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Five Health Insurance Predictions for 2009

Les Masterson, for HealthLeaders Media, January 7, 2009

Medicare Advantage fight begins

The president-elect made Medicare Advantage costs a campaign issue and the concept of private insurers running Medicare offerings is a Republican idea. With Democrats controlling Washington, expect Medicare Advantage payment cuts in Obama's first 100 days.

Reducing payments to private insurers will start a slow exodus with insurers dropping out of the program because it simply won't be as profitable.

The road won't be easy for Democrats though. The insurance industry and senior groups will push back claiming that Medicare Advantage cuts will lead to seniors not having access to these popular programs.

More employers will turn to CDHPs

Consumer-driven health plans (CDHPs) comprise a relatively small percentage of the market, but look for more employers to implement these plans as a way to reduce their healthcare costs.

The issue in 2009 will be the employers that view CDHPs simply as a way to shift costs onto employees. This is exactly what CDHP advocates don't want.

The idea behind CDHPs is to create educated healthcare consumers. Sure, the definition of a CDHP is a high-deductible health plan with a health savings account, but education is the critical third leg to the consumer-driven stool.

In order to create effective consumer-driven plans, health insurers and employers need to provide cost and quality information as well as educate members about how to be wise healthcare consumers.

If health insurers and employers do not create CDHPs with an educational component, members will see the plans as a way to transfer costs onto them rather than an opportunity for both sides to save money. That will cause individuals to rebel against the plans and view employers and insurers as the enemy.

It's up to health insurers and employers to make sure that does not happen in 2009.

Questions about DM

Supporters of disease management (DM) were glad to see the end of 2008.

The previous year was a difficult one for DM. Not only did CMS end the DM-inspired Medicare Health Support project because of disappointing results, but more experts questioned whether DM actually reduces costs and improves outcomes.

The turn of the calendar will not end those questions, but there is an opportunity for the industry. This year should see the DM industry release objective reports about which offerings work best for particular disease states.

In order for DM to have a seat at the healthcare reform table, the industry will need to fund research and look critically at its programs. Otherwise, 2009 could become the year in which DM was lowered into the ground alongside other healthcare acronyms that did not prove their value.

Those are just five predictions in what could become a watershed year for healthcare. I'll check back at the end of 2009 to see if any or all of my predictions come true.


Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.
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