Association of American Medical Colleges (AAMC)’s Post

Think market consolidation is a problem in #healthcare? You’re right, but let’s start with the insurers (payers). A new data snapshot from the AAMC Research and Action Institute demonstrates the relative market concentration among health care providers and insurers. Across all U.S. states, the largest health systems (by total inpatient hospital discharges) account for about 20% of the state market on average; the largest health insurers account for 50% of the large-group state insurance market. In any given state, the three or four largest health systems combined have an average of 43.1% of the market share, while the top three large-group insurers hold an average of 82.2% of the market share. Check out Alabama on our interactive...can you imagine being a physician practice or community hospital trying to negotiate rates with a payer controlling over 95% of the private market? Insurer consolidation can lead to higher (not necessarily lower) premiums for patients –and lower rates paid to providers, which can result in detrimental effects for patients including discontinued specialized services, hospital closures, and other cuts. Regulators and courts concerned about consolidation must consider all sides of the market for health care goods and services, including the impact of both insurer and provider consolidation on payment rates, patient access, out-of-pocket costs, and quality of care. Read the full snapshot: https://ow.ly/fWG250RtFX4

How much and why 2024 premiums are expected to grow in Affordable Care Act Marketplaces By Jared Ortaliza, Matthew McGough, Meghan Salaga, Krutika Amin, and Cynthia Cox An analysis of preliminary health insurance provider filings in 50 states and Washington, D.C., found that average premiums for Affordable Care Act plans could increase 6% next year. Most insurers say inflation and rising health care costs and utilization are the main drivers for the increase. Others cited changes in COVID-19-related costs, the end of continuous Medicaid enrollment and growing use of diabetes and weight loss drugs such as semaglutide as potential contributors to higher premiums, according to the report from the Petersen-KFF Health System Tracker. https://lnkd.in/gSzU2pf8

As you know, last month Change Healthcare was the target of a cyberattack that has had significant impacts on much of the nation’s health care system. The effects of this attack are far-reaching; Change Healthcare, owned by UnitedHealth Group (UHG), processes 15 billion health care transactions annually and is involved in one in every three patient records. The attack has impacted payments to hospitals, physicians, pharmacists, and other health care providers across the country. Many of these providers are concerned about their ability to offer care in the absence of timely payments, but providers persist despite the need for numerous onerous workarounds and cash flow uncertainty. In a situation such as this, the government and private sector must work together to help providers make payroll and deliver timely care to the American people. The Biden-Harris Administration has taken action by removing challenges for health care providers and addressing this cyberattack head on. Now, we are asking private sector leaders across the health care industry – especially other payers – to meet the moment. The Biden-Harris Administration remains committed to ensuring that all Americans can access needed care in spite of this cyberattack. We urge the private sector to quickly identify and carry out solutions. Specifically, we call on UHG, other insurance companies, clearinghouses, and health care entities to take additional actions to mitigate the harms this attack places on patients and providers, particularly our safety net providers. Capital Health Billing acknowledges this challenge and is at forefront of providing seamless credentialing and billing services to health care professional on reduced and subsidized costs.

The medical loss ratio (MLR) rules under the ACA require health insurers to spend a minimum percentage of premium dollars on medical care and health care quality improvement, rather than administrative costs. This percentage is 85% for issuers in the large group market and 80% for issuers in the small and individual group markets. If your insurance carrier did not meet the applicable MLR percentage for 2022, they must provide your group with a rebate by Sept. 30, 2023. These rebates may be in the form of a premium credit or a lump-sum payment. Note: MLR rebates apply only to fully insured plans – not self-funded or excepted benefit plans. Using MLR rebates: In general, unless you pay the entire cost of health coverage without any employee contribution, at least a portion of the rebate will be a plan asset under ERISA. For example, if you paid 60% of the premiums and employees paid 40%, you may keep 60% of the rebate. The remaining 40% of the rebate is a plan asset. Any rebate amount that qualifies as a plan asset must be used for the exclusive benefit of the plan’s participants and beneficiaries. You can satisfy ERISA’s exclusive benefit requirement by distributing the plan asset portion of the rebate to participants under a reasonable, fair, and objective allocation method. If distributing payments to participants is not feasible, you may use this portion of the rebate for other permissible plan purposes, such as applying the rebate toward future participant premium payments or benefit enhancements. Also, to avoid the requirement to hold plan assets in trust, you should use any plan asset portion of the rebate within three months of its receipt.

