Tag Archives: insurance provider

Why Doctors Don’t Trust Insurers

Having health insurance and dependable healthcare is one of the biggest concerns for people all over the world, but, unfortunately, there are many doctors who simply don’t trust the health insurance their patients use. No matter if you currently have health insurance, knowing what your doctor feels about your coverage can give you a deeper insight into just how well (or poorly) insured you truly are.

One of the main reasons physicians don’t trust health insurance providers is because they feel insurance companies prevent them from offering patients the absolute best care. It’s understandable to be upset at the idea of not being able to perform your job to the best of your abilities.

Insurance providers that are considered the most trustworthy include Blue Cross Blue Shield and Cigna, while those deemed the least trustworthy are UnitedHealthcare and Humana. These results stem from a 2015 survey conducted by the ReviveHealth Payor Trust Index, with responses from more than 600 specialists and primary care physicians. One thing to note is that Blue Cross Blue Shield earned a combined trust index rating of about 60 out of 100, which was the highest score but which also leaves an abundance of room for improvement.

The Future of American Health Insurance

The two most important factors physicians cited as influencing their opinions about how health plans help or hurt the quality of care they deliver were the level of coverage and number of claim denials.

Physicians might also soon have to contend with new medical insurance companies made up of two or more of the most difficult companies to deal with, such as through the proposed merger of Anthem and Humana. If the deal goes through, physicians might find health insurance companies to be downright insufferable.

Additional Reasons

Besides having their hands tied, doctors provided the ReviveHealth Payor Trust with several more reasons they distrust health insurance companies. Physicians also don’t believe insurance providers do their best to honor commitments made to policyholders. Nor do they believe that companies advertise themselves accurately or honestly. Respondents to the survey also said insurance providers take advantage of doctors.

If even doctors don’t trust insurance companies, where does that leave their patients? Not only do doctors have a better idea than their patients about how the human body works, doctors also have a better idea about how the health insurance industry works. If you’re considering health insurance plans, or if you’re thinking about switching insurance providers, ask your doctor for recommendations.

The Shifting Sands of Group Benefits

If there is one thing that is consistent within the group and voluntary benefits market, it is that nothing is consistent. From year to year, market changes make it very difficult for insurers to get settled into a comfortable framework for moving forward.

Consider what insurers have to contend with:

  • Shifting mandates and regulations within the Affordable Care Act.
  • An increasing number of benefit administration firms and benefit enrollment partners.
  • Employer interest in increasing the number and type of voluntary benefits to produce well-rounded packages.
  • Employer requests to administer products and billing in ways that fit their systems and processes.
  • Increased need for accessible reporting so HR departments can track usage within their employee populations.
  • Market saturation from companies wanting to enter the voluntary and worksite space.

Though we can’t cover solutions to all of these in this blog entry, we can quickly look at strategies that make sense with the increasing number of players in the market.

In the past, carriers had a very close relationship with the employer market. Because of the complexity of employee benefit communication, especially in the large employer market, employers are engaging benefit administration firms and benefit enrollment partners. These partners will often offer a free or subsidized service; they bring relationships to the carrier and earn commissions that offset enrollment cost for the benefit partner.

The key benefit partners in the industry have begun to integrate with carriers before the sale. This allows a benefit partner to offer multiple carrier products for a single employer. Further, this will help ensure that the communication between the benefit partner and the carrier is predictable. Because brokers and benefit partners are, more than ever, responsible for bringing the benefit relationship to the carrier, integrating with them is as much a strategic need as it is an efficient way of transferring data.

Insurers are attracted to the group market because one sale means hundreds or thousands of premiums. Catering to and selling through brokers and benefit partners takes that multiplication to exponential proportions AND supplements an insurer’s own sales efforts. But many brokers will only carry lines of business that are simple to administer and prepared for the higher volume from a wider array of companies. Both of those questions are answered with technology solutions.

Most insurers are by now familiar with shifting sales channels. The difference in this case is that group benefits providers need to prove their abilities to meet employer needs and remain flexible to broker requests. In this and other areas, insurers need to prepare their systems for the future by building a foundation that is solid and proven, yet agile enough to handle the market’s unpredictability.

Will ACA Shift Claims to Workers’ Comp?

Hundreds of millions of dollars of claims could shift from group health to workers’ compensation as accountable care organizations (ACO) expand under the Affordable Care Act (ACA), according to our new study: Will the Affordable Care Act Shift Claims to Workers’ Compensation Payors?

Although pundits have written about “cost shifting” to workers’ compensation, a significant and underappreciated effect of the ACA is “case-shifting” from group health to workers’ compensation.

The ACA seeks to greatly expand the use of ACOs-where providers are rewarded for meeting cost and quality goals. This effort will expand the use of “capitated” health insurance plans. Under these plans, providers are paid a fixed insurance premium per insured regardless of the amount of care provided to a given patient during the year. Under traditional fee-for-service insurance plans, providers are paid for each individual service rendered.

