Health advocates hit back at opposition to labelling plans

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Health Plans Focus on Senior Sensitivity

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NY health plans continue as US court OKs Obama law

ALBANY, N.Y. (AP) — With state health officials advancing plans to help provide uninsured New Yorkers with health coverage under President Barack Obama's health care overhaul, Thursday's U.S. Supreme Court ruling upholding most of the law was being celebrated at places like a network of neighborhood medical clinics in New York City.

"It's really not melodramatic to say that lives are going to be profoundly affected for the better," said Dr. Daniel Baxter, top medical officer for the William F. Ryan Community Health Network. "This means that children are going to be able to get their immunizations, women are going to be able to get appropriate cancer screening, people with diabetes are going to be treated."

In April, Gov. Andrew Cuomo issued an executive order to establish a statewide exchange starting in 2014, a marketplace where individuals and small businesses could tap into as much as $2.6 billion in federal tax credits and subsidies under the overhaul law. It is meant to insure every American, mainly those who don't have employer health plans or don't qualify for Medicaid. The U.S. Supreme Court upheld the overhaul's main provisions Thursday.

Cuomo on Thursday praised the ruling and Obama's leadership for measures that will provide access to health care for more than a million New Yorkers. His administration will keep moving forward with implementing the exchange, which also will lower coverage costs for businesses, he said.

Outside the Capitol, two dozen advocates from Health Care For All New York rallied. Organizer Bob Cohen called the promised coverage "basic economic security" people need to survive in a tough economy.

Right now, between 20 to 30 percent of the Ryan Network's patients are uninsured, Baxter said. Not all are poor. In these lean economic times, Baxter said he has seen a growing number of patients who have lost their private health insurance when they lost good-paying jobs.

The uninsured still get care, he said, but many patients often forgo treatment or precautionary measures rather than risk getting a big bill. One uninsured patient skipped a recommended X-ray a year ago because she didn't have insurance. As a result, Baxter said, it took an extra year for doctors to discover that she had cancer.

The law will also be a financial boon for places like the Ryan Network. Baxter said the health centers have long received some government reimbursement for treating the uninsured, but he said it has never been close to covering costs. "Had the law been overturned, many community health centers would find their viability in jeopardy," he said.

In Buffalo, Liz and Tim Evans have health insurance now through Liz's employer, Medaille College, but have gone without it for periods of years while employed part-time. At nearly $1,000 a month, it was too expensive. "I didn't really know how I felt about (the law) until the ruling. I was relieved and pleased it was upheld," Liz Evans said.

"I'm glad my daughter is going to be covered until she's 26," said Evans, a college librarian whose daughter is 12. "We've been in the position before of having pre-existing conditions and having to wait for coverage so I'm glad that's gone."

Evans has a thyroid condition, and her husband, a laid-off carpenter, has diabetes.

State Attorney General Eric Schneiderman said his office stands ready to enforce the law to ensure New Yorkers benefit from its protections, calling the court's decision a "historic victory" for millions of Americans.

"This law will continue to provide a spectrum of key consumer protections including keeping young adults on their parents' plans, ending pre-existing condition restrictions and increasing consumer information about health care choices," he said.

Under Cuomo's order, issued after legislation to establish the exchange stalled in the Republican-controlled state Senate, health officials plan to show by January that the state is ready to participate in the federal program. The goal is to have the exchange operating on Jan. 1, 2014, Health Department spokesman Peter Constantakes said.

New York has about 11 million residents who are insured, mainly through employer health plans, and 5 million low-income residents enrolled in Medicaid. Census data from last year showed nearly 2.9 million New York residents, or about 15 percent, without insurance, although the state estimate is 2.7 million — mainly working poor who don't have employer-sponsored coverage and Medicaid-eligible residents who haven't registered.

The Business Council of New York State said employers already struggle with high coverage costs, taxes and surcharges, and the Supreme Court's ruling does nothing to "bend the cost curve." The group said it will work to assure the exchange has full participation by insurers, agents, brokers, chambers of commerce and employers in all stages of development for "as robust a health insurance market and health care delivery system as possible."

An assortment of tax increases, health industry fees and Medicare cuts are supposed to pay for the changes. Starting in 2014, almost everyone will be required to be insured, with some exceptions, or pay a yearly fine. That would be $695 per person up to $2,085 per household, or 2.5 percent of household income, whichever is greater.

"We disagree with the Supreme Court's decision to affirm a massive tax increase that people cannot afford right now," said Scott Reif, spokesman for the Senate Republican Conference.

____

Associated Press writer Carolyn Thompson in Buffalo contributed to this report.

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U.S. health plans to keep some reforms, however court rules

(Reuters) - Three major U.S. health insurers that provide coverage to millions of Americans said they would keep some protections included in President Barack Obama's healthcare overhaul regardless of how the Supreme Court rules on the law.

The Supreme Court is expected to decide later this month whether to strike down all or portions of the law, Obama's signature domestic policy achievement that was passed in 2010.

UnitedHealth Group Inc, the largest health insurer by market value, announced its intention early on Monday to preserve some of the provisions that have already taken effect. Rivals Aetna Inc and Humana Inc made similar pledges later in the day.

All three said they would still offer coverage for dependents up to age 26 under their parents' plans. The companies will also continue to offer certain preventive healthcare services without out-of-pocket cost-sharing.

