Interesting Carrier News

Not all of our company-related posts are for Stupid Carrier Tricks© [ed: believe it or not]. Sometimes, there's just interesting announcements. For example:

■ In Special Open Enrollment news, United Healthcare has come out with its take on what counts as a Qualifying Event. What's interesting to me is that, for once, a carrier also explicitly details those things which don't trigger a Special Enrollment, most notably: "Voluntarily ending coverage."

Why is that so notable?

Because I've been getting a number of folks complaining about their existing plan's premiums, and wanting to switch (as if an ObamaTax-compliant plan is a real bargain). I've had to explain to them that, even if I could find less expensive coverage, it does them no good until next Fall.

■ As one who has seen Hospice Care up-close-and-personal, let me assure you that there are no finer people in the health care delivery system. What's a shame is that not everyone even knows about Hospice, or how to access their services. In fact, Dr. Randall Krakauer (a vice president at Aetna) recently testified before a Senate committee on Aging " urg[ing] senators to improve end-of-life benefits for patients in Medicare Advantage plans by changing the rules that govern use of hospice benefits. Medicare managers should let enrollees who seem to have as many as 12 months to live use hospice benefits."

Typically, Hospice services are available only to those who face imminent death, not a year away. Expanding that could relieve some of the burden from traditional health care facilities.

■ Our friend (and Long Term Care insurance guru) Randy G tips us that Genworth has made available an interactive map comparing cost of (long term) care across all 58 states.

Of course, I checked my own beloved Buckeye State, and saw that the average cost for a (semi-private) room in a nursing home is north of $75,000 a year.

Are you prepared?

Cavalcade of Risk #209: Call for submissions

Claire Wilkinson hosts next week's Cav. Entries are due by Monday (the 26th).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Just When You Thought it Couldn't Possibly Get Any Worse ...............

You run across this report on the Obamacare SNAFU:

The full extent of the failure, however, is reflected in the details provided by the Judicial Watch FOIA document revelations. They include:

• On October 1, there were 43,208 accounts created and 1 enrollment. 

• As of October 31, 2013, there were 1,319,425 accounts created nationwide -- but only 30,512 actual enrollments in Obamacare. 

• On October 1, 2013, at the end of the first day (4:30), the Senior Advisor at Center forConsumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services, Brigid M. Russell, sent out an email to her staff with a subject line celebrating "2 enrollments!" The body copy of the email read: "We have our second official FFM enrollment! The first two Form 834s sent out are to: 1) CareSource in Ohio, 2) BCBS of North Carolina 

Market Wired

Keep in mind that enrollment means someone selected a plan and put it in their shopping cart. It doesn't mean they actually applied for coverage ..................... or paid their premium.

A New Twist on an Old(er) Idea?

We've been blogging about Medical Tourism for going on 8 years. Generally, we've referred to two "flavors:"

1 - Foreign nationals taking advantage of what they perceive to be superior health care here in the US, and

2 - Americans traveling abroad for less expensive treatment, ostensibly as good as what's available here.

But there seems to be a new and growing trend: inter-state medical tourism.

Hunh?

Here's the idea:

"The phenomenon of this new trend in medical travel -- inter-state to Centers of Excellence (COEs) throughout the country and inbound to the U.S. – is largely the result of the impact of U.S. health reforms, employer receptivity to introducing a medical travel benefit, consumer willingness to travel to other parts of the United States to access quality care with improved outcomes, and increased demand for more cost-effective care"

Nate's discussed this idea before, that higher cost doesn't necessarily translate to better outcome. And there's a growing sense among employers that this is an area that can be addressed. Currently, it appears that only self-funded plans will be able to easily add this benefit, but one wonders if there'll be a move among the fully-insured crowd to do so.

One obstacle, of course, is the ObamaTax and its requirement for plan conformity. Perhaps this could be marketed as an "ancillary" benefit, available to groups (maybe even individuals) who are willing to pay for it.

Health Wonk Review: Life's a Beach edition

Good morning, and welcome to this edition of the Health Wonk Review.

In casting about for a theme suitable to the occasion, my mind wandered a bit (as it's prone to do this time of year), and I flashed on a serene stretch of sand and crystal clear water (and no, I did not have my hands wrapped around an ice cold Corona).

And so, I figured I'd share some moments of calm as we plunge into the best of the blogosphere's posts on health care polity and policy:

■ First up, a blast from the past: Jared Rhoads has transitioned from the more traditional blog platform to the v-log model (Mazel tov, Jared!). He last hosted the HWR back in January of 2012. In this vid-post, he presents the Urban Institute's Howard Gleckman discussing the challenges of financing Long Term Care.

■ Next, Chris Langston (Program Director of the John A. Hartford Foundation) offers his take on how the Center for Medicare and Medicaid Innovation (CMMI) might improve its effectiveness.

■ Bradley Flansbaum thinks that maybe the P4P (Pay for Performance) train has lost its caboose. He points out that the P4P phenomenon isn't an exclusively American idea: the Brits have been at it for a long time, "with mixed results."

■ HWR co-founder (and all around mensch) Joe Paduda ventures into Workers Comp territory (watch out, Julie!), ACA plan rate increases, Medicaid non-expansion and a few other interesting tidbits in this eclectic (and interesting) post.