The mounting cost inflation within the healthcare industry is expected to translate into further premium increases over the ratings horizon, but should be credit neutral for U.S. health insurers, which have sufficient ratings headroom to withstand rising cost pressures. Learn more: https://ow.ly/P7HZ50Q5uv2 #FitchRatings #Insurance #Healthcare #HealthInsurance

"Consumers are struggling to understand and afford healthcare in the United States. A new federal requirement aimed at increasing healthcare price transparency aims to help, but payers can also use this newly available information to their advantage.  While insured individuals with public and private plans generally report positive experiences with their health insurer, premiums and out-of-pocket costs pose barriers to care. A KFF poll found that 4 in 10 insured adults reported skipping or delaying care in the past year due to cost. Additionally, 55% of adults with marketplace plans rated their insurance negatively regarding premiums." #Healthcare #HealthInsurance #PriceTransparency #HospitalPriceTransparencyRule ##EmployeeBenefits

A recent survey by HealthEdge reveals that one-third of U.S. healthcare consumers are likely to switch insurers next year. Conducted among over 3,500 participants with various types of healthcare plans, the survey highlights significant consumer dissatisfaction. The primary issues driving potential switches are cost-related, with 51% of respondents seeking reduced out-of-pocket expenses and 47% desiring lower monthly premiums. Additionally, consumers are demanding increased personalization, better transparency regarding financial responsibilities, and a seamless digital experience from their insurers. Satisfaction was also assessed in areas such as benefits, coverage, personalized support, and preventative care. The report emphasizes that the competitive and dynamic health insurance market is forcing insurers to innovate in member engagement and satisfaction. Consumers' expectations for personalized, high-touch experiences, similar to those in other sectors of their lives, are influencing these trends. The findings underscore the need for health plans to adapt to meet evolving consumer demands. Our credentialing team is ready to assist providers with comprehensive credentialing and contracting services, ensuring smooth onboarding and compliance. We offer expert support, personalized guidance, and efficient processes to meet all regulatory requirements, helping providers focus on patient care while we handle administrative complexities. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Managed Healthcare Executive

Excellent read from Alejandro Badia, MD as he was featured in the Miami Herald commentary section on January 4, 2024, providing his views on the public's role in health care - article is called "It’s not just insurance to blame for US healthcare woes. We have to look at ourselves | Opinion". Employers, he is speaking to you....you must assume responsibility here because you have contributed to the unprecedented wealth you have created for the insurance companies, hospitals, pharmaceuticals, and Pharmacy Benefit Managers (PBM). SOLUTION: Move away from Insurer-Built Health Plans and implement EMPLOYER-Built Health Plans built by Mitigate Partners to allow your employees to receive better care allowing you, employer, to keep the profits you are sending to the insurance company, reduce your healthcare spending and reallocate that savings into human capital, instructional program improvements, local communities, and employee compensation. Provide better healthcare with fewer financial burdens at the point of service. Better benefits at lower costs. https://lnkd.in/g_iwvpkk

The 2023 ISG (Information Services Group) Provider Lens™ Healthcare Digital Services report for the U.S. is now available. The report finds #healthcare providers and health insurance companies in the U.S. are increasing the use of #digitalhealth tools, integrated EHRs and patient-facing apps to enhance the efficiency, accessibility and quality of care. “A powerful wave of modernization is transforming the U.S. healthcare industry,” said Bob Krohn, partner, Healthcare, for ISG (Information Services Group). “As knowledge grows about the social determinants of health, companies are using technology to improve health equity and focus more closely on outcomes.” Link to PR - https://lnkd.in/gBFDS7aY James (Jamie) Burke Shayne Yeager, MHA, CISM, PMP, CHCIO SG Anand Namratha Dharshan Sneha Jayanth Sonam Khanna Sibin Varghese

Excellent read from Alejandro Badia, MD as he was featured in the Miami Herald commentary section on January 4, 2024, providing his views on the public's role in health care - article is called "It’s not just insurance to blame for US healthcare woes. We have to look at ourselves | Opinion". Employers, he is speaking to you....you must assume responsibility here because you have contributed to the unprecedented wealth you have created for the insurance companies, hospitals, pharmaceuticals, and Pharmacy Benefit Managers (PBM). SOLUTION: Move away from Insurer-Built Health Plans and implement EMPLOYER-Built Health Plans like our FairCost Health Plan built by Mitigate Partners to allow your employees to receive better care allowing you, employer, to keep the profits you are sending to the insurance company, reduce your healthcare spending and reallocate that savings into human capital, instructional program improvements, local communities, and employee compensation. Provide better healthcare with fewer financial burdens at the point of service. Better benefits at lower costs. https://lnkd.in/g_iwvpkk