"The protections we are voluntarily extending are good for people's health, promote broader access to quality care and contribute to helping control rising health care costs," UnitedHealth Chief Executive Officer Stephen Hemsley said in a statement. "These provisions make sense for the people we serve and it is important to ensure they know these provisions will continue."

The law, known as the Affordable Care Act, represented the biggest overhaul to the $2.6 trillion U.S. healthcare system in nearly 50 years. The three health insurers committed to maintaining some of the provisions that are already in place, although many of the more sweeping changes are due to take effect in 2014.

The law is designed to expand coverage to more than 30 million uninsured Americans, by establishing insurance exchanges and broadening the Medicaid program for low-income people.

Shares of UnitedHealth, Aetna and Humana fell about 1 percent, in line with a decline for the broader Standard & Poor's 500 Index

KEEPING POPULAR POLICY IN PLACE

The provision allowing children to stay on their parents' plans up to age 26 is perhaps the law's single most popular component. It has already helped about 6.6 million young adults to join their parents' health insurance plans last year, according to The Commonwealth Fund, a non-profit organization that analyzes healthcare issues.

Should the law be struck down, Republican lawmakers who opposed Obama's health reform efforts may seek to reinstate the extension of young adults dependent coverage.

The three insurers also said they will maintain a provision that provides clear ways for members to appeal coverage claim decisions.

UnitedHealth and Humana said they will keep two other provisions: forgoing lifetime dollar coverage limits on policies and eliminating rescissions, which are generally considered to be retroactive policy cancellations, except in the case of fraud.

It was not immediately clear where Aetna, the No. 3 health insurer, stood on those provisions.

Cigna Corp, another large national insurer, said it was "prepared to proceed as appropriate on behalf of our customers when the court deliberations reach their conclusion."

UnitedHealth, which serves more than 38 million members, said the protections are effective immediately and will be available to current and future plan members.

At the heart of the Supreme Court case is a requirement in the law that individuals buy health insurance coverage or face a penalty, known as the individual mandate. In return, health plans will have to provide coverage to patients with pre-existing medical conditions that would have disqualified them in the past.

Should the mandate alone be struck down, and the companies are still required to cover people regardless of health status, the insurers have said people will buy insurance only when they become ill, causing premiums to rise.

The law already bars insurers from denying coverage to children up to age 19 with pre-existing medical conditions.

UnitedHealth said it recognized the value of this provision, but said "one company acting alone cannot take that step, so UnitedHealthcare is committed to working with all other participants in the health care system to sustain that coverage."

The ban on denying coverage to those with pre-existing conditions will apply to adults starting in 2014, under the law.

DeAnn Friedholm, director for health reform at Consumers Union, said if a single company "declared they would take any comers, and their competitors do not, then they will immediately attract the sickest population, which would disadvantage them in trying to compete on prices."

"It requires a level playing field so that all the companies have to play by the same rule," Friedholm said.

(Reporting by Lewis Krauskopf in New York; Editing by Michele Gershberg and Tim Dobbyn)

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Pfizer plans animal health IPO

(Reuters) - Pfizer Inc plans to separate its animal health unit into a stand-alone company, a move Wall Street expected as the largest U.S. drugmaker focuses more intently on its core pharmaceuticals business.

Pfizer said on Thursday that preparations were under way for a public offering of a minority stake in the new animal health company, which would be called Zoetis.

The business, which generated revenue of about $4.2 billion last year, sells medicines, vaccines and other products for livestock and pets. It has more than 9,000 employees and markets products in more than 120 countries.

Pfizer said it would provide details of the proposed IPO in the coming months, when it reports second-quarter earnings.

New York-based Pfizer, which agreed in April to sell its baby formula business to Nestle SA for $11.85 billion, had also been shopping its animal health unit since last year. But Chief Executive Officer Ian Read has said in recent months that any separation of the animal health business would probably be in the form of an IPO, to avoid hefty taxes.

ISI Group analyst Mark Schoenebaum valued the animal health unit at about $15 billion, and estimates Pfizer could generate $3 billion in cash proceeds by spinning off 20 percent of the business through an IPO.

"Pfizer did not provide any information on what they will do with the majority stake that they will continue to own," he said in a research note.

Schoenebaum speculated Pfizer would eventually divest its possible 80 percent remaining stake by offering those shares of Zoetis to Pfizer shareholders at a slightly discounted price. By doing so, he said the drugmaker would reduce by about 8 percent the number of outstanding shares of Pfizer.

In the meantime, however, Pfizer will treat the animal health business as a continuing operation.

The Pfizer unit competes with thriving animal health operations of Merck & Co, Eli Lilly and Co and Sanofi SA, all of which are able to use knowledge from their human medicines to develop products for pets and farm animals.

Animal health operations are also attractive, compared with prescription drugs, because there are fewer concerns about patent expirations and regulatory interventions that can decimate sales of their products. Moreover, middle-class populations are growing in emerging markets such as China, with adequate disposable incomes to acquire pets.

Pfizer's animal health sales jumped 16 percent in the first quarter to $982 million, boosted by the company's recent acquisition of King Pharmaceuticals and its Alpharma animal health brands. By contrast, Pfizer's sales of prescription drugs slumped 2 percent in the quarter to $14.2 billion, hurt by the loss of U.S. patent protection on its Lipitor cholesterol fighter and ensuing competition from cheaper generics.