■ Health care guru Roy Poses is concerned about how much money is being thrown at the boob-tube over the past few years in attempts to influence the public's perception of ObamaCare. He's also leery of the anechoic effect (which he introduced and explained way back in '06: "Why is it that folks can behave like such miscreants and everyone turns a blind eye?").

■ David Williams offers us the transcript of a podcast he recently did with the director of a new, not-for-profit effort designed to provide unbiased information to help patients choose physicians. It's called "The Doctor Project," and David's interview provides some background and a progress report.

■ I refer to Jason Shafrin as my favorite health care economist for a reason: he knows his stuff. This time out, he explores how the ACA's Medicaid enrollment expansion has affected even those states which didn't opt in to it.

■ For some reason, I always smile when I see posts from Wing of Zock. Ann Bonham, PhD (chief scientific officer at the Association of American Medical Colleges) offers her insights on the need to address sex differences in pre-clinical research that relies on cell and animal models (Whew!). I say: Viva la difference!

■ Julie Ferguson is one of my very favorite blog-buddies: she coordinates the HWR, helps me out when I run into glitches with the Cavalcade of Risk, and always has interesting, thought-provoking posts. This one's sure to take your breath away, perhaps literally, as she presents a last letter from a dying miner caught in a 1902 collapse, and takes to task public authorities both here and in Turkey for failing to safeguard the lives of contemporary miners. 

 ■ Louise Norris is another great blog-friend, and this week she offers her perspective on reference-based pricing. She explains how it's really just another way of looking at the difference between in- and out-of-network costs, and that the patient just needs to be more aware of them.

■ Harold Pollack interviews Sabrina Corlette, a Research Professor and Project Director at Georgetown University’s Health Policy Institute. They discuss how the new health insurance marketplaces are actually working: how many have paid their premiums, differences between the kinds of available insurance plans, the likely impact of the “Cadillac tax” on high-expenditure insurance plans, and more.

■ Finally, our own Kelley Beloff (a Certified Medical Office Manager) posts about the reality of physicians' wages. Spoiler: they're not as great as you've been led to believe.

Thanks for stopping by, and please make sure to join us again in 2 weeks over at Joe P's place.

You Are a Man, Not a Woman

Woe be unto you if you have an Obamacare plan and the government does not know your

gender.

A report that aired on Asheville, NC ABC affiliate WLOS on Tuesday detailed the plight of college student Shelby Higdon, who under ObamaCare was refused medicine because of a gender mix-up within the ObamaCare provider's system, which according to Higdon could not be fixed due to bureaucratic red tape. 

"When it was time to get my medicine, they told me that they couldn't give it to me because on my insurance I was registered as a man," Higdon said. 

Breitbart

Guess you need to borrow Tina Fey's bossy pants

Predictive Analytics (A Risky P & C Post)

So, a few weeks ago, I attended one of our carriers' annual sales meeting. This is a fun-filled afternoon of speakers discussing topics ranging from commercial automobile polices to surplus markets, loss ratios and liability umbrellas.

Oh yeah, and 5 minutes on life insurance.

Oddly enough, I always enjoy this meeting, primarily to put faces and handshakes with voicemails and intercompany emails. And this year, my curiosity was piqued by the introduction of a new (to me, anyway) term: Predictive Analytics (PA).

This is a risk-assessment tool that enables Property and Casualty companies to further refine the underwriting process. After the meeting, I spent a few minutes with the gentleman who had discussed the topic, and he agreed to put me in touch with one of his PA experts.

A few days later, I had the opportunity to spend about a half hour on the phone with Sam (not his real name - carriers are generally skittish about speaking on the record, which I can understand). In the event, Sam was forthright and interesting. Here's the low-down:

Predictive Analytics (aka "modeling") is used primarily on underwriting commercial (and sometimes other) risks. It really began in the 90's with personal auto policies; it's an extension of a concept called "risk segmentation" that's used in addition to more traditional categories.

Basically, PA delves more deeply into the financial and demographic data of a given risk (property or business). This goes beyond, by the way, just credit scores (which are the subject of some controversy in the industry). In commercial lines insurance, this could include information from the Bureau of Labor Statistics and even the Census Bureau.

Sam stressed that PA is useful in the aggregate, but (obviously) can't predict how an individual risk would behave; it's an indication of what's "likely" to happen, not what's "going" to happen. Which seems a lot like traditional underwriting (just because you have diabetes doesn't mean you're going to lose a limb). The difference is something called "univariate" versus "multivariate" analysis.

Yikes.

Univariate analysis is generally used in traditional underwriting: things like construction (steel vs wood), protection class (is it near a fire hydrant) and occupancy.  These are looked at individually and summed up.

Mulitvariate analysis uses these, but then adds in financial, demographic and other information and - most importantly - how all of these factors interact with and affect each other.

And then there's the "secret sauce:" each carrier has its own formula for determining what weight to give each of these factors and how they interrelate: what's the propensity for a loss to which this information leads you? This will differ from carrier to carrier. That's why, for example, Company A might say "no thanks, we're not writing that" and Company B might say "hey, we'll give you a great rate!"

Sam also stressed that these models have to be constantly updated, as data and relationships change over time with the change in a carrier’s book of business. The models are (as noted above) customized for each carrier, but there's a bit of a catch to that:

There's a limited pool of Subject Matter Experts available in this field, so each carrier's models will be similar but still variable based on each carrier’s history and philosophy.

Thanks, Sam!