As Insurers Pull out of Exchanges, an Obamacare Alternative
Here’s yet another aspect of the Affordable Care Act (ACA) that the federal government didn’t account for: the financial sustainability of the state exchanges. As major media outlets have reported, health insurance companies are warning are losing money so quickly from their participation in the Obamacare exchanges that they are compelled to pull out.
The most prominent example took place in April 2016, when United Health Group – the largest health insurer in the United States – announced that it will be withdrawing from the Obamacare exchanges in most states. Following United Health’s lead, other insurers are saying they may need to follow suit.
What the Experts Say
When the Kaiser Family Foundation speaks, we in the healthcare consulting community listen. Here’s what the foundation has to say about the sustainability of the Obamacare exchanges. “Something has to give,” said Larry Levitt, an ACA expert at the Kaiser Family Foundation. “Either insurers will drop out or insurers will raise premiums.” But even if those premiums increase in 2017, there’s no guarantee that the insurers will recoup their losses; plus, patients will be inevitably forced to change doctors (there’s no “you can keep your doctor, you can keep your plan” in this scenario). And if the insurers drop out of Obamacare, there is virtually no possibility that the exchanges will sustain themselves.
Not coincidentally, United Health pulled out of Obamacare exchanges the day after the Kaiser Family Foundation analysis report. In order for insurance companies to remain profitable, there is no way they can participate in the Obamacare state exchanges for the long-term. Clearly, there is a deep need for an Obamacare alternative.
Other Serious Problems
Of course, the Affordable Care Act is only compulsory for those who are not covered by an employer or individual health plan. According to a March 2016 Blue Cross/Blue Shield Association report, new ACA/Obamacare enrollees have 22% higher medical costs than those covered by employer health plans. That said, it is still preferable to have coverage from one’s employer – but as employers know, covering employees comes with all kinds of caveats in the Obamacare era.
A Real Obamacare Alternative
The only viable way for employers to avoid the burdens imposed on them by the Affordable Care Act is to seek out an alternative solution like direct contracting. Direct contracting is a healthcare model that gives employers an affordable way to cover their employees, while giving employees a customized network of providers to choose from. This is the best Obamacare alternative there is. Contact GM&A to request a free health plan analysis; we will be glad to tell you more.
A Free Healthcare Seminar for Employers!
We at GM&A are excited to announce a limited time offer to large scale employers. As healthcare consultants specializing in direct contracting - a service that can save employers up to 30% per year in healthcare costs, and one that delivers better care services to employees as patients - we are launching an offer to present a complimentary educational seminar, onsite at the location of any large employer that is interested.
If you are a decision-maker at a large employer, public or private, the GM&A team will fly to any location in the U.S. to provide this free seminar to your employees. We feel it is a valuable thing to offer not only your executives, management and HR, but your entire company - all employees. Why? Because the employer health plan affects all employees!
During this complimentary presentation, your organization can learn:
- Why traditional health insurance and health plan models are phasing out
- Why direct contracting is the healthcare delivery model of the future
- How GM&A’s proprietary software can use the claims information of an organization's employees to analyze what the parameters of your coverage should be - and, how that can save the employer money
- What healthcare services may not be covered by your current plan - but can be covered in a direct contracting plan
As stated, this is a complimentary seminar that can be highly valuable for any large employer interested in saving money while still delivering a high quality employer-sponsored health plan to employees.
Best of all, there is no obligation; we are happy to present to you with no commitment required on your part. We understand that employers may look at a variety of options, and we are just one piece of the puzzle. That’s why we would like the opportunity to present to you, follow up with you to answer your questions and let you tell us how we can best meet your needs. Contact GM&A today to learn more! We can be reached at (325) 224-3245.
What is a Health Plan Checkup?
Believe it or not, it isn’t an exam in your physician’s office. It’s an entirely different kind of checkup – more of an analysis, really. And, to make a more important point: It’s designed primarily for employers who provide health insurance to employees and self-insured individuals.
