KFF analysis shows group segments remain steady while individual segment moves into compliance
More than $2 billion in consumer payments were driven out of the healthcare system last year through medical-loss-ratio (MLR) rebates and premium reductions. Early estimates indicate consumer savings for 2013 will total $571 million, according to the Kaiser Family Foundation (KFF).
The KFF analysis looks at the basic proportion of premiums plans paid out before and after the 80% and 85% MLR provisions went into effect. Weighted average traditional MLRs for the large group and small markets over the past three years remained steady, and most group plans were already meeting the threshold prior to the provision.
The individual segment MLRs, however, rose from 78% in 2010 to 83% in 2012, which indicates that the rule is having the effect desired by regulators. In other words, individual plans are spending more on medical care and less on administration.
MLR provisions went into effect in 2011. Since then, plans are expected to spend 80% of premiums in the small group and individual market on medical care and 85% in the large group market.
For example, in Tennesee alone, Cigna must issue rebates of $92,967 to large group customers and UnitedHealthcare will write checks for more than $1 million for individual policyholders because the insurers failed to reach the prescribed MLRs. Rebates must be issued by August 1.
Emerging Therapies Committee at UC Davis Hits the Accelerator Not the Brake | AMCP 2024
April 18th 2024After the onboarding of cell and gene therapy bogged using normal pharmacy and therapeutics (P&T) committee procedures, UC Davis Health set up an emerging therapeutics committee to streamline and speed up the process of delivery expensive cell and gene therapies.
Read More
DC Roundtable: Patrick Cooney of The Federal Group Drops the Latest on PBM Legislation in Washington
April 11th 2024In this episode of "DC Roundtable," Peter Wehrwein, managing editor of Managed Healthcare Executive, spoke with Patrick Cooney, president of The Federal Group, a lobbying and strategic planning firm in Washington, D.C., about recent developments in Washington concerning PBMs.
Listen
2024 Emerging Leaders in Healthcare — Submit For a Chance to Be Featured in MHE's August Issue
April 18th 2024MHE Editors are seeking diverse healthcare professionals from different backgrounds and healthcare sectors, with individual interests. Eligible candidates are early or mid-career leaders with less than 10 years of experience. Award winners will enjoy complimentary passes to the PBMI Annual National Meeting in Orlando, Florida, from Sept. 4-6. Additional perks include a feature in our August issue, a subscription to MHE and more!
Read More