In the case of Merck, its animal-health sales - also from livestock and pets - rose 7 percent in the first quarter to almost $760 million, eclipsing the 2 percent growth for its prescription drugs.

The contrast was even more stark at Lilly. Sales from its Elanco animal health business soared 33 percent to $491 million in the quarter, while overall company sales fell 4 percent due largely to generic competition for its Zyprexa schizophrenia drug.

Despite Pfizer's strategy of focusing on its prescription drugs, which have high profit margins, the company has decided to hold onto its consumer products business, including Centrum vitamins and the Advil painkiller.

Shares of Pfizer were up 0.4 percent at $22.02 in early afternoon trading.

(Reporting By Ransdell Pierson and Lewis Krauskopf; Editing by Lisa Von Ahn and Tim Dobbyn)

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State of Illinois Selects Coventry Health Care for Open Access Plan and HMO Health Benefit Plans

CHAMPAIGN, Ill.--(BUSINESS WIRE)--

Coventry Health Care of Illinois, Inc. (“Coventry Health Care”), formerly PersonalCare Insurance of Illinois, Inc., is pleased to announce that Coventry Health Care will continue to participate in the state of Illinois’ Open Access Plan (“OAP”) and HMO benefit plans.

On May 1, the state of Illinois and Coventry Health Care signed a long-term contract for the OAP that will allow Coventry Health Care to administer the health benefits plan through 2016.

The state also recently announced its decision to offer Coventry Health Care’s HMO plan to its employees for a 90-day period, effective July 1 to September 28. HMO members looking for a long-term solution are encouraged to consider the OAP, which offers many of the same benefits as the HMO with an expanded provider network and an option to renew through 2016.

The OAP administered by Coventry Health Care offers nationwide provider access, low-cost dependent coverage, online wellness resources and a proven track record of excellent service. Based in Champaign, Coventry Health Care’s services are delivered locally and supported by national parent company Coventry Health Care, Inc.

"We’re grateful for another opportunity to assist state employees and their families with high quality, affordable health care,” said Mike Wolff, Coventry Health Care executive director in Illinois. “The state and their employees can rest assured our local health plan staff is prepared to provide the same excellent service and benefits they have enjoyed for the past 28 years."

State employees can enroll in the plan of their choice throughout the benefit choice period, which began on May 1. The duration of the open enrollment period is being determined by the state. Employees are encouraged to stay up to date by visiting www.benefitschoice.il.gov.

About Coventry Health Care

Serving the community since 1984, Coventry Health Care, formerly PersonalCare Insurance of Illinois, Inc., is a local health plan supported by resources of its parent company, Coventry Health Care, Inc. Recognized by Consumer Reports and the National Committee for Quality Assurance (NCQA) as one of the top-ranked commercial health plans in Illinois for the sixth consecutive year in November 2011, Coventry Health Care’s employees serve customers from offices in Champaign, Downers Grove, Peoria and Rockford. Visit www.chcillinois.com to learn more.

About Coventry Health Care, Inc.

Coventry Health Care, Inc. (“Coventry”) is a national managed health care company operating health plans, insurance companies, network rental companies and workers’ compensation services companies. Coventry provides a full range of risk and fee-based managed care products and services to a broad cross section of individuals, employer and government-funded groups, government agencies, and other insurance carriers and plan administrators. The company is based in Bethesda, Md.

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High-Deductible Plans 'Quiet Revolution in Health Insurance'

As health costs rise, insurance plans characterized by lower premiums and higher out-of-pocket costs are on the rise in American workplaces. Health correspondent Betty Ann Bowser reports on the growing trend toward high-deductible health plans, and concerns that they may encourage delays in receiving needed medical care.

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High-Deductible Plans 'Quiet Revolution in Health Insurance'

As health costs rise, insurance plans characterized by lower premiums and higher out-of-pocket costs are on the rise in American workplaces. Health correspondent Betty Ann Bowser reports on the growing trend toward high-deductible health plans, and concerns that they may encourage delays in receiving needed medical care.

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Health Plans Will Pay $1B Obamacare Rebate For Not Spending Enough On Care

WASHINGTON, DC - FEBRUARY 15: Health and Human Services Secretary Kathleen Sebelius testifies during a Finance Committee hearing on Capitol Hill on President Obama's Fiscal 2013 budget request for the Department of Health and Human Services. (Image credit: Getty Images via @daylife)

More than $1 billion is headed to consumers and employers this summer from their insurance companies thanks to a part of the federal health law that requires a rebate from plans that don’t spend at least 4 of every 5  premium dollars on medical care.

A new study by the Kaiser Family Foundation estimates the rebates at $1.3 billion, which should arrive by August, from health plans that spent too much on administrative overhead. The money paid will be tax free to the recipients, according to rules on so-called medical-loss ratios that are part of the Affordable Care Act signed into law two years ago by President Obama.

Under the law, individual policies and those sold to small groups with 49 or fewer workers generally have to spend 80 percent of health plan subscriber premiums on health costs. Policies sold to businesses or groups with more than 50 workers typically have to spend at least 85 percent of premiums on medical care.

Supporters of medical loss ratios say they are important because they differentiate between how much of the premium goes toward medical claims and how much of the premium goes toward administrative expenses.

