Managed Care - October 2008 - (Page 10) NEWS AND COMMENTARY by McCain, would hurt the workforce. Obama’s “pay or play” proposal would also hurt workers, according to 46 percent of respondents. They would like to see more focus on cost (58 percent) and quality (74 percent) from both candidates. Issues that would benefit the workforce include disclosure of medical outcomes and pay for performance (76 percent) and promotion of information technology (64 percent). Further findings indicate that 91 percent overwhelmingly support maintaining ERISA standards and oppose regulation of employer-sponsored health plans at the state level (84 percent). medical is not an option. These products typically reimburse the insured by paying certain fees for services, e.g., $1,000 a day for hospital expenses or $50 for a doctor’s visit. They often pay for certain tests and typically have very little underwriting requirements and do not exclude preexisting conditions. Many of these options are not insurance in the classic sense, but serve more as discount programs. In efforts to cut cost and still offer coverage, MFA reports that some employers are moving to this type of product as well. • Health risk assessments are the most popular wellness initiatives among employers and service organizations. • Health plans most often favor cholesterol screening and counseling. Headlines On Deadline . . . Eight managed care plans have been recognized by the National Committee for Quality Assurance for their innovative programs aimed at improving health care for African Americans, Hispanics, Asians, and other ethnic groups. The winners of the “Recognizing Innovation in Multicultural Health Care Awards” were Aetna, Highmark, Keystone Mercy Health Plan, Molina Healthcare of Michigan, UnitedHealthcare of New York, UnitedHealthcare Latino Health Solutions, Virginia Premier Health Plan, and WellPoint. . . . Fifteen pharmacy benefit managers have agreed to do business in a fully transparent manner, according to the HR Policy Association. To be considered, PBMs have to agree to meet the HR Policy Association Pharmaceutical Coalition’s standards, which provide employers with the most rigorous level of drug purchasing transparency available. . . . Medicare’s Physician Quality Reporting Initiative got low marks from medical practice leaders, according to the Medical Group Management Association (MGMA). The group’s members voiced their frustration with the initiative, citing the lack of data available for improving patient outcomes, the administrative burden of participating, the difficulty accessing and downloading the 2007 feedback reports, and delays in receiving the results, sometimes as long as 18 months after initial submission of data. — Tony Berberabe Wellness Programs’ Popularity Grows It looks like wellness programs have arrived, according to DMAA, the disease management trade group. A survey of 114 major health plans, employers, and companies that provide wellness and disease management services found that 84 percent of health plans and employers offer one or more wellness programs now and 91 percent will within the next year. Results indicate that health plans and employers show a strong and growing interest in wellness programs and view participant satisfaction as an important measure of success. The survey also found that • Member engagement, having a strong willingness to change behavior, and physician engagement are three of the strongest determinants of disease management program success. • Health plans and employers view participant satisfaction with wellness efforts as an important measure of success. • The top three diseases for disease management enrollment are chronic — diabetes, coronary artery disease, and asthma. Individual Market Grows a Bit About 17 million Americans bought nongroup health coverage directly from health insurers in 2007, according to a report issued by Mark Farrah Associates (MFA), a consulting company. MFA found that in 2007, 229 companies offered major medical coverage to over 9 million people. MFA asserts that the individual market is emerging as a key product line for health insurers, with factors such as employer groups reducing benefits, growing unemployment, and opportunities in the group and government markets shrinking. Health insurance offerings for individuals range from major medical to limited benefit to student and short term products. Of insurers offering individual plans, WellPoint is the largest player, insuring about 21 percent of the market. Limited benefit plans, offered by 55 companies in states where limited plans are permitted, cover an additional 2 million people. These products are not intended to take the place of major medical plans, but serve as an alternative when major 10 MANAGED CARE / OCTOBER 2008
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