Managed Care Trends
Posted: Saturday, December 19, 2009
by Rose-Marie Chaperon
Chaperon Consulting, LLC
The high cost of health insurance and the increasing unemployment rate are the two trends which is driving managed care. High healthcare costs have driven employers to cut back on benefits. Only 60% of U. S. employers offered health insurance in 2007 -- a decrease from 68% in 1999. This decrease is driven primarily by a drop in offer rate by small firms. For instance, only 45% of firms with 3 to 9 workers offer coverage, while 76% of firms with 10 to 24 workers, 83% of firms with 25 to 49 employees and over 95% of those with 40 or more workers offer health insurance coverage (C. Showen, 2008) .
For example, CIGNA rolled out a Health Savings Account plan through JPMorgan Chase for small companies which gives members the benefits of a tax-advantaged savings account as well as a high-deductible health plan and its financial and wellness management tools. 6 In New York City, Aetna introduced a new plan that will make health benefits more affordable for small business (C. Showen, 2008) .
The plan cuts costs by using a smaller network of providers, lowering the financial barrier for many small employers through lower premiums and free preventive care. Employee participation in either wellness programs dental plans may reduce the premium rate increase to 4. 5%. 8 Guideline also believes that the growing number of employees switching in and out of labor markets, as a result of the current economic situation in the United States, has direct implications to new health insurance products.
This growing segment of individuals could benefit from new products such as affordable, personalized and portable health insurance plans that provide basic coverage while they hold consumers more accountable for managing their own lifestyles The underinsured and the uninsured populations account for a total of 75 million Americans.
In the past five years, the proportion of the U. S. population that is either uninsured or underinsured has significantly increased among adults between the ages of 19 and 64, reaching 42% in 2007 from approximately 33% in 2003. A slowing economy for the next few months will most likely contribute to an increase of these markets. According to The Wall Street Journal, the uninsured amount to a growing 47 million of possible health plan customers (D'Aulti, 2008) .
The largest and fastest-growing group of uninsured individuals in the US is comprised of individuals 34 years old and younger. Aiming to help these uninsured adults attain healthcare coverage, several Managed Care Companies have rolled out specific products that cater to the needs of this segment. Some of these plans, for example, provide benefits such as teeth whitening and gym membership discounts in addition to basic medical coverage. Most of these plans also encourage preventive care and routine tests such as Pap-smears, include regular check-ups, dental or vision care and generic prescription drug coverage (C. Showen, 2008) .
These plans have high deductibles and have stripped-out coverage of maternity care and brand-name prescription drugs. Also, some plans limit the number of doctor visits per year, sometimes to a maximum of three, and may have maximum lifetime payouts, usually in the one or two million dollar range. In order to help policyholders offset out-of-pocket expenses, some plans offer the possibility of opening Health Savings Accounts (D'Aulti, 2008) .
These trends will continue to influence managed care a great deal, there is no perfect way to fix the issues except with education. Education was the top proactive measure taken to help ensure health and wellness by most of the respondents. Employers sponsored wellness programs are probably the most effective way to reduce the high cost of health insurance. It is not a cut and dry decision; it requires a little extra work from the employees part. Most plans require that the member invests a portion of his or her time on tasks such as completing health assessment questionnaires, inputting personal data and educating themselves on health topics.
REFERENCES
C. Showen. (2008). Kaiser Commision on Medicaid and the Uninsured and Urban Institute analysis. Los Angeles: Kaiser Permanente.
D'Aulti, M. (2008). New England Medical Center studying the effects of managed care on the underinsured. Boston: New England Medical Center.
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