Massachusetts Gov. Deval Patrick has formed a panel of top state officials, which will look into whether a recently disclosed, eight-year-old agreement between Partners HealthCare System Inc. and Blue Cross Blue Shield of Massachusetts drove up healthcare costs and in turn made it harder to extend insurance to all residents. The panel will also look at current contract negotiations between Partners, and other insurers to see whether the negotiations might also create artificially high rates that threaten healthcare reform.
Managed care stocks are ailing, as higher-than-expected medical costs have burned up health insurers' profits and companies have faced potential exposure to failed investment banks. And officials say insurers set themselves up for a tough year last year by pricing premiums too low to cover medical cost outlays. Competition also led insurers to take risks by pricing coverage low.
Dozens of Cuban immigrants are evading prosecution for fleecing Medicare out of hundreds of millions of dollars by fleeing to their native country. The Miami Herald has reported that 56 fugitives absconded with at least $142 million in taxpayer funds.
Healthcare groups in Massachusetts are urging Gov. Deval Patrick to use expected federal bailout money to shore up health programs slashed this fall because of the state's budget crisis. A coalition of three-dozen social service, healthcare, labor, and legal groups—dubbed Put Patients First—is mailing 100,000 Boston area voters a flier about the specific effect of recent cuts to Boston Medical Center and Cambridge Health Alliance. The two institutions serve a large share of the region's low-income residents and, hospital officials say, are suffering from disproportionate state budget cuts.
North Carolina has begun offering a health insurance program to the state's riskiest patients, and officials are looking to attract more. The new program targets those with high-risk health conditions, such as multiple sclerosis or hemophilia, and is meant for people who don't have employer coverage and can't get private insurance without paying an exorbitant amount. Officials say as many as 180,000 people are eligible in the state.
After spending countless hours at the mall over the past month, you probably don't want to even think about those centers of commerce and aggravation, but shopping malls could play a role in the future of health plans.
There could be a day in the near future when a trip to the mall would include a list like this:
Buy milk and eggs at Piggly Wiggly
Purchase socks at Target
Ask about deductibles and health savings accounts at the health insurer
Health insurers are looking beyond their office complexes and moving into retail spaces as a way to connect with members and prospective ones. Pittsburgh-based health insurer Highmark Inc. announced last week that it will open retail spaces in January in two Pennsylvania locations, Mechanicsburg and suburban Pittsburgh.
Called Highmark Direct, the two pilot stores will help individual policy shoppers, small business owners looking to compare plans, seniors locating supplemental insurance, and the uninsured getting information about public programs.
The move into retail marketing channels might seem strange at first blush, but it is a natural progression in consumer-driven health. If health plans want members to act more like consumers, insurers may have to meet shoppers in that consumer environment.
Studies show that health insurers need to try something new because Web portals and incoming call centers are not enough to educate consumers about healthcare decisions. Hence, the trip to the shopping center.
Highmark Direct is not the insurer's first foray into retail. The Pennsylvania insurer has six Member Service locations that help members with questions about their plans.
While Highmark Direct will focus mainly on helping non-members, Steven Nelson, vice president of consumerism and retail marketing at Highmark, says the stores will also offer education programs and assist current members with core services.
Nelson says Highmark Direct will answer questions, such as what's an HMO, what's a PPO, how do deductibles work, and what are health savings accounts.
Highmark's new stores will include services found in retail spaces, such as self-service kiosks, as well as a video conference room that will allow consumers to speak with a call center representative to answer specific questions.
Nelson says the two Highmark Direct stores are a way for the insurer to learn more about consumer engagement. The storefronts are part of a larger movement at Highmark to improve member touch points, such as call centers, consumer relationship marketing techniques, and member portals and Web sites.
If these stores are successful in educating and engaging prospective and current members, one wonders how long it will take before health insurers find other ways to use retail spaces. One possibility is implementing disease management programs in the stores. Rather than wait for claims data from providers to find at-risk members, health insurers could collect biometric data at retail spaces and better keep track of patients. The retail spaces could even take the form of retail clinics.
Imagine how these services could improve disease management programs and provide a more complete picture of the individual member than claims data can offer.
As this example shows, retail spaces could become more than places to retain and acquire members. The possibilities are endless, but the ultimate question will be whether those advantages are cost-effective enough to offset a mall storefront.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.Note: You can sign up to receiveHealth Plan Insider, a free weekly e-newsletter designed to bring breaking news and analysis of important developments at health plans and other managed care organizations to your inbox.