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Health Plans Invest in Trigger-Based Communications with Focus on Health and Wellness

TROY, N.Y.--(BUSINESS WIRE)--

More than 50 percent of health plans will invest in trigger-based communications to prompt consumers to take action, according to a new IDC Health Insights research study commissioned by Pitney Bowes Software, a global leader in customer data, analytics and communications management. Trigger-based communications use data analytics to detect a consumer’s current status, and automatically initiate relevant communications to inspire consumer action.

According to the study, only 50% of health plans surveyed indicated that their organizations considered consumer communications a strategic initiative; yet, they also report increasing investments aimed at better consumer engagement

The absence of a coordinated communication strategy becomes a liability as health plans execute more and more communications from multiple departments and business units. At least 50 percent of health plans surveyed reported initiating consumer communications from each of the major business units queried (Marketing, Health & Wellness, Customer Service, Care & Disease Management, Billing, Benefits and Claims).

“Health plans interviewed perceived communications technology as a source of competitive advantage, said Janice Young, Program Director, Healthcare Payer IT Strategies at IDC Health Insights. “Analytics capabilities will play a significant role in promoting member wellness and improved patient outcomes.”

Other key findings include:

Process integration and multichannel delivery are top of the agenda for healthcare IT execs, supporting the move from paper and phone to more diverse channels. Health plans have not adopted efficient and cost-effective communication models and are not yet leveraging new channels preferred by consumers. The concept of a senior corporate executive responsible for managing and executing an enterprise-wide coordinated communication strategy is only just emerging.

To read Health Payer Communications: Strategies for Engagement, please visit http://slp.pbinsight.com/info/idc-survey.

About Pitney Bowes Software

Pitney Bowes Software provides multichannel solutions that leverage data to create relevant dialogue between organizations and their customers. These solutions enable lifetime customer relationships by integrating data management, location intelligence, sophisticated predictive analytics, rules-based decision making and cross-channel customer interaction management to increase the value of every customer communication while also delivering operational efficiencies.

Pitney Bowes Software is a wholly-owned subsidiary of Pitney Bowes Inc. (NYSE:PBI - News), a customer communications management technology leader. For more information, please visit www.pb.com.

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Health Alliance Medical Plans Selects McKesson Analytics Advisor

Health Alliance Medical Plans, a prominent provider-sponsored health insurer in the Midwest, has signed an agreement with McKesson renewing its license for several care management solutions while adding McKesson Analytics Advisor™. McKesson Analytics Advisor is a powerful analytics and reporting tool that helps turn utilization, network, member and claim level data into actionable clinical and financial intelligence to support the organization’s business decisions as well as the clinical decisions of its providers. Together, these solutions create a platform that fully informs care management processes while enabling payers and providers to more easily optimize decision making.

Established in 1980 and headquartered in Urbana, Illinois, Health Alliance administers health plans for more than 320,000 members primarily in Illinois and Iowa. In Illinois, it is the top-ranked health plan for its commercial and Medicare plans, based on National Committee for Quality Assurance (NCQA) rankings.

“Health Alliance has worked closely with McKesson for twelve years. The company has been a consistent, collaborative partner,” explained Health Alliance chief medical officer Robert Parker. “As a provider-sponsored organization, we have always understood the importance of getting accurate and current information to our affiliated medical professionals in time to inform sound decisions. McKesson’s solutions have been a fundamental part of our success in that role.”

Health Alliance chose McKesson Analytics Advisor because of its existing partnership with McKesson, as well as the solution’s many provider-friendly attributes. For example, McKesson Analytics Advisor supplies automated communication tools that help providers reach out to their patients to proactively close gaps in care, as well as an easy-to-use interface that gives providers better visibility into quality, efficiency and pay-for-performance metrics. In addition, the clinical and financial intelligence solution has become well known for its ability to reduce pharmacy spend by identifying appropriate alternatives to patients’ current drug regimens.

“Because McKesson Analytics Advisor was designed by providers and proven in the provider setting, it establishes the strong, credible information foundation upon which payers and providers can build their performance improvement initiatives. Working together, payers and providers can more effectively balance healthcare quality and efficiency, which has been a guiding principle for Health Alliance since it was founded,” said James Evans, vice president, Payment Management, McKesson Health Solutions.

Also as part of the agreement, Health Alliance renewed its license for Coordinated Care Management System™ (CCMS™), workflow technology that integrates utilization, case and disease management into a seamless process that helps payers decide where to focus resources, better coordinate care through automation and effective communication, integrate data at key points in the workflow, and base interventions on evidence-based standards of care. The insurer also renewed its license for Clear Coverage™, utilization management software that brings intelligent, automated decision support to the point of care.

About Health Alliance Medical Plans

Health Alliance Medical Plans is a leading provider-sponsored health insurer in the Midwest, administering healthcare coverage for more than 320,000 lives. Health Alliance Commercial HMO/POS ranked #1 in Illinois and Iowa in NCQA’s Health Insurance Plan Rankings.* Nationally, Health Alliance ranked the 39th best HMO/POS for 2011-2012.** Additionally, in recognition of its exceptional commitment to quality, Health Alliance holds an Excellent accreditation from NCQA for its commercial HMO, PPO and POS plans as well as its Medicare HMO and PPO plans.

About McKesson

McKesson Corporation, currently ranked 15th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visit http://www.mckesson.com.

*Nationally ranked 39/390 in private health plans and 27/336 for Commercial HMO plans.

