Entries by David Anderson

More churn than a butter factory

Two conservative health policy wonks are outlining an auto-enrollment option that is philosophically aligned with what is in the Collins-Cassidy draft bill state option. I don’t have an intrinsic problem with auto-enrollment with an opt-out. I have a major pragmatic problem with their proposal. But let’s look at the core of their program: Congress should […]

Who is your Doctor

Who is your doctor? That should be an easy question to answer.  It’s not. Most of the time, it is a fairly straightforward question.  A person’s primary care provider (PCP) is responsible for quarterbacking the individual’s care pathways and is supposed to be looking at the big picture as well as the day to day […]

Split filings and CSR worries

April 30th is roughly the date when insurers need to know what set of actuarial assumptions they need to use in order to build their filings.  Those filings are due to the state and federal regulators for initial review by the end of June. After the initial filings, networks and benefits are stable but rates […]

Less is less or the battle for cost control

I incidentally saw the Ellen DeGeneris “I’m Gay” Time magazine cover this afternoon on Twitter.  In the top right hand corner of the cover is a header for a backlash against HMO practices story.  That sent me down a rabbit hole.  Cost control is hard.  Cost control is predicated on either doing less or paying […]

The CMS rule and states impacted

As part of the Center for Medicare and Medicaid Services (CMS) rule that was released yesterday, the actuarial value bands increased from a de minimas actuarial value (AV) variation of +/-2 to an allowed variation of +2 or -4.  A Silver plan can now range from 66% AV to 72% AV instead of formerly having […]

ACA rule comments

The Department of Health and Human Services (HHS) just released their final rule for the 2018 Exchange parameters. There are not too many surprises.  The theme is consistent.  Premiums are reduced for people who make more than 400% FPL by cutting benefits for people who make under 400% FPL.  It is a slight transfer of […]

Benefit Design Complexity

One of the projects I’m working on is simulating the patient’s cost of treatment for several types of diseases with multiple clinical pathways. We’re assuming the patient is on-Exchange and subsidized at various levels. Part of this research project means we need to categorize every single benefit design. I think I’m done with that part […]