David Axene

The need for freedom of choice has limited the effectiveness of care management programs and produced expensive healthcare.

Our Titanic-like healthcare system has missed some icebergs, but we don't yet have clear sailing.

Customers are making choices, and insurers are in the middle of getting rates approved. The time for Congress to act is now.

The Patient Protection and Affordable Care Act has significantly changed the way health plans do business and will do business. This creates considerable uncertainty and risk for the health plans. Since health plan costs have increased far more rapidly than anyone wishes, any further influence to increase health care costs is unwanted by most. Very recent reports suggest that US health care will exceed 20% of GDP in the very near future. How much more
can we absorb? No one really knows, but we are so close to that point that other changes are needed to help stop the rise.|

The continued increase in health care costs encourages employers to rethink their health care strategy.  Recently we were approached by a major international company asking us to take a look at their health care offering and help them estimate costs of continuing it under a reformed health care system.  They are seriously considering terminating the program worldwide, and paying the benefit penalty to be assessed by the Federal Government.
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If and when California AB52 is finally put into law, it is critical that this new empowerment of regulators includes appropriate actuarial review of what is going on, not just the arbitrary judgment of regulators and public opinion polls.|

For many years, this has been an internal health plan issue. How big should the network be? Care managers preferred concentrated membership by provider to maximize their ability to impact provider’s behavior. Marketing and sales staff preferred broad networks to maximize the attractiveness of the program to as many potential members as possible. Both sides have their point, but in recent years the scale has tilted to the care manager’s perspective which frankly has become the plan’s perspective.|

Health care reform in the form of PPACA was signed into law by President Obama on March 23, 2010. Now more than a year later it is still a significant matter of discussion. The House and the Senate continue to discuss whether or not we need it. Yes this topic has its political sides and strong supporters on both sides, but few seem to get to the real issue, “do we really need it?” Health care reform has been widely discussed for most of the past forty years. Many have feared its coming, others have anxiously awaited it. Now that it is a reality, it continues to dominate much of the discussion.|