A focus at the America's Health Insurance Plans Institute 2012 is health insurance exchanges (HIX). With 30 million newly insured lives entering HIX in 2014, insurers face considerable risk. To assist insurers with managing this risk, the Centers for Medicare & Medicaid Services have developed 3 methods-reinsurance, risk adjustment, and risk corridors.
One of the main focuses at the America’s Health Insurance Plans (AHIP) Institute 2012 is health insurance exchanges (HIX). In fact, the discussion around HIX is so important at this time that a separate Exchange Conference was set up for a full day of discussions featuring some of the key opinion leaders in this space.
Two speakers in particular—Alice Hagan and Jim Whisler of Deloitte Consulting LLP—spoke about the “3 R's” — Reinsurance, Risk adjustment, and Risk corridors. With 30 million newly insured lives entering HIX in 2014, health insurers face considerable risk in that claims could significantly exceed premiums. In addition, traditional risk management tools, such as underwriting and pre-existing condition exclusions, are no longer permitted. To help insurers manage this risk, the Centers for Medicare & Medicaid Services have developed these methods, which Hagan and Whisler helped define as the following:
Reinsurance — A temporary program to provide stability in the individual market when insurance reforms go into effect. Additionally, reinsurance aims to offer protection to issuers by paying a portion of the claims for high-cost members.
Risk adjustment -- Permanent protection to issuers that enroll high-risk populations by adjusting payments across issuers to reflect risk of enrolled population. There are 5 components to the risk adjustment model:
(There still remain a number of unknowns around each of these components, added Whisler.)
Risk corridor — A temporary program to protect against uncertainty in setting rates. In this method, payments made between qualified health plans by Health and Human Services (HHS) limit loss or gains. This method is funded through contributions from the plans (including self-insured plans) and is similar to the Medicare Part D Program. The aim is to limit risks to plans that are pricing incorrectly. The target is equal to earned premium less actual administrative costs with a 20% limit. The risk corridor method is intended to be used by qualified health plans that are outside of the exchange but are substantially similar to those offered within the exchange.
Here are some of the other key takeaways from Hagan and Whisler’s presentation:
To learn more about the evolution of HIX, please visit the AHIP Institute 2012 website.
ATS 2024: Bridging the Past, Present, and Future of Respiratory Care
May 16th 2024The application of artificial intelligence in medicine is anticipated as a highlight of ATS 2024, with sessions exploring its applications in research, radiological interpretation, and pediatric pulmonology.
Read More
The Importance of Examining and Preventing Atrial Fibrillation
August 29th 2023At this year’s American Society for Preventive Cardiology Congress on CVD Prevention, Emelia J. Benjamin, MD, ScM, delivered the Honorary Fellow Award Lecture, “The Imperative to Focus on the Prevention of Atrial Fibrillation,” as the recipient of this year’s Honorary Fellow of the American Society for Preventive Cardiology award.
Listen
Looking Back on ISPOR 2024: Hot Policy Topics, Welcome Focus on Employers, and More
May 10th 2024Kimberly Westrich, MA, chief strategy officer of the National Pharmaceutical Council, reflects on the most valuable learnings from the 2024 meeting of ISPOR—The Professional Society for Health Economics and Outcomes Research, including lively discussions of the Inflation Reduction Act and workshops on value assessment.
Read More
Promoting Equity in Public Health: Policy, Investment, and Community Engagement Solutions
June 28th 2022On this episode of Managed Care Cast, we speak with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.
Listen
Posters Characterize DMD Caregiver Experiences, Impact of Gene Therapy on Caregiving Demands
May 10th 2024Posters presented at the ISPOR—The Professional Society for Health Economics and Outcomes Research meeting explored Duchenne muscular dystrophy (DMD) caregiver experiences and gene therapy’s impact on work opportunities for caregivers.
Read More
A Focus on Women: AUA Best Posters Highlight Female Athletes, Prenatal Care, and Women in Urology
May 9th 2024Three posters from the American Urological Association (AUA) 2024 Annual Meeting focused on urinary incontinence in female athletes, prenatal care for fetuses with spina bifida in California, and the experiences of women residents at the Brady Urological Institute.
Read More
ATS 2024: Bridging the Past, Present, and Future of Respiratory Care
May 16th 2024The application of artificial intelligence in medicine is anticipated as a highlight of ATS 2024, with sessions exploring its applications in research, radiological interpretation, and pediatric pulmonology.
Read More
The Importance of Examining and Preventing Atrial Fibrillation
August 29th 2023At this year’s American Society for Preventive Cardiology Congress on CVD Prevention, Emelia J. Benjamin, MD, ScM, delivered the Honorary Fellow Award Lecture, “The Imperative to Focus on the Prevention of Atrial Fibrillation,” as the recipient of this year’s Honorary Fellow of the American Society for Preventive Cardiology award.
Listen
Looking Back on ISPOR 2024: Hot Policy Topics, Welcome Focus on Employers, and More
May 10th 2024Kimberly Westrich, MA, chief strategy officer of the National Pharmaceutical Council, reflects on the most valuable learnings from the 2024 meeting of ISPOR—The Professional Society for Health Economics and Outcomes Research, including lively discussions of the Inflation Reduction Act and workshops on value assessment.
Read More
Promoting Equity in Public Health: Policy, Investment, and Community Engagement Solutions
June 28th 2022On this episode of Managed Care Cast, we speak with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.
Listen
Posters Characterize DMD Caregiver Experiences, Impact of Gene Therapy on Caregiving Demands
May 10th 2024Posters presented at the ISPOR—The Professional Society for Health Economics and Outcomes Research meeting explored Duchenne muscular dystrophy (DMD) caregiver experiences and gene therapy’s impact on work opportunities for caregivers.
Read More
A Focus on Women: AUA Best Posters Highlight Female Athletes, Prenatal Care, and Women in Urology
May 9th 2024Three posters from the American Urological Association (AUA) 2024 Annual Meeting focused on urinary incontinence in female athletes, prenatal care for fetuses with spina bifida in California, and the experiences of women residents at the Brady Urological Institute.
Read More
2 Commerce Drive
Cranbury, NJ 08512