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UnitedHealthcare’s exit from many exchanges worries patient advocates


For Kaiser Health News


UnitedHealthcare’s decision to quit insurance exchanges in about 30 states next year has patient advocates concerned that fewer options could force consumers to pay more for coverage and have a smaller choice of network providers.

The company’s departure could be felt most acutely in several counties in Florida, Oklahoma, Kansas, North Carolina, Alabama and Tennessee that could be left with only one insurer, according to an analysis by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

To sell policies next year on the health law’s exchanges, also called marketplaces, insurers must apply within the next few weeks and get state approval this summer.

Two counties in southwest Florida — Lee and Collier — will be most affected. With UnitedHealthcare’s departure, the 80,000 consumers in those counties could be left with only one option: plans offered by Florida Blue, the Blue Cross and Blue Shield company. Two counties in Oklahoma — Oklahoma and Tulsa — which had about 60,000 enrolled on exchanges this year, could be left with only the Blue Cross and Blue Shield of Oklahoma, the Kaiser analysis found.

Lynne Thorp, regional director of the Health Planning Council of Southwest Florida, which helps consumers enroll in plans, said the impact depends on how Florida Blue handles its monopoly. While most enrollees get subsidies that keep their monthly premium low, many are concerned about possible increases in copayments and other cost-sharing on physician visits and drugs. Florida Blue offered the plans with the lowest premiums in the region last year.

“Absolutely there are concerns with United leaving,” said Andrea Stephenson, executive director of Health Council of Southeast Florida, which also assists consumers with enrollment. “Having another big carrier pull out of the market will be a real challenge,” she said.

While Florida Blue has a strong reputation, her group did hear complaints that the insurer did not offer enough choice of specialists. Without having a company compete against Florida Blue for exchange customers, Stephenson worries those networks could remain tight or get even narrower. If customers can’t find a robust choice of doctors, they may decide to remain uninsured. “Even with the individual mandate, the value proposition has to be there,” she said.

UnitedHealth Group cited escalating losses on the Obamacare plans — $475 million in 2015 and $650 million expected this year — as a reason the company planned to quit most marketplaces. United operated in 34 states this year but has committed to staying only in New York, Virginia and Nevada for 2017. United’s independent subsidiary, Harken Health, is expected to continue operating in Atlanta and Chicago.

So far, UnitedHealthcare is the only large carrier to announce it was quitting the marketplaces in multiple states.

While UnitedHealth is the nation’s largest health insurer overall, most of its business historically has not been in the individual market, which the exchanges serve.

Jodi Ray, director of Florida Covering Kids & Families, which has the largest federal navigator contractor in the state to conduct enrollment assistance, played down the impact of UnitedHealthcare leaving. “United is not a low-premium issuer … and most consumers are price driven,” she said. “Consumers will adjust accordingly no matter who the issuer is.”

Denise Cyzman, executive director of the Kansas Association for the Medically Underserved, said UnitedHealthcare will be missed even though it only had about 10 percent of marketplace enrollees. She said she hopes another carrier comes in to give the Blue Cross and Blue Shield plan some competition. “It’s good for consumers to have choice,” she said.

Kansas Insurance Commissioner Ken Selzer is meeting with companies to try to entice one into the marketplace, a spokesman said.

Having just one insurer left in counties near Winston-Salem and Wilmington is concerning, said Sorien Schmidt, North Carolina director for Enroll America, but she’s confident another player will step in. She said marketplace enrollment was still strong last year even after the Blue Cross plan raised rates an average of 32 percent. But she said the more companies in the marketplace, the better chance to drive down premiums and get the word out about options under the health law.

In Florida, Thorp said, the biggest challenge is still educating people that many can get government assistance to buy coverage. “It’s still surprising how many people we find who don’t know that.”

6 new ACO-type pacts


Herewith, from Becker’s Hospital Review, a list of  six accountable-care and shared-savings agreements signed in November and December:

“1. Saint Francis HealthCare Partners, UnitedHealthcare team up for accountable care: 3 things to know
Hartford, Conn.-based Saint Francis HealthCare Partners, a joint venture between a network of primary care and specialty physicians and Saint Francis Hospital and Medical Center, and UnitedHealthcare are collaborating through a new accountable care relationship.

“2. Delaware Valley ACO expands partnership with Humana
Philadelphia-based Delaware Valley ACO and Humana expanded their accountable care relationship after seeing favorable results in the first year of their partnership.