A periodic health plan checkup is an analysis of your current health plan, whether it’s the plan you provide for your employees or the plan you insure for yourself and your family. More often than not, it’s self-insured employers who will need this type of analysis. During this appointment, we will help you:
- Analyze new trends for insurers and providers
- Make informed projections about the future
- Identify ways you can save more money on your health plan
Think this is a waste of time? Think again! On any service that requires a large investment, you should want to sit down and analyze where the money is being spent, in addition to examining ways to save more money in the coming year. Some employers wait until the open enrollment period to do this, but in reality, a health plan checkup can happen any time of year.
For instance, school district employers may want to do their health plan check up now before the end of the school year – in time to make any necessary adjustments before breaking for summer. That way, there can be a fresh start when school picks back up in the fall. For any business that slows down in the summer, now is a great time to schedule a health plan checkup so that things are squared away before you start thinking about vacations.
Last of all, employers and individuals who still haven’t taken advantage of direct contracting can make their appointments for health plan checkups. To make an appointment for your health plan check up, contact GM&A. No matter what your current health plan is, we will be glad to examine it and identify ways where you can save money by directly contracting with healthcare providers.
Direct Contracting in Healthcare | Real Value for Employers
Direct contracting is not a "new" healthcare service; at GM&A, we’ve been doing it since 1999. But for a variety of reasons, mainstream HMOs and PPOs continue to be the default organizations for servicing corporate health plans. One of those reasons, we believe, is recognition. If the decision makers at a given employer have never heard about the concept of establishing direct contracts with healthcare providers, they may be inclined to reject looking into it any further when someone brings it to their attention. A common, instinctive reaction is, "If direct contracting so great, why isn’t everyone doing it?"
We understand that – and the truth is, we don’t want every employer to do it. If they did, then providers might not be as willing to negotiate with us on behalf of our clients. A healthcare provider’s willingness to contract with our clients for deeply discounted services is dependent on direct contracting staying out of the mainstream. It’s the law of supply and demand: If there is enormous demand for direct contracting and it eventually becomes the norm, providers will respond to the demand by raising prices – just because they can. It happened with HMOs, and it can happen to direct contracting if the service begins to permeate the healthcare marketplace.
The good news for employers is that direct contracting is still a valuable, niche service that can save them an enormous amount of money. At GM&A, our research shows that our clients’ healthcare costs reduce by an average of 30% by switching to a health plan that relies on direct contracts. That isn’t the only benefit; direct contracting healthcare services also allow employers to have the valuable cost and performance discussions that just aren’t possible when going the "traditional" health plan route. If an employer wants to know why a healthcare claim was filed by a specific employee, that information is obtainable when there is a direct contracting relationship.
An employer that wants to see hard data on its employees’ health claims isn’t going to get it with a traditional plan; with direct contracting, though, virtually anything is possible. Acting as a broker between provider and employer, GM&A can request the facts and figures the employer needs to make practical, cost-conscious health plan decisions. It’s real value that no other type of health plan provides.
Political Candidates and Healthcare | Who’s Best for Your Corporate Health Plan Costs?
One of the biggest misconceptions we have heard from potential clients lately is the idea that one political party or the other can "save" them from healthcare cost ruin. If you’re a CEO, CFO or HR professional, we want you to hear this: It really doesn’t matter who wins the election this year when it comes to saving money on your company’s health plan. No matter what anyone says, none of the candidates would have any control as President over the rising costs of healthcare. Was there something to be done about it before the Affordable Care Act? To an extent, yes. But now, what’s done is done. Repealing the ACA, if that were to happen (which is unlikely), would not bring about the sweeping healthcare cost changes that politicians promise it would. It’s just too late for that now.
Here’s what can be done, though, no matter who wins the election. You, as a corporate leader, can implement a company health plan model that saves money year after year. It’s called direct contracting, and it’s the only guaranteed way to reduce your current health care expenditures by 30%. By contracting directly with physicians, hospitals and other providers, you can save substantially on your company health plan while keeping the coverage in place for your employees.
There’s a lot to worry about in an election season – but your company health plan costs shouldn’t be one of those things. No matter what party you’re a member, you can remove healthcare costs from your list of reasons to vote for any particular candidate because it’s all the same. What isn’t the same is direct contracting. It’s a service that can save companies on their healthcare costs time and time again.