NH Insurance Department Issues Updated List of Health Care Provider Networks

2015 Marketplace Will Offer Five Insurers and More Plans

Concord, NH – The New Hampshire Insurance Department has updated its listing of health care provider networks that will be available through 2015 insurance plans sold on the federally facilitated New Hampshire Health Insurance Marketplace. This is a welcome upgrade from last year, when NH had the distinction of having the fewest insurers in the federal marketplace.

Five insurance companies will offer 2015 plans to New Hampshire residents through the Marketplace in New Hampshire:

• Anthem Blue Cross and Blue Shield; 
• Assurant Health (Time); 
• Harvard Pilgrim Health Care; 
• Maine Community Health Options; and 
• Minuteman Health.

 “New Hampshire residents will have a variety of networks and plan designs to choose from when they visit HealthCare.gov beginning November 15,” said New Hampshire Insurance Commissioner Roger Sevigny.

The network information is available on the Insurance Department website at this link.

People who wish to determine whether a particular doctor is included in any health care provider network should visit the insurance company’s website to view a more detailed list. New Hampshire residents are encouraged to contact the Insurance Department’s Consumer Services division at (603) 271-2261 with any questions.

Massachusetts AGO Report Identifies 7 Health Care Cost Drivers

Boston — Massachusetts Attorney General Martha Coakley and members of her Health Care Division presented the findings of the office’s year-long examination of the factors that contribute to health care cost increases in Massachusetts at a hearing today before the Division of Health Care Finance and Policy.

“The information gathered through this process about how health care is paid for is unprecendented in Massachusetts, and unique in the nation,” said Coakley. “Access to this information has allowed us to identify what factors contribute to the ever-rising cost of health care in Massachusetts. We found that health care costs most closely correlated to the market leverage of hospitals and physician groups, rather than other issues that we would expect – like quality of care or patient population."

Seven key drivers identified by the study that have powerful implications for the health care marketplace in Massachusetts are:

1. Prices paid by health insurance companies to hospitals and physician groups vary significantly within the same geographic area and amongst providers offering similar levels of service;
2. Price variations for hospitals and physicians offering similar services are not explained by
• quality of care, 
• the complexity of services or the sickness of the population being served,
  the extent to which a hospital cares for a large portion of patients on Medicare or Medicaid , or
• whether the hospital is an academic teaching or research facility;
3. Price variations are correlated to market leverage as measured by the relative market position of the hospital or provider group compared with other hospitals or provider groups within a geographic region or within a group of academic medical centers;
4. Variations in providers’ per member per month expenses are not correlated to the methodology used to pay for health care, with expenses sometimes higher for globally paid providers than for providers paid on a fee-for-service basis;
5. Price increases, not increases in utilization, caused most of the increases in health care costs during the past few years in Massachusetts;
6. Higher priced hospitals are gaining market share at the expense of lower priced hospitals that are losing volume;
7. The commercial health care marketplace has been distorted by contracting practices that reinforce and perpetuate disparities in pricing.

For more information on the outcome of the report including recommendations to promote value-based purchasing, see the full press release.

The final report is available on the Attorney General’s website.

Massachusetts Physician Shortage in Age of Mandated Health Insurance

The 2007 Physician Workforce Study produced by the Massachusetts Medical Society, or MMS, reports a "severe" shortage of family physicians in that state for the second year in a row. Remember, this is in a state that recently mandated health insurance coverage.

"Among the new specialties showing strain are family practice and internal medicine, two of the most important to providing adequate preventive care and minimizing the use of emergency departments," says the report's executive summary (31-page PDF). "Newly insured (Massachusetts) residents may find it difficult to get timely appointments with physicians due to these shortages."

The MMS report points out that statewide shortages in "(n)ew specialties, such as family practice and internal medicine, have now emerged as severe and critical, respectively, for the second year in a row, underscoring the warning from primary care physicians in Massachusetts and the nation that a workforce shortage is imminent."

Read more...

Massachusetts Healthcare Reform Act and Health Insurance

Big changes are happening in Massachusetts health care. Most adults must now carry health insurance, and employers must be aware of new rules. The Commonwealth Connector is a web site that provides tools and facts to help find the right health plan for individuals and employers. Also see what Massachusetts employment lawyers have to say on the topic in: Massachusetts Health Care Reform Act: What Employers Need To Know a downloadable PDF newsletter.