**NCQA’s Health Insurance Plan Rankings 2011-12—Private.

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India plans big increase in health-care spending to catch up to rivals

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Correction:

A previous version of this story incorrectly said that national spending for New Delhi’s health budget is about $3 billion annually. The actual amount is $20 billion. This story has been corrected.

India plans big increase in health-care spending to catch up to rivalsView Photo Gallery — ?As other developing countries race ahead of India in improving health care, the country announced it plans to increase health-care spending.

Text SizePrintE-mailReprints By Rama Lakshmi,

NEW DELHI —With its health-care system increasingly eclipsed by rivals, India has a plan to nearly double public spending on health over the next five years, with the goal of eventually making medical care free for all Indians.

It is an ambitious goal, and the kind of investment many experts have been advocating for decades. But already critics are wondering if the government will live up to its promise, or if throwing money at the problem without reforming the health-care delivery system from top to bottom will make much of a difference.

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In recent years, India has watched with alarm as countries such as China, Egypt, Mexico and Brazil raced ahead, and as its performance on child health and infant mortality was overtaken even by much of sub-Saharan Africa.

The planned budget increase would lift annual spending on health to 2.5 percent of the country’s economic output, from a current 1.4 percent. The increase is aimed at giving free medicine to all Indians at government facilities, setting up free ambulances in rural areas, doubling the number of trained health workers, and lifting millions of young children and women out of chronic malnutrition and preventable deaths.

“In the past five years, other emerging economies like Brazil, Mexico, Malaysia have marched ahead on basic public health indicators,” said Amarjeet Sinha, a senior health official in the northern state of Bihar, who helped design India’s rural health program. “Just two decades ago, we were all in the same place. It’s a shame that we got left behind in our health performance despite our economic progress.”

With a rapidly growing young population, India urgently needs to harness the energy of its youth by creating jobs and improving their health care, or it will squander the gains of its recent economic boom, analysts say.

A newborn baby dies every 20 seconds in India and four out of 10 children are malnourished. Last month, Prime Minister Manmohan Singh called the state of the health-care system a “national shame.”

“In the years to come, these children will join our workforce as scientists, farmers, teachers, data operators, artisans and service providers,” Singh said, releasing a report by an anti-hunger and anti-malnutrition advocacy group Hungama. “We cannot hope for a healthy future for our country with a large number of malnourished children.”

The proposed hike in New Delhi’s health budget, from a current national allocation of a little more than $20 billion annually, was first discussed almost a decade ago, but bureaucratic delays and a lack of political will delayed the decision to go ahead.

Misspent money

Critics say Singh’s government has a habit of throwing money at problems without reforming basic delivery systems to ensure that the money reaches those it is meant for. Already, India spends $7.8 billion every year on one of the largest rural job guarantee programs in the world. It is also planning a $20 billion program to make food accessible to millions of poor. Much of the money ends up in the pockets of local officials, or lost in poor implementation.

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Health Alliance Plan's New Branding Initiative Reinforces Distinction and Helps Members Find "Peace"

DETROIT, MI--(Marketwire -02/27/12)- Health care reform ushers in an era where consumers will be more engaged in their health care coverage decisions than ever before. An estimated one million Michigan residents will be seeking their own health insurance in 2014. As a result, health insurers must adapt to a dramatically changing marketplace.

Health Alliance Plan (HAP) is launching a new branding initiative in anticipation of the changes health plans will face in providing and marketing their products and services under health care reform.

According to Donna S. Reid, HAP's Vice President, Marketing & Communications Strategy, HAP launched a branding initiative on Sunday, February 26 that plays on HAP's perceived strength as a nonprofit health plan company known for compassion, personalized attention and customer relationships reinforced by innovative Metaphor Study® research.

The initiative kicked off publicly with a bold, new television spot immediately before, during and after the 84th Academy Awards®, broadcast in southeast Michigan on WXYZ-TV7. Advertising on Detroit-area billboards, radio stations, newspapers and websites will follow today.

"We want to reinforce that HAP cares deeply about helping our members achieve a sense of peace and comfort with health insurance decisions best suited for them and their families," said Reid. "It makes sense for HAP, with a reputation for exceptional customer service, to lead with this type of initiative."

The new HAP television spot ends with this narrative: "And we may wonder: Am I doing the best for myself and my family? Am I keeping them safe? Ask us a question. We'll figure things out together. Welcome to Peace. Welcome to HAP."

HAP is the first health plan in Michigan to use innovative market research to pinpoint customers' emotional connection. The advertising campaign was created by The TMV Group with the Metaphor Study® research conducted by D.P. Bostwick & Associates, led by Dave Bostwick, former Director of Consumer Market Research for the Chrysler Corporation. Both companies are based in Birmingham, Mich.

"The objective of Metaphor Study® market research is to gain an in-depth understanding of the underlying idea behind a commercial concept," Bostwick said. "Metaphor Study® market research enables a company like HAP to refine and reinforce the emotional connection with its target audiences. The strength of HAP's existing brand, as the health insurance company best known for its compassion, personalized attention and customer relationships, really stood out loud and clear in the HAP Metaphor Study®."

The Bostwick agency obtained input from more than 300 individuals from southeast Michigan in 12 separate focus groups held in December 2011.