The question addressed in the study is to what extent do the financial incentives facing providers and their healthcare organizations influence whether a case is deemed to be work-related. In other words, how many cases will get moved to workers’ comp, which covers fees for each additional service, from group health, where the fixed fee under capitation means providers wouldn’t get any additional payment.

The study found that a back injury was as much as 30% more likely to be called “work-related” (and paid by workers’ compensation) if the patient’s group health insurance was capitated rather than fee for service. The study can be extrapolated to different states-for example, the study predicts about a $100 million increase in workers’ compensation costs in a state like Illinois if the share of capitated patients rises from 12% to 42%.

Case-shifting was more likely in states where a higher percentage of workers were covered by capitated group health plans. In a state where at least 22% of workers had capitated group health plans, the odds of a soft tissue case being called work-related were 31% higher for patients covered by capitated plans than for similar workers covered by fee-for-service group health plans. By contrast, in states where capitation was less common, there was no case-shifting seen. This is more than just the result of having fewer capitated patients seeking care. It also appears that, when capitation was infrequent, the providers were less aware of the financial incentives.

This study relies on workers’ compensation and group health medical data coming from a large commercial database. This database is based on a large sample of health insurers and self-insured employers. It includes individuals employed by mostly large employers and insured or administered by a variety of health plans. The database is unique in that, for a given employee, it contains information on both the group health services used and the workers’ compensation services used.

For more information about this study, visit http://www.wcrinet.org/result/will_aca_shift_wc_result.html.

How Do We Insure Connected Cars?

Without any doubt, connected cars are one of the most exciting and interesting areas right now, with focus from almost every sector: motor manufacturers, insurance providers, mobile and networks and so much more.

Given the vast number of partnerships, from Apple CarPlay to Spotify to mapping providers and more, the car will be no doubt the most connected device that any of us own. Ten years ago, you jumped into a new car to test drive and wanted to see how it drove, handled and more. Today’s customer jumps in and wants to know: Can I can connect my phone? What apps can I use? And more.

However, and I think this was inevitable for us all – merely a matter of “when,” not “if” — Jeep just got hacked, and with a simple experiment that has demonstrated the catastrophic potential and risk that “connected everything” has. Fiat Chrysler (Jeep) is now recalling 1.4 million cars for an update that needs to be physically delivered — ironic that the update can’t even be delivered over the air, creating a huge cost for Jeep and an even bigger warning to the manufacturers and consumers alike.

That said, there is a good interview here on CNBC with one of the security researchers, where he says he is more afraid of distracted drivers (texting, eating, smoking, etc.) than of hacked cars.

From an insurance perspective, what are the implications here?

  • Do we price connected cars at more expensive rates because of a higher hacking risk?
  • Do we void any policy for motorists who have failed to collect their latest mandated update?
  • Do we need to update our terms and conditions to ensure that it’s the customer’s obligation to make sure her car is running the latest version of software?
  • What happens if you are in an accident with a vehicle that has been hacked? Who owns the risk?

What do you think?

3 Analytics Strategies for the Middle Market

As if there isn’t enough pressure on middle market carriers today, with the big players combining to get even bigger and with the rolling up of supply chains — the carriers are now faced with a strategic imperative: Make sense of their data through analytics.

Meeting that imperative comes with a new competitive issue: fighting the war for talent to recruit and retain data scientists.

The demand for data scientists is spiking at a time when it can’t be met by supply. The largest organizations have enough scale to fund and attract a team of analysts, but what is the middle market insurer to do?

There are some straightforward strategies:

Count on partners

Many of the business demands for analytics will be met with software tools. The vendors for these solutions will be more than happy to have some data science types participate in your implementation and help to sort out your data. The same is true of marketing campaign vendors. They will have in their circles the experts needed to slice and segment targets, just like the large insurers can do on their own.

Services vendors

The services vendors are investing and building muscle in big data and analytics. Just as insurers augment their in-house actuarial talent when needed, we see the ecosystem of services vendors maturing nicely. You may pay more per hour than if you hired someone, but you only pay for what you need and you get a team that has “been there and done that.”

Decide not to decide

We talk to a lot of middle market companies that are looking at big data analytics. Some are saying that they aren’t seeing the demand for it from the business areas. They know this may mean that people aren’t doing enough to evangelize about analytics within the business, but analytics have no value if they don’t meet some kind of demand. If there’s no demand, push analytics out on the road map — but keep it on the road map. That allows you to revisit the subject when the labor market for data science talent is less frothy.

As is often the case, the reality is that most of the companies we see are doing some combination of these three strategies. They are engaging tool vendors for particular complementary needs, reaching into the service companies when that makes sense and putting the investment in their full-time staff until resources are more available.

At the end of the day, we see the middle market reacting creatively and nimbly to the challenge. But, hey, that’s what they do with all of the challenges they face, so why would this time be any different?