoroughly vetted in CT, and intensely monitoring compliance is key. The exchange’s proposal to initially implement a weak exchange and implement some standards later will sound eerily familiar to CT advocates – with a very poor history. Other comments include better cost sharing structures, standardize rating options so differences are meaningful, wellness programs that aren’t a screen for cherry-picking, constructive connections to the Medicaid program, accreditation standards, quality improvement plans (at least have one), and CID rate reviews as a floor. Perhaps the most troubling thing about the proposal is how much is taken on faith in attestations from insurers. Will anyone be monitoring to see if the promises are real?

Exchange advisory committees reject “any-willing insurer”

Tuesday, November 20, 2012

Today in a joint meeting of the Health Plan Benefits/Qualifications and Consumer Experience/Outreach committees of the CT Health Insurance Exchange voted against the staff recommendation “that the Exchange not deny any carrier QHP certification on the basis of its approved rates”. The only votes for the staff’s any willing insurer proposal were from Aetna and CT Insurance Dept. representatives. The committees asked staff to come back with a new proposal that includes rate negotiation.

Insurance Agent Marketing - Escape the Lead Avalanche

Sunday, November 18, 2012

Leads. Every insurance agent needs an inflow of qualified insurance leads. No matter how big your current book of business, attrition will surely erode it. People move, pass away, or--heaven forbid--find another agent for their insurance needs. Of course, you know a key component of your insurance marketing plan must be the ongoing retention of your clients. It's vital for you, as a top-producing insurance agent, to keep frequent contact with your current customer base. But, no matter how skilled your efforts at marketing insurance products to your customers, there is simply no way retention efforts alone can sustain a healthy agency's growth incline. You need new clients. And that means you need to source insurance leads. Don't fall into the trap so many insurance agents do--avalanche. Agents are extremely busy people. Like most salespeople, agents tend to prospect heavily and discover several new clients, then back off on the prospecting efforts. Avalanches tend to bury people. If a person feels inundated with new business to write, then it's critical to keep prospecting. Yet this is just when many insurance agents stop prospecting altogether. The agent becomes buried under a snow of new business, and so makes the seemingly rational choice that a client in the hand is worth two in the bush; and so focuses exclusively on the new business. This is the avalanche trap. You're buried with new business because you've been prospecting hard. But, you're too busy to follow up leads. And the leads are piling up and you keep paying for more and pretty soon you simply stop buying the leads. And then you write all the current business and follow-up with the leads and at the end of the day you are just too busy to prospect.

CT Insurance Exchange holding public events

Saturday, November 17, 2012

In response to concerns about the lack of public input, CT’s Health Insurance Exchange will be holding seven “Healthy Chat” events in the next month. Similar to Consumer Conversations last month but sponsored by the exchange this time, they will be reporting on their activities but will also be taking questions. We will be asking why they aren’t willing to negotiate with insurers to keep premiums affordable. The events will all be 5:30 to 7:00pm with registration at 5:00. The events will be in Hartford on November 27th, Waterbury on November 29th, New London on December 4th, New Haven on December 6th, New Britain on December 11th, Stamford on December 13th, ending with Bridgeport on December18th. For more details, click here.

Where Are The Consumers in the Consumer Committee??

Tuesday, November 13, 2012

I attended this week’s CT Health Insurance Consumer Experience and Outreach Committee meeting to give the Committee an update on the success of the previous week’s Advocate’s “Conversation with Kevin Counihan” event sponsored by Small Business For A Healthy Connecticut and CT Health Policy Project. My point was to emphasize the importance of consumer involvement at the upcoming combined meetings of the Consumer and Qualified Health Plan Committees. My attention was immediately drawn to all the empty chairs at the Committee table. Of the fifteen Committee members listed on the Exchange web site (a list that is not accurate), seven were present and one was participating by phone. Of the eight Committee Members attending, three were Exchange Board Members. With consumer voices being so few in the Exchange structure the Committee absences are particularly troubling. WHERE IS THE CONUMER’S VOICE IN THIS?
Why were the seven Committee members not there?
Why was the Co-chair not there?
Where were the consumers to access their right to address the Committee? The audience was primarily made up of insurance industry representatives and lobbyists. I commented that there were probably more folks in the room with (.Gov) email addresses than there should have been or needed to be for a meeting of consumers. With nearly half of the Committee members missing, what are the Committee members that were present going to do to impress the importance of attendance to the members who were missing? Might it make sense to have Committee meeting times after normal working hours to better accommodate the consumer audience? Might the Committee adopt the practice of having Public Comment at both beginning and end of each meeting again to better accommodate the consumer audience? What are the Committee’s plans to have consumer attendance at the upcoming combined Committee meeting? I’m not sure how we can expect the general public to take the implementation of Health Care Reform seriously when the people charged with representing us do not show up to meetings. Kevin Galvin