“3. Humana, Collaborative Health Partners launch value-based care program
Lynchburg, Va.-based Collaborative Health Partners and Humana signed a value-based care agreement for 4,000 Humana Medicare Advantage members in the Lynchburg area.

“4. Lee Memorial, Florida Blue launch ACO
Ft. Myers/Cape Coral, Fla.-based Lee Memorial Health System’s affiliated physicians teamed up with Florida Blue to launch an ACO for businesses and individuals with commercial plans.

“5. Aetna, CHOP to collaborate on ACO
Aetna has announced a first among its ACOs — It is launching a pediatric accountable care program with The Children’s Hospital of Philadelphia.

“6. Cigna rolls out 2 new collaborative care arrangements in Chicago
Cigna is teaming up with two Chicago area physician groups, Alexian Brothers Clinically Integrated Network and Midwest Center for Women’s HealthCare, on collaborative care programs similar to ACOs.”



Customer-hungry insurers offering free visits to physicians


For Kaiser Health News


Health insurers in several big cities will take some pain out of  physician visits in 2016. The plans will offer free visits to primary-care physicians in their networks.

You read that right. Doctor visits without co-pays. Or co-insurance. And no expensive deductible to pay off first either.

In Atlanta, Chicago, Dallas, Miami and more than a dozen other markets, people seeking coverage through the insurance exchanges can choose health plans providing free doctor visits, a benefit once considered unthinkable.

The change is rolling out in a limited number of plans following reports that high co-pays and deductibles have discouraged many Americans who signed up for private coverage the past two years from using their new insurance under the Affordable Care Act.

Insurers say they hope encouraging visits to doctors will benefit members and their bottom lines by catching illnesses early before they become harder and more expensive to treat. For example, prescribing antibiotics promptly to a patient with pneumonia could avoid a lengthy hospitalization costing tens of thousands of dollars.

In addition, the policy could also cut down on the use of more expensive urgent-care centers and emergency rooms for cases that aren’t critical.

In most states, Dec. 15 was the deadline for coverage starting Jan. 1, though people have until Jan. 31 to enroll for 2016.

Two new health insurers, Harken Health, an independently operated affiliate of UnitedHealthcare, and Zoom+ are offering unlimited free primary-care visits at company-owned clinics. Harken operates in Chicago and Atlanta. Zoom+ is based in Portland, Ore.

Down South, Florida Blue, the state’s largest insurer, has health plans in Miami-Dade and nine other counties where low-income members buying plans can also get two free primary-care visits per year.

California-based Molina Healthcare, is offering not only free primary-care visits in some plans, but also free visits to specialists in Florida, Texas and five other states.

The no-fee visits go beyond the preventive services, such as immunizations and screenings, that all insurers must provide under Obamacare without charging a co-pay, even when a deductible hasn’t been met.

Health policy experts say the new approach sets the insurers apart in crowded insurance markets and may attract younger, healthier people who don’t have relationships with physicians.

“This is a great development … and shows how the market is trying to innovate,” said Katherine Hempstead, director of coverage for the Robert Wood Johnson Foundation.

“Consumers should find this very appealing. … It might be like ‘a spoonful of sugar helps the medicine go down,’ ” she said, quoting a line from the Mary Poppins song. “People are not going to grouse as much about cost-sharing later if they are getting something free first.”

Consumer advocates applaud the trend, which they say underscores why people need to look beyond the monthly premium when shopping for a plan. “It’s a smart move to reduce financial barriers to basic outpatient care to help patients manage their health,” said Lydia Mitts, a senior policy analyst at Families USA. “I hope other health plans will realize removing financial barriers to primary care doctors is a smart direction for patients and for the plans.”

The health plans offering free doctor visits are typically among the lowest-priced plans in many markets, according to a Kaiser Health News review of plans sold on the exchanges.

Some insurers can offer free visits because they operate health clinics staffed by salaried physicians. That’s the case at Harken Health, which has four primary-care clinics in Chicago and six in Atlanta for its members to use for unlimited visits. Harken also offers members access to a doctor by telephone and Internet. “We are creating unfettered access between the care team and the patients,” said Tom Vanderheyden, CEO of Harken Health. “We think it’s a significant differentiation.” Harken also offers free yoga and cooking classes.

Patients with easy access to Harken’s clinics should be able to avoid trips to urgent care centers, retail clinics and emergency rooms, and develop a deeper relationship with their primary care doctor, Vanderheyden said. “Better access … should mean better outcomes and happier people.”

