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Deals for a new (PPACA) world

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Companies are starting to announce more alliances and ventures based on the premise that the Patient Protection and Affordable Care Act of 2010 (PPACA) will be making big changes in the U.S. health insurance market.

Many companies have been talking about “private heath insurance exchange” programs — efforts to capitalize on the attention given to the new PPACA Web-based health insurance supermarkets by offering employers commercial systems that can give workers access to a menu of coverage options.

Many of the private exchange system companies have been talking about marketing the systems to large, self-funded employers. Some of the better-known systems are aimed primarily at big employers that are trying to get out of offering employer-paid retiree health benefits.

Now companies may be making more of an effort to offer commercial PPACA-exchange alternatives to small employers.

InsureX Solutions, for example, reported today that that more small businesses in its area — the region around Chicago — are thinking about using private exchanges.

Working with a private exchange might be a practical way for a small employer to give workers a fixed amount of benefits money and have the workers buy their own individual and family coverage, InsureX suggested.

In Colorado, organizers of the Colorado Health Insurance Cooperative – one of the new PPACA CO-OP plans — has hired SeeChange Health to help get the plan to market quickly by administering the plan.

PPACA drafters included the CO-OP program in the law to encourage people to set up nonprofit, member-owned health insurers. Some skeptics have questioned whether would-be CO-OP organizers will be able to get the plans to market by Oct. 1, when the PPACA exchanges are supposed to open, and Congress recently eliminated new CO-OP startup funding for organizers that have not yet received CO-OP startup funding commitments from the U.S. Department of Health and Human Services.

SeeChange is a benefit plan administrator that has been emphasizing the use of “value-based” plan designs — benefit plan designs that try to encourage enrollees to spend freely on important, health-improving, money-saving care and avoid unnecessary and unnecessarily expensive care.

SeeChange now runs or helps run health plans with about 1.1 million enrollees.

The Colorado CO-OP hopes to sell the SeeChange-administered plans both through the Colorado PPACA exchange and through traditional health insurance brokers.

Meanwhile, in Tennessee, BlueCross BlueShield of Tennessee said it is joining with MissionPoint Health Partners, a health care provider organization, to offer accountable care organization (ACO) plans to self-funded employer groups.

An ACO is supposed to put a team of health care providers in charge of managing and coordinating a patient’s care and providing the kind of oversight that a good insurer-based wellness or condition management program might provide.

The providers in the ACO are supposed to share some of their reimbursement and get payments based in part on how efficiently they provide care and the quality of the care they provide. 

PPACA encouraged Medicare managers to set up ACO test programs for traditional Medicare program enrollees.

Tennessee Blue will use a four-year ACO agreement with MissionPoint as the basis for offering employers access to a program with the potential to improve the patient experience while reducing health care costs, the carrier said.

MissionPoint now has about 50,000 ACO enrollees, Tennessee Blue said.

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