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Smart Benefits: More Exchanges, More Choice for Small Employers

Monday, March 03, 2014

 

The article “New Competition for HealthSource RI Emerges” in GoLocalProv on February 4 reported that UnitedHealthcare caused a stir with a recent announcement that it would start a private exchange for small businesses in the state. In the piece, Christine Ferguson, Executive Director for HealthSource RI, was quoted as saying UnitedHealthcare’s exchange would limit options because employers who chose the private exchange would only get United plans compared to plans from a variety of carriers available through the public exchange. 

But with small business enrollment in HealthSource RI at just 107 employers (658 covered lives) as of February 4, the low numbers signal that a mix of carrier plans may not be that important.
 
Private Exchange Open Up Options

Most employers are used to dealing with one carrier, and they place cost and plan design above other considerations. For an employer who already offers UnitedHealthcare and has no desire to switch to another insurer or has selected United because its costs are less than the other carriers, United's private exchange will make sense. The only difference is that the employer’s employees will need to be computer savvy enough to embrace the exchange’s online, self-service approach to plan selection and enrollment.

And to compete with United, other major carriers and benefit advisors are expected to launch other private exchanges in Rhode Island soon that will further expand choices for employers. That’s because, with the private exchanges, the employer is still free to choose the carrier, but will have a new option within the product portfolio.
 
Moreover, the private exchanges can also offer more than just medical plans, including dental, life/disability, vision and even voluntary plans, enhancing their efficiency.

The Real Concern?

Rather than be concerned about UnitedHealthcare’s exchange plans, perhaps Ferguson's should be focused on justifying the $23 million she has requested for the next state budget to keep the HealthSource RI operating. 

After the $80-plus million it cost to build HealthSource RI, the state’s General Assembly is leery of the added cost. And four major business groups have teamed together to demand that the users of HealthSource RI pay for it - not the taxpayers, the insurers (by passing fees to employers) or employers. Rhode Island Business Group on Health, the Chambers of Commerce, the Rhode Island Manufacturers Association and the National Federation of Independent Businesses have requested in writing that Governor Chafee, the legislators and other members of Chafee's administration assess the user fee and have these participants incur the cost.

So it’s not whether the United’s private exchange is better or worse for employers than HealthSource RI that’s the real question, but how to make HealthSource RI accountable to the taxpayers. 

Amy Gallagher has over 21 years of healthcare industry experience guiding employers and employees. As Vice President at Cornerstone Group, she advises large employers on all aspects of healthcare reform, benefit solutions, cost-containment strategies and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, and is often quoted by national publications on the subject matter. Locally, Amy is a member of SHRM-RI, the Rhode Island Business Group on Health, and the Rhode Island Business Healthcare Advisory Council.
 

 

Related Slideshow: New England’s Healthiest States 2013

The United Health Foundation recently released its 2013 annual reoprt: America's Health Rankings, which provides a comparative state by state analysis of several health measures to provide a comprehensive perspective of our nation's health issues. See how the New England states rank in the slides below.

 

Definitions

All Outcomes Rank: Outcomes represent what has already occurred, either through death, disease or missed days due to illness. In America's Health Rankings, outcomes include prevalence of diabetes, number of poor mental or physical health days in last 30 days, health disparity, infant mortality rate, cardiovascular death rate, cancer death rate and premature death. Outcomes account for 25% of the final ranking.

Determinants Rank: Determinants represent those actions that can affect the future health of the population. For clarity, determinants are divided into four groups: Behaviors, Community and Environment, Public and Health Policies, and Clinical Care. These four groups of measures influence the health outcomes of the population in a state, and improving these inputs will improve outcomes over time. Most measures are actually a combination of activities in all four groups. 

Diabetes Rank: Based on percent of adults who responded yes to the question "Have you ever been told by a doctor that you have diabetes?" Does not include pre-diabetes or diabetes during pregnancy.

Smoking Rank: Based on percentage of adults who are current smokers (self-report smoking at least 100 cigarettes in their lifetime and currently smoke).

Obesity Rank: Based on percentage of adults who are obese, with a body mass index (BMI) of 30.0 or higher.

Source: http://www.americashealthrankings.org/

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6. Rhode Island

Overall Rank: 19

Outcomes Rank: 30

Determinants Rank: 13

Diabetes Rank: 26

Smoking Rank: 14

Obesity Rank: 13

 

Strengths:

1. Low prevalence of obesity

2. High immunization coverage among adolescents

3. Ready availability of primary care physicians  

Challenges:

1.High rate of drug deaths

2. High rate of preventable hospitalizations

3. Large disparity in heath status by educational attainment

Source: http://www.americashealthrankings.org/RI

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5. Maine

Overall Rank: 16

Outcomes Rank: 25

Determinants Rank: 12

Diabetes Rank: 23

Smoking Rank: 29

Obesity Rank: 28

 

Strengths:

1. Low violent crime rate

2. Low percentage of uninsured population

3. Low prevalence of low birthweight  

Challenges:

1. High prevalence of binge drinking

2.High rate of cancer deaths

3. Limited availability of dentists

Source: http://www.americashealthrankings.org/ME

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4. Connecticut

Overall Rank: 7

Outcomes Rank: 15

Determinants Rank: 4

Diabetes Rank: 16

Smoking Rank: 4

Obesity Rank: 12

 

Strengths:

1. Low prevalence of smoking

2. Low incidence of infectious diseases

3. High immunization coverage among children & adolescents  

Challenges:

1. Moderate prevalence of binge drinking

2. Low high school graduation rate

3. Large disparity in health status by educational attainment

Source: http://www.americashealthrankings.org/CT

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3. New Hampshire

Overall Rank: 5

Outcomes Rank: 7

Determinants Rank: 5

Diabetes Rank: 16

Smoking Rank: 11

Obesity Rank: 22

 

Strengths:

1. Low percentage of children in poverty

2. High immunization coverage among children

3. Low infant mortality rate  

Challenges:

1. High prevalence of binge drinking

2.High incidence of pertussis infections

3. Low per capita public health funding

Source: http://www.americashealthrankings.org/NH

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2. Massachusetts

Overall Rank: 4

Outcomes Rank: 14

Determinants Rank: 3

Diabetes Rank: 10

Smoking Rank: 7

Obesity Rank: 2

 

Strengths:

1. Low prevalence of obesity

2. Low percentage of uninsured population

3. Ready availability of primary care physicians & dentists  

Challenges:

1. High prevalence of binge drinking

2. High rate of preventable hospitalizations

3. Large disparity in health status by educational attainment

Source: http://www.americashealthrankings.org/MA

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1. Vermont

Overall Rank: 2

Outcomes Rank: 12

Determinants Rank: 1

Diabetes Rank: 4

Smoking Rank: 9

Obesity Rank: 5

 

Strengths:

1. High rate of high school graduation

2. Low violent crime rate

3. Low percentage of uninsured population  

Challenges:

1. High prevalence of binge drinking

2. Low immunization coverage among children

3. High incidence of pertussis infections

Source: http://www.americashealthrankings.org/VT

 
 

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Comments:

So nowhere in this column does the author or an editor acknowledge that Ms. Gallagher works for a company--Cornerstone Group--that has or soon will establish its own private insurance exchange and therefore may be an interested party.

There's this thing in journalism, I think they call it "full disclosure." But I'm not an expert.

Comment #1 by Mark Gray on 2014 03 03




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