Dave Sanders, M.D., CEO of Zoom+ and a physician, said offering free doctor visits at its modern clinics, should help attract young enrollees. “We are unabashedly focused on the millennial generation,” he said.

To that end, Zoom+ lets members make appointments using a smartphone app. The company’s  physician emphasize changing diets before prescribing drugs.

Dr. Craig McDougall of ZOOM+ talks about food as medicine with a patient visiting one of the insurer’s clinics in Portland, Ore.

Zoom+ has run clinics in the Portland area for the past year, but it has never offered an insurance plan before. Members can get free care at the clinics or Zoom’s freestanding emergency room.

Under the health law, marketplace plans must cover a certain percentage of a member’s health costs with the amount varying based on gold, silver or bronze tiers. “What we have done is to spend the resources on primary care,” Sanders said.

Zoom+ also offers free mental health visits and one free dental visit for a cleaning.

Florida Blue, the state’s Blue Cross and Blue Shield plan, developed a new product for 2016 called myBlue which offers two free primary-care doctor visits and then charges $1 a visit thereafter, $3 visits for specialists, free routine lab tests and free diabetic supplies. The myBlue plan was created to help people whose incomes qualify for the highest cost-sharing subsidies under the Affordable Care Act.

To offer such benefits, Florida Blue developed a smaller network of doctors, hospitals and pharmacies so it could better control costs. But to encourage enrollment in Miami-Dade County it recently partnered with three CliniSanitas medical clinics, which primarily serve the Hispanic audience in the area. The plan is also available across South Florida, and counties around Tampa and Orlando.

Jon Urbanek, a senior vice president for Florida Blue, said the new plan is intended to increase the insurer’s market share. He said participating providers in the myBlue products are not necessarily paid less than other doctors but their pay is more closely tied to reaching certain quality targets such as cancer and cholesterol screenings. In 6 of 10 counties where it’s available, the myBlue product offers the lowest premium. “We think our pricing positions us to do very well,” Urbanek said.

Molina Healthcare is offering zero co-pays for unlimited primary-care doctor visits for one of its silver-tier plans for 2016. Unlike Florida Blue, it says it offers free doctor visits in its plans without using a narrow network of doctors and hospitals. “We really want folks to get value from their premium dollar and not have any barriers for care,” said Lisa Rubino, senior vice president at Molina.

Molina offers the zero co-pay physician plans in Florida, Michigan, New Mexico, Ohio, Texas, Utah and Wisconsin.

This story was produced through collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health care policy research organization. Neither the foundation nor the news service is affiliated with Kaiser Permanente.

Insurers get into the healthcare-store trade


The Miami Herald reports that insurers such as Florida Blue are jumping into the  healthcare-store business — with a South Florida spin.

”In September, the insurer will debut three ‘integrated care’ facilities designed to cater to South and Central American populations by offering primary care, specialty services, labs and diagnostics under one roof — a model that is common in Latin America.

‘The move reflects a consumer-focused style of administering care that has grown in popularity since the implementation of the Affordable Care Act. Now, more consumers are insured than ever before — 1.6 million Floridians enrolled in the marketplace in 2015 alone — many also leaving their employer’s coverage to shop for individual plans on the exchange.”

”Consumers want more transparency and affordability, with the option to price compare and get speedy service.”

Phil Galewitz: Why GOP-run Florida is tops for signups in ACA



By PHIL GALEWITZ for Kaiser Health News 


When Florida workers promoting President Obama’s health-law marketplace want instant feedback, they go to an online “heat map.” The map turns darker green where they’ve seen the most people and shows bright red dots for areas where enrollment is high.

“The map shows us where the holes are” and what communities need to be targeted next, said Lynn Thorp, regional director of the Health Planning Council of Southwest Florida. She hands out information about the health law’s marketplace at rodeos, farmers markets, hockey games and almost any place where people gather.

That mapping strategy is one reason why a Republican-controlled state like Florida, whose leaders criticize the health law at every turn, is leading the nation in signing people up for private Obamacare health plans. With two weeks to go until the deadline for 2015 enrollment, Florida’s tally exceeds that of even Democrat-led California, which has embraced the law building its own online marketplace and has twice the population and uses three times as much federal funding for outreach.

