Most Popular Stories
- Handwashing more common in public restrooms than in hospitals
- Rising tide of violence puts hospital workers in harm's way
- Hospitals oppose new ER facility
- Unanimously approved: San Francisco's first new hospital in decades
- 'Medical mill' billing scams on the rise
- ONC official discusses 'Beaconology' for local health IT communities
- Leading health plan CEO paychecks
- 15 Free Healthcare Apps for the iPhone
- Aetna is best health plan, UnitedHealthcare is worst, hospital execs say
- Nurses' jobs at risk for allegedly posting patient info on Facebook
- UnitedHealthcare contracts stop making no-warning fee changes
- WI nurses fired over cell photos of X-ray
- Stay on top of the hottest field in health care!
November 13 - 17
- AdvaMed 2010: The MedTech Conference
October 18 - 20 — Washington, DC
- Streamlining Your Revenue Generating Service Lines
December 2 - 3 — San Francisco, CA
- Need Help Achieving 'Meaningful Use'?
Sept 29 - Oct 2
FierceHealthPayer provides the latest news about the fast-changing and heavily regulated area of healthcare reimbursement. Join thousands of healthcare plan executives who get FierceHealthPayer via weekly email. Sign up today!
High-risk pool contracts contain hidden risks
Health plans that elect to bid on state and federal administrative-services-only (ASO) contracts may face pros and cons, Health Plan Week reports.
On the plus side, health insurers and third-party administrators that administer the new, federally backed high-risk insurance pools known as Pre-existing Condition Insurance Plans (PCIPs) can expect administrative services fees based on the number of people they enroll each month. In return, PCIP administrators will handle enrollment, claims payment, premium collection, utilization management and customer service.
Although health insurers and TPAs shouldn't expect much money from this, James Drennan, a principal and consulting actuary at Ingenix Consulting, a subsidiary of UnitedHealth Group told Health Plan Week, there is an upside. Not only do government contracts, such as Medicare and TRICARE, give you the ability to spread fixed costs over a larger population, they also give plans better bargaining power when it’s time to negotiate rates with providers.
Just don't expect the new risk pools to translate into a lot of new enrollments. Only 2,400 people had applied for 22 pools administered by the federal government as of Aug. 13, although nationally an estimated 4 million people are eligible for coverage.
The slow enrollment may be due to limited promotion of the programs and a requirement that enrollees must have been uninsured for at least six months to quality for the high-risk pool. People who are already enrolled in a state high-risk pool aren't going to dump their coverage for half a year just to cut premium costs, Scott Bentley, an actuary with Milliman's health practice said. Expect public relations problems if the $5 billion in federal funding set aside for the program runs out and people lose coverage.
And perhaps the biggest risk health plans might face if they administer high-risk pools now is that they could end up with more high-risk members even after the state health insurance exchanges--which allow high-risk members to buy coverage without being charged more because of their condition--go live in 2014, because they're already familiar with your plan.
To learn more:
- read the Health Plan Week article
Home | Subscribe | Advertise | Mobile Edition | RSS | Privacy | Site Map
THE FIERCEMARKETS NETWORKFierceFinance | FierceFinanceIT | FierceComplianceIT | FierceHealthcare | FierceHealthFinance | FierceHealthIT | Hospital Impact | FierceMobileHealthcare | FierceHealthPayer | FiercePracticeManagement | FierceEMR | FierceCIO | FierceCIO:TechWatch | FierceContentManagement | FierceMobileIT | FierceGovernmentIT | FierceBiotech | FierceBiotech Research | FiercePharma | FierceVaccines | FierceBiotechIT | FiercePharma Manufacturing | FierceMedicalDevices | FierceDrugDelivery | FierceIPTV | FierceOnlineVideo | FierceTelecom | FierceVoIP | FierceBroadbandWireless | FierceDeveloper | FierceMobileContent | FierceWireless | FierceWireless:Europe | FierceCable
© 2010 FierceMarkets. All rights reserved.