Targeted News Service (Press Releases) June
28, 2018
MINNEAPOLIS, Minnesota, June 27 -- UnitedHealth Group
issued the following news release:
Of the 325 million people in the United States,
employer-sponsored insurance covers 174 million, Medicaid and related
State-based health programs cover 75 million, Medicare serves 58 million,
Exchanges cover approximately 10 million, and more than 28 million people
remain uninsured.
Health care is profoundly local, with considerable
variation from market to market. States are best positioned to achieve the
important goals of expanding and enhancing the quality of coverage and care.
Establishing the State as the benefits/coverage owner will require increased
flexibility, new, modern capabilities and approaches, and adequate funding in
order to achieve a simpler, more affordable and effective market-based system
that can achieve targeted coverage, quality, and fiscal goals.
Any health care reform and modernization efforts should
protect and preserve the stability, choice, and access of existing, successful
market segments such as employer-sponsored insurance, Medicare Advantage, and
Medicaid.
Premiums in the Individual Market more than doubled within
the first two years under the Affordable Care Act (ACA). They have continued to
rise at aggressive rates since. Exchanges have meaningfully failed to achieve
enrollment expectations, and deeply flawed product and risk pool designs have
led to unsustainable economics and limited choice, ultimately discouraging healthy
individuals from enrolling and staying enrolled. Further, the Exchanges lack
the capacity to effectively help patients with complex health conditions that
require specialized, high-quality care.
The ACA's Tax on Health Insurance and other ACA taxes have
aggravated already untenable health care costs, and need to be repealed. The
Tax on Health Insurance directly increases the cost of coverage for more than
150 million Americans and the return of the Tax in 2020 threatens further
premium increases or benefit reductions.
Medicaid expansion is succeeding in cost-effectively
expanding access to care. More than 16 million additional people have enrolled
in Medicaid since 2013. A State-based, structured mechanism for coverage - with
more value, flexibility, and superior performance than Exchanges - Medicaid
costs 40percent less than Exchange coverage, and has proven to be a more
effective option to deliver affordable and stable health care to millions of
individuals.
Exchange beneficiaries, as well as the remaining uninsured
in the United States, would gain the most from being in suitably managed
State-based public and private market structures which are more stable,
efficient, and effective.
The following solutions - a blend of existing and new
flexible, State-based public and private coverage platforms - are offered to
achieve greater stability, affordability, and choice in health care and can
meaningfully advance access to coverage for the tens of millions of individuals
who remain uninsured or in the Exchanges.
State-based Health Care Market Solutions
A coherently organized portfolio of State-based public and
private coverage platforms would comprise a blend of existing and new coverage
platforms with increased flexibility and modern capabilities and approaches,
including:
Across all State-based Health Care Market coverage
platforms, additional investments in modern health care capabilities, best
practices, and proven solutions are needed, including:
* Converting big data to actionable information, through
advanced analytics, predictive modeling, and applied technology;
* Advancing care effectiveness, through integrated care
delivery approaches across medical, pharmacy, behavioral, and social services;
* Improving clinical engagement and the consumer
experience through digitally enabled individual health records;
* Providing access to high-quality, lower-cost ambulatory
care settings; and
* Accelerating value-based care by promoting aligned,
performance-based networks.
State-based Health Care Market Coverage Platforms,
Specific Flexibilities, and Modernized Approaches Include:
Medicaid
States should design, implement, and offer sustainable
Medicaid coverage solutions - often enabled through Federal waivers - that
provide new flexibilities and program elements, such as:
* Designing localized, flexible health benefits to
encourage appropriate use and place of services;
* Developing performance-based networks to improve quality
and lower costs;
* Aligning provider payment rates to reward quality
outcomes and efficient health care resource use ; u Implementing innovative
wellness and prevention programs, consumer incentives, and engagement tools;
* Establishing appropriate consumer cost-sharing
requirements and benefit designs that recognize the differences among
beneficiaries;
* Leveraging a pharmacy care services approach to lower
drug and medical costs through integrated care delivery, transparency, and
applied technology;
* Utilizing financial tools - such as Health Savings
Accounts - in benefit structures;
* Transitioning dual eligible and complex populations to
managed care, including Long-Term Services and Supports (LTSS);
* Promoting fully integrated health and human services
care models that incorporate social determinants of health to improve outcomes
by eliminating barriers and aligning incentives; and
* Implementing enrollment strategies that simplify
eligibility determinations and increase access to coverage.
Managed care best practices and capabilities - across
existing Commercial, Medicare, and Medicaid markets - can be deployed in new
and distinctive ways to expand coverage, address affordability challenges, and
achieve sustainability.
Flexible Private Individual Market Benefits
States should pursue innovative approaches that seek to
revitalize State-based, flexible private individual market benefits. To restore
consumer choice, access, and affordability - often enabled through Federal
waivers - States should:
* Establish State-specific approaches to benefits
standards, product choice, and age rating bands; u Allow insurers to offer
innovative, affordable products that appeal to consumers, such as short-term,
limited duration plans and association health plans;
* Maintain risk adjustment and develop other structures to
mitigate risk, such as creating Complex Coverage Pools;
* Foster network flexibility, emphasizing quality and
accountability; and
* Maintain a majority of the ACA consumer protections.
Defined, Funded, and Well-Managed Complex Coverage Pools
Achieving strong, affordable, and stable State-based
individual markets by better covering and caring for those with clinically complex
conditions:
Our Complex Coverage Pool (CCP) proposal requires no
additional federal funding and produces meaningful savings for CCP members,
reducing current premiums and cost sharing by up to 62percent. Importantly, CCP
members would pay less than the premiums they are currently paying in the
Exchanges.
Complex Coverage Pools would be administered by
State-enabled public-private partnerships with organizations that have
expertise in managing patients with complex conditions, coordinating their care
providers, and ensuring accountability for improving outcomes. Key components
of a CCP should include:
* Predefined conditions designating individuals for
automatic enrollment in coverage;
* Enrollment limited to those not eligible for Federal
health programs or employer-sponsored insurance;
* Dedicated federal funding for the Complex Coverage
Pools;
* Rigorous participation requirements established to
maintain eligibility;
* A reduction to premiums and out-of-pocket costs and
other barriers to coverage and care;
* Custom referrals to high-performing providers most
capable of coordinating care to address the specific needs of the individual;
and
* Provider payment rates set at Medicare levels with
incentives to practice high-quality, evidence-based medicine with effective use
of health care resources.
Upon implementation of CCPs, the 93percent of the
individual market that is not enrolled in a CCP would experience premium
reductions of 27percent. For the 7percent of the individual market in a CCP,
members would receive the same 27percent premium reduction and the additional
benefit of resulting federal tax credit savings. This would total as much as
62percent savings - in premium and cost sharing combined - for CCP members,
depending on their income levels.
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