HAP's Reid said, "The Metaphor Study® reinforced the existing strength of the HAP brand, which has us positioned perfectly for the health care reforms to come. Great brands get out in front of others and we already have momentum since HAP is known less as a claims payer and more as a consumer-friendly, caring, compassionate health-solution company that takes a very personalized approach to making the lives of our members easier and more fulfilling."

"This goes beyond simply an advertising campaign," said Reid. "The brand initiative will have many touch points in everything we do, and it will be reinforced throughout 2012 and beyond."

About Health Alliance Plan
Health Alliance Plan (HAP) is a Michigan-based, nonprofit health plan that provides health coverage to more than 648,000 members and companies of all sizes. For more than 50 years, HAP has partnered with leading doctors and hospitals, employers and community organizations to improve the health and well-being of the lives we touch. HAP offers a product portfolio with six distinct product lines: Group Insured Commercial, Individual, Medicare, Medicaid, Self-Funded and Network Leasing. HAP excels in delivering award-winning preventive services, disease management and wellness programs, and personalized customer service. The National Committee for Quality Assurance awarded HAP's commercial HMO and HAP Senior Plus Excellent Accreditation.

HAP employs more than 1,000 southeast, east central and western Michigan residents through its corporate offices in Detroit, Southfield and Flint, and its subsidiaries Midwest Health Plan and ASR Health Benefits.

Documents and/or Photos available for this release:

HAP Brand Launch Press Release

HAP helps at every age and every stage

To view supporting documents and/or photos, go to www.enr-corp.com/pressroom and enter Release ID: 322167

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Health Plans Provide the Worst Customer Experience, According to New Temkin Group Research

WABAN, Mass., Feb. 20, 2012 /PRNewswire/ -- A new research report published by Temkin Group, 2012 Temkin Experience Ratings, rates the customer experience of 206 large companies across 18 industries. This is the second year that Temkin Group has released these ratings.

The research, which is based on a survey of 10,000 U.S. consumers in January 2012, includes 13 health plans. Kaiser Permanente was the top-rated health plan, the only plan to receive an "okay" rating, but it only ranked 87th in the overall ratings. TriCare, Medicare, Aetna, United Healthcare, Humana, Empire BCBS, Blue Shield of CA, and CIGNA all received "poor" ratings. Four plans received "very poor" ratings and are ranked in the bottom seven across all 18 industries: Highmark BCBS, Health Net, Medicaid, and Anthem BCBS.

Health plans represented the lowest-rated industry, and only one of three industries to receive an average rating of "poor." The industry, however, experienced a modest improvement between 2011 and 2012.

"It's troubling that only one health plan can even achieve an okay rating; the entire industry needs a customer experience wake-up call. While it's great to see some improvement, it's not enough," states Bruce Temkin, author of the report and Managing Partner of Temkin Group.

The Temkin Experience Ratings evaluates three dimensions of customer experience:

Functional: Does the company meet consumers' needs?Accessible: How easy is it for consumers to do what they are trying to do?Emotional: How do consumers feel about their interactions with companies?

Other highlights from the research include:

Kaiser Permanente and TriCare received the highest Functional ratings, while Highmark BCBS and Health Net received the lowest.Kaiser Permanente and Aetna received the highest Accessible ratings, while Medicaid, Health Net, and Highmark BCBS received the lowest.Kaiser Permanente and TriCare received the highest Emotional ratings, while Highmark BCBS and Health Net received the lowest.Ten health plans were included in both the 2011 and 2012 Temkin Experience Ratings. Kaiser Permanente had a double-digit improvement in its score while five other plans increased their score by five or more points: Anthem BCBS, Aetna, United Healthcare, CIGNA, and Humana.TriCare was the only health plan to slip by five points or more between 2011 and 2012, but Medicaid and Medicare also declined.

This report can be accessed from the Temkin Group website at http://www.temkingroup.com or from the blog, Customer Experience Matters, at http://experiencematters.wordpress.com. The data can be accessed from the Temkin Ratings website, http://www.temkinratings.com.

For more information about Temkin Group, visit http://www.temkingroup.com.

About the author, Bruce Temkin

Bruce is widely recognized as a customer experience thought leader and is Customer Experience Transformist and Managing Partner of the Temkin Group. He is also the author of a very popular blog, Customer Experience Matters. Prior to forming Temkin Group, he was a VP at Forrester Research for 12 years. Bruce is a highly demanded speaker who consistently receives high marks for his content-rich, entertaining keynote addresses. He is also the co-founder and Chair of the Customer Experience Professionals Association (CXPA.org), a global non-profit organization dedicated to the advancement of customer experience management.

About Temkin Group

Temkin Group is a leading customer experience research and consulting firm with one simple goal for its clients: increase customer loyalty by becoming more customer-centric. The company combines customer experience thought leadership with a deep understanding of the dynamics of large organizations to help senior executives accelerate their customer experience results. For more information, contact Bruce Temkin at 617-916-2075 or info@temkingroup.com.

This press release was issued through eReleases(R).  For more information, visit eReleases Press Release Distribution at http://www.ereleases.com.

