In case you missed it: CMS has issued payment parameters for 2019. Key provisions include changes in EHB-benchmark plans, more state-control of benefit plans, exemptions, and QHP certification standards. More here: go.cms.gov/2vks1v3

About 3 days ago from ISAHU's Twitter via AgoraPulse Manager

President’s Message – April 2018

As I write this article, I am on a plane heading home from a three day national conference held in Washington DC sponsored by a major pharmacy benefit manager that our TPA works with. This conference was attended by 1200 people representing 500 payers consisting of TPAs, health insurance carriers, and large national employers that account for approximately 40% of all individuals covered by private sector health insurance plans in this country. To give you a perspective on the significance of this conference, Seema Verma, the Director of CMS, attended, but was not a speaker or presenter.

As most of you know, health care is a very complex and fragmented animal, which is one reason the U.S. Congress has not been able to come to any consensus on how to address the many issues and problems the health care delivery system in this country faces. Health care is also a very expensive “budget buster” at the federal level, which is another reason Congress has not been able to enact legislation.

Some interesting statistics I gleaned from this conference:

  • 4% of the insured population are responsible for 50% of the total annual health care claim costs
  • 25% of ER visits are preventable
  • 40% of all households in the U.S. have liquid assets totaling less than their annual health plan deductible (that figure jumps to 98% for all U.S. households with annual incomes at 200% or less of the federal poverty level)
  • Heath care provider consolidation has increased costs 40% over the last decade
  • The shortage of primary care physicians in the U.S. is currently projected to be 50,000
  • Total health care costs have increased 55% over the past 10 years, but consumer out-of-pocket costs have only increased 3% over that same period
  • Specialty Rx is the largest driver of increase in health care costs currently
  • Specialty Rx will increase to 50% of total Rx spend in 2 years
  • 1.7 million new cancer patients are diagnosed annually in the U.S.
  • 600,000 die annually from cancer and there are 19 million cancer survivors in the U.S.
  • Average oral cancer Rx cost is now $145,000 per patient per year
  • 20,000 hemophiliacs in the U.S. and the current projected cost to treat each one over their lifetime is $15 million

Well………how many times has one of your clients complained to you that health insurance is too expensive? You now have the above dozen bullet points to explain why.

What else I took away from this conference was some of the largest corporations and stake holders in health care have come to the conclusion that the federal government is not going to be able to fix the many problems facing the health care delivery system in this country and they are going out on their own to attempt to develop new models to do so. Recently, we have learned of acquisitions or joint ventures being formed such as CVS acquiring Aetna; Amazon, Berkshire Hathaway and JP Morgan Chase combining together to create their own health plan with the promise of opening it up to other employers at some point in the future; Cigna acquiring Express Scripts; and Walmart negotiating with Humana for a potential acquisition and/or other joint ventures.

The lines are blurring in health care with all the acquisitions pending in the marketplace and from what I learned last week in Washington DC this is just the tip of the iceberg as to what is to come in the future. Some are now calling these new models “vertical integration systems” and others are calling them “open source platforms”. Whatever they become and whether or not they can become successful to make an impact is yet to be known. Only time will tell and one thing I have learned over 33 years of being in this business……..it constantly changes and evolves. Thank you all for everything you do for our association and our industry!

Denny Wright
ISAHU President

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Indiana State Association of Health Underwriters

Indiana State Association of Health Underwriters

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