Workers Compensation Insurance: The Basics

Sunday, November 11, 2012

WHAT IS WORKERS' COMPENSATION INSURANCE? It is a policy issued to a business owner which provides them with insurance coverage for the costs of work related injuries to their employees. This type of insurance pays for all costs associated with a workers' injuries such as, medical bills, lost wages, rehabilitation, and permanent disability or death. The benefits under a workers' compensation policy are set by the state's workers' compensation regulatory commission. HOW IS WORKERS' COMPENSATION PREMIUM DETERMINED? This is rather simple. The premium is a percentage of your estimated pay roll for the policy term. Since the risk of injuries to workers varies by the type of work they perform, each business is assigned a specific classification which represents the degree of hazard in their industry. For example, if you own a convenience store which stays open later than 11:00 pm, your workers' compensation classification code would be 8061 - Store- Convenience -retail. Note both the classification number and the description are set by the state under section 11658 of the California Insurance Code. There are approximately 500 classifications which are published by the state to cover every industry, and business in California. The premium rate for each classification is determined by the degree of hazard of injuries in the industry it represents. i.e. A convenience store's premium rate is lower than a construction contractor's, and higher than a telemarketing firm's. DO I HAVE TO HAVE WORKERS' COMPENSATION INSURANCE? If you are operating a business in the state of California, and employ any workers, you are required by the state labor commission to have workers' compensation insurance. The only businesses which are exempt from this rule are the ones operated solely by the owners with no employees. In other words, if you have any employees including occasional or seasonal part time help you must obtain workers' compensation coverage. If you operate without it you run the risk of heavy fines, and possible shut down of your business. An employee is considered to be anyone who works for the business, and is not a legal owner. The relatives including the children of the owner, who do any work for the business are also considered to be employees, even if such relative or children are donating time without pay. There is another reason for you to have workers' compensation insurance, and that is to protect yourself from financial disaster. The medical costs of treating an injured worker, the lost wages, and other costs associated with it could be extremely burdensome for any small or large business, and could put their assets in jeopardy. ARE OWNERS COVERED UNDER A WORKERS' COMPENSATION POLICY? They are covered only if they want to be. In other words, the owners have the option to include or exclude themselves from coverage. This would mean if they are included in the coverage, then they are also entitled to the benefits in case they are injured. If you choose to be included, then your pay roll would also be included in the calculation of your workers' compensation premium. You can also elect to be excluded from coverage; in this case you would not be charged the premium for your pay roll. WHO IS CONSIDERED TO BE AN OWNER? Who can be excluded is determined based on the legal form of ownership of your business. The three most common legal ownership entities used by businesses are as follows: 1. Sole proprietorship or individual ownership - in this case, the individual, their spouse and their resident relatives can be excluded from coverage. 2. Partnership - All partners can be excluded, spouses and relatives can not be excluded 3. Corporation - All share holders who are also officers can be excluded only if the officers own 100% of the stock of a corporation. Officers who do not have shares or share holders who are not officers can not be excluded. Spouses and relatives can not be excluded... I hope this has been helpful in shedding some light on workers' compensation workers' compensation coverage for your business. Please feel free to call us for any question you may have. We would also like you to know that we offer some of the lowest cost workers' compensation policies for your type of business. We can provide you with a quote very quickly at no cost or obligation to you.

Why CT’s health insurance exchange needs to negotiate

Tuesday, November 6, 2012

CT’s health insurance exchange is not planning to negotiate with insurers to improve value and control costs for consumers. As of January 2014, consumers will be mandated to secure coverage. Consumers eligible for affordability assistance must purchase in the still developing exchange to get the subsidies. Massachusetts’s exchange (the Connector) negotiates, termed active purchasing, with insurers saving consumers $16 to $20 million annually. In contrast, Utah’s exchange does not negotiate with insurers but includes any qualified insurer, as the CT exchange is planning, and premiums are HIGHER inside the exchange than in the outside market. There is some disagreement about whether the Board and the Qualified Health Plan Committee have already made the decision. No public comment was solicited on the issue and the decision memo was posted a day after the QHP committee meeting. For more on the issue, go our Policymaker Brief.

CT health reform progress up to 16.7%

Thursday, November 1, 2012

CT inched up only 0.3% in progress toward health reform last month. We have completed 16.7% of the tasks needed to be ready for January 1, 2014 when individuals will be legally required to secure health coverage. Highlights remain Medicaid and patient-centered medical homes. Unfortunately, problem areas continue to be the insurance exchange and insurance review. Last month, CT health care thoughtleaders gave CT a C+ grade for reform progress. For more, visit the CT Health Reform Dashboard at www.cthealthreform.org.
 
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