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WellCare Health Plans Implements MedAssurant's Star Advantage™ Solution

BOWIE, Md., Feb. 20, 2012 /PRNewswire/ -- MedAssurant, Inc., a leading provider of data-driven health care solutions, today announced that WellCare Health Plans, Inc. (NYSE: WCG - News), a leading provider of government-sponsored health care programs, has selected MedAssurant's Star Advantage™ and INDICES™ solutions for a multi-year engagement to provide an integrated capability to both better understand and meaningfully impact its CMS Five-Star Quality Ratings. The combined solution leverages the nation's most widely used health care quality measurement system, large-scale health care dataset analytics, and a nationwide clinical operations infrastructure to proactively identify, and both efficiently and effectively resolve gaps in member quality outcomes.

(Logo: http://photos.prnewswire.com/prnh/20120215/NE54014LOGO)

Star Advantage's predictive analytics are informed by MedAssurant's Medical Outcomes for Research on Economics and Effectiveness (MORE2) Registry™ which contains more than 5.2 billion medical events from more than 77 million unique de-identified individuals. Leveraging the unprecedented insight afforded by this comprehensive dataset, Star Advantage provides WellCare near-real-time insight to identify highly specific opportunities for quality improvement. An additional analytical layer is applied to determine ideal intervention modality, venue, content, and timing for optimal member and provider engagement and gap resolution success. MedAssurant's nationwide infrastructure of clinical call centers, message fulfillment, integrated data platforms, and in-market clinical personnel numbering in the thousands brings to bear an end-to-end capability from analysis to impact -- enabling meaningful quality outcomes improvement.

"WellCare is focused on leveraging innovative approaches that both improve our quality outcomes and help us enhance health and quality of life for our members," said Walter Cooper, Chief Administrative Officer of WellCare. "We are pleased with the opportunity to continue working with MedAssurant and are confident that the unique capabilities offered by the Star Advantage and INDICES solutions will play a key role in helping us achieve our service and quality goals."

"MedAssurant understands the importance of quality outcomes and the necessity for today's leading health care organizations to have detailed, timely insight into their CMS Five-Star Quality Ratings," said Keith Dunleavy, M.D., President and Chief Executive Officer of MedAssurant. "Even more critical, however, is to have visibility into the predictive progression of these quality ratings and the intervention capabilities to support the achievement of targeted goals. Throughout our relationship with WellCare, we have been very impressed by their attentive approach to best practices with both their members and providers. It is a pleasure to work with a partner that is so clearly and consistently dedicated to these values."

The MedAssurant and WellCare relationship dates back to 2008 when MedAssurant began coordinating clinical data accuracy and claims analytics solutions for WellCare's Medicare lines of business. In 2010, MedAssurant and WellCare expanded their relationship to add prospective analytical processes (known as Prospective Advantage™). With this expansion of the relationship, MedAssurant will now implement its Star Advantage and the INDICES solutions.

About the MedAssurant Solutions

Star Advantage™ enables health plans to both better understand and meaningfully improve their CMS Five-Star Quality Ratings by leveraging the nation's most widely used health care quality measurement system, large-scale health care dataset analytics, and a nationwide clinical operations infrastructure designed to provide deep, dynamically updated insight into clinical quality outcomes and highly sophisticated gap closure capabilities -- end-to-end. Informed by MedAssurant's Medical Outcomes for Research on Economics and Effectiveness (MORE2) Registry™ which contains more than 5.2 billion medical events from more than 77 million unique de-identified individuals, Star Advantage gives health plans near-real-time insight needed to identify highly specific opportunities for quality improvement; derives detailed intervention planning for each specific member's needs, history, behavior and current situation; and then brings to bear highly targeted gap-closure operations using MedAssurant's national and local clinical resources.INDICES™ Reporting and Business Intelligence platform leverages OLAP cube technology and customized pre-calculated analytics to enable health care organizations near-real-time insight into member, provider, and clinical facility care, utilization, quality, disease, demographic, risk score and financial trends and performance. INDICES brings further value by providing comparative insight against over 77 million patients -- enabling users to not only gain deep insight into their own performance with industry-leading detail, but also against highly relevant comparatives otherwise unmatched in the marketplace.About WellCare Health Plans, Inc.

WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children, and the aged, blind, and disabled, as well as prescription drug plans. The company served approximately 2.6 million members nationwide as of December 31, 2011. For more information about WellCare, please visit the company's website at www.wellcare.com.

About MedAssurant, Inc.

MedAssurant, Inc. is a leading technology-enabled health care solutions provider focused on the importance of health care data and its ability to drive dramatic, objective improvement in clinical and quality outcomes, care management and financial performance throughout the health care community. Proprietary health care datasets, aggregation and analysis capabilities, combined with a national infrastructure of leading-edge technology, clinical prowess and deep human resources, empower MedAssurant's advanced generation of health care assessment and improvement through highly informed solutions. Driven by a mission to improve today's health care landscape, the employees of MedAssurant proudly apply care, ingenuity and dedication to delivering a new approach to health care touching nearly 120 million Americans -- one driven by data and insight -- one resulting in meaningful action. Please visit www.medassurant.com for more information.

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Genomic Health 4Q profit grows; plans new division

REDWOOD CITY, Calif. (AP) — Cancer test maker Genomic Health Inc. reported a larger fourth-quarter profit on Monday, and said it will start a new genetics business.

Genomic Health said its income grew to $2.6 million, or 8 cents per share, from $1.7 million, or 6 cents per share. Its revenue rose 13 percent, to $53.4 million from $47.1 million. The company said it delivered 17,080 test results with its Oncotype DX test, up 13 percent from a year ago. The Oncotype DX test is designed to predict the risk that a patient's breast or colon cancer will recur.

