Renewed cost containment efforts

The Wall Street Journal reports on renewed health insurer efforts to control medical costs through wellness programs and devices such as medical homes, accountable care organizations that team up hospitals and doctors. Insurers have been at this for a while but the poor economy and the Affordable Care Act upheaval may create leverage with health care providers

NPR reports on insurers offering “high performance” provider networks to employers.  “They come in a few different flavors:

  • Doctors or hospitals may be placed into different tiers based on the insurer’s evaluation of their cost and quality. You may have a lower copayment and deductible if you use one of the providers in the first tier that is deemed most efficient.
  • Some providers in a health plan may be designated as the high-performance group, and you may get a lower premium if you choose them as your network.”
Another Wall Street Journal article surveyed employer approaches to Affordable Care Act implementation and cost containment for the upcoming open enrollment period in the private sector (which occurs through out the country in the fall due to the IRS cafeteria plan rules).  There will be big changes for the 2011 open enrollment period but those changes will pale in comparison to the 2014 open enrollment period when the health insurance exchanges under the Affordable Care Act become operational. For example, for 2014 (or perhaps before them), large employers (meaning an employer with more than 200 employees, including the federal government) will be required to automatically enroll all full time employees in their health benefits program. The Labor Department will be writing those rules which will provide for opt out opportunities.