“It’s surprising Florida has done as well compared to other states, and they will be looked at by folks who want to learn lessons to promote enrollment,” said Joel Ario, managing director for Manatt Health Solutions, a consulting firm, who worked for the administration setting up the exchanges soon after the law was passed.
As of mid-January, 1.27 million Floridians had enrolled in exchange plans, according to federal data, compared to 1.2 million Californians. Texas, which has 6 million more people than Florida, enrolled about 919,000 people in private plans. Both Florida and Texas have a 22 percent uninsured rate. California’s rate is 17 percent, according to latest Census data.

“It is truly ironic that Florida leads the nation in enrollment … with leadership that has actively opposed the law,” said Leah Barber-Heinz, executive director of Florida CHAIN, an advocacy group involved in outreach efforts. “It shows true commitment on the part of many and it portrays an extremely high need for affordable coverage.

There are other reasons cited for Florida’s robust enrollment —including intense competition among insurers in several big counties and the high degree of coordination among the nonprofits and community groups which received federal grants to sign people up.

Another key factor is the state’s decision not to expand Medicaid under the law. That’s left consumers with incomes above the federal poverty level of $11,600 per year with no coverage option other than to buy a private plan — with help from sliding-scale government subsidies. About 800,000 Floridians who make less than the federal poverty level are shut out altogether because they make too little to qualify for subsidies for private plans, but too much to qualify for Medicaid. In Florida, adults with children qualify for Medicaid only if their income is below 34 percent of the poverty level. Childless adults are ineligible. Florida is one of 22 states that chose not to expand Medicaid after the U.S. Supreme Court made that provision optional for states.

In contrast, California expanded Medicaid to those making up to 138 percent of the poverty level, or $16,100 for an individual. The program has grown by 2.3 million people since fall of 2013, boosted partly by publicity for the online marketplace.

Covered California spokesman James Scullary said the exchange is not allowed to enroll people in private plans if their incomes fall between 100 and 138 percent of the federal poverty line, because they qualify for Medicaid.

A snapshot of the “heat map” of a four-county area around Tampa used by Obamacare outreach workers. The darker the dots, the higher the percentage of enrollments in that zip code. The darker the green color, the more residents who received outreach.
A snapshot of the “heat map” of a four-county area around Tampa used by Obamacare outreach workers.
The darker the dots, the higher the percentage of enrollments in that zip code. The darker the green color, the more residents who received outreach. (Source: Family Healthcare Foundation)

Jon Urbanek, senior vice president of Florida Blue, the state’s dominant insurer, credits Florida’s strong enrollment in private plans, in part, to the state’s decision not to expand Medicaid. He also points to the intense outreach by thousands of the carrier’s insurance agents. Florida Blue has conducted about 3,000 “town-hall” style meetings at its 18 retail centers. “We knew going in that this was going to be a face-to-face, get in the community type of action to build trust with people,” he said.

Florida has also gained from having an older population which is more likely to buy coverage than younger people, Ario said. That population is centered in a handful of urban areas such as Miami, Orlando and Tampa, making them easier to target, he said.

In contrast, many uninsured Texans live outside the big markets of Dallas, Houston and San Antonio. Texas also has a higher proportion of Hispanics who have been more challenging to enroll because of language barriers.

Then there’s the unusual effort to coordinate outreach. John Gilbert, national field director for Enroll America, a nonprofit doing outreach in 10 states, said Florida has benefitted from having several large nonprofits with experience signing up children for Medicaid. They have worked together closely – helped in part by the heat map.

Thorp of the Southwest Florida Health Planning Council describes how every time she hands out Obamacare flyers at a fair, or counsels at a local library, the action get entered into a computer log, which immediately changes the heat map. That way, other outreach workers see where contacts have been made.

Data from actual enrollment in the Obamacare health plans is added using dots, although that information lags because it is controlled by the U.S. Department of Health and Human Services.

The darker the dots on the map, the more saturated the enrollments in that zip code. When users hover over a dot, it pulls up a box showing how many residents in that zip code received outreach, including how many got one-on-one help filling out an application.

“We can then make sure we are appropriately allocating resources,” said Melanie Hall, executive director of the Tampa-based Family Healthcare Foundation, which devised the mapping tool. Her group is working with the University of South Florida, which received a $5.4 million federal grant to help people anywhere in the state enroll. In all, Florida nonprofits received $6.8 million in federal “navigator” grants.

Perhaps another, harder-to-measure factor is how advocates have been fired up by the opposition of many of the state’s political leaders, said Barber-Heinz of Florida CHAIN.

“Stakeholders that didn’t work together in the past are working together on this,” she said. “It drives us to work even harder.”

Barbara Feder Ostrov contributed to this story.

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