Analysts expected the company to report a profit of 10 cents per share on revenue of $53.8 million, according to FactSet.

The company said its new subsidiary will focus on commercial applications of the human genome. It will invest $20 million in the business over the next two years.

It will establish the business by March 1 and offer its first commercial service by 2013. Randy Scott will step down as chairman of Genomic health to become CEO of the new venture on March 1, and company President and CEO Kim Popovits will become chairman of Genomic Health. Julian Baker has been named lead independent director.

In 2011, the company's profit climbed to $7.8 million, or 26 cents per share, from $4.3 million, or 14 cents per share. Revenue grew 16 percent, to $206.1 million from $178.1 million. Genomic Health said it returned more than 66,600 Oncotype DX test results.

In 2012, the company expects adjusted income of $5 million to $8 million, excluding its losses related to the new subsidiary. It forecast $230 million to $240 million in revenue and 75,000 to 77,000 Oncotype DX test results.

Analysts expect the company to report a profit of $13.4 million, or 44 cents per share, on $235.9 million in revenue.

Shares of Genomic Health lost $1.45, or 5 percent, to $27.40 in extended trading following the release of the earnings report. They had ended the regular trading session down 49 cents at $28.85.

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Saving Retiree Health Plans

More companies in dire financial straits are pulling the plug on retiree health-care benefits—dealing a blow to everyone from hourly union employees to upper management.

Eastman Kodak and Hostess Brands, both of which filed for Chapter 11 bankruptcy this month, are expected to ask the courts to let them kill their plans, following in the footsteps of bankruptcies at American Airlines parent AMR Corp., Harry & David, the mail-order food retailer owned by private-equity firm Wasserstein & Co., and scores of auto-parts companies, steelmakers and others.

Bankruptcy judges usually let companies terminate such plans, figuring the move will make it more likely that creditors will be paid and that the company's chances of turning itself around will be enhanced if it can shed millions or even billions of dollars in retiree obligations at the stroke of a pen. Retirees, who are unsecured creditors, always are vulnerable.

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But loss of coverage can devastate retirees who might not be able to obtain, or afford, coverage in the open market, especially involuntary early retirees who are years away from collecting Medicare benefits and might be one heart attack or bout of cancer away from financial ruin.

Still, retirees of companies in bankruptcy protection have an option unavailable to retirees of companies that are healthy but eliminate retiree health coverage anyway: the Health Coverage Tax Credit, or HCTC, a federally funded program administered by the Internal Revenue Service.

The credit pays a portion—currently 72.5%—of health-insurance premiums for retirees whose benefits have been reduced or eliminated in bankruptcy proceedings and whose pensions are taken over by the Pension Benefit Guaranty Corp., the federal insurer that assumes control of failed plans and pays the benefits.

The program will pay for comprehensive major medical coverage, including prescription drugs and dental and vision care, if they are included in that coverage.

People can elect to pay 27.5% of their monthly premium to the HCTC program, which will then send the full payment to the insurer. Or they can pay their health insurer directly each month and claim a credit on their federal tax return for the 72.5%.

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To be eligible for the subsidy, you must be receiving a pension from the Pension Benefit Guaranty Corp. You also must be 55 to 64 years old and enrolled in a qualified health plan (provided you are paying more than 50% of the costs). That includes Cobra, which requires your former employer to continue offering job-based health coverage to you if you lose your job.

In 2009, Congress expanded HCTC coverage to include benefits sponsored by Voluntary Employee Benefits Associations, or VEBAs, which are trust funds established during the bankruptcy process to provide retiree health benefits. Such large-scale associations have since been set up to cover retirees of some bankrupt companies, including Delta Air Lines and General Motors' floundering auto-parts spinoff, Delphi. These post-bankruptcy arrangements cover both union and salaried retirees, including management.

Roughly 7,000 participants in the Delphi VEBA pay $150 to $200 a month in premiums per person, for example, with a $250 deductible and total out-of-pocket expenses capped at $1,200. American Airlines retirees have recently formed a committee that will likely explore setting up a VEBA if their coverage is terminated, and retirees of another major airline is in the planning stages of setting up such a plan.

In a little-noticed move last October, a New York bankruptcy court judge approved the creation of the first industrywide VEBA, which will provide benefits to retirees of failed auto-parts manufacturers based in Ohio, Michigan and Wisconsin.

Retirees in the auto and steel industries are planning to roll out VEBAs in March and April, says Cathy Cone, managing partner of Cone Insurance Group, a Houston-based insurance broker that helps set up the plans.

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The Health Care Tax Credit was set to expire at the end of 2010, but it was extended and expanded from 65% to 72.5%, with the increase retroactive to Feb. 13, 2011, after retiree groups and unions lobbied vigorously.

The tax credit is authorized through 2013, but there is likely to be strong pressure to reauthorize it—and not just from retirees and unions. Insurers, which have been developing products and services financed by the taxpayer subsidy, will push vigorously to keep it alive, though there isn't a guarantee it will happen.

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When health plans go high deductible

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(Courtesy of Journal of General Internal Medicine)

As health costs rise, employers are increasingly turning to high-deductible health plans: Insurance coverage that usually pairs catastrophic coverage with a health savings account, leaving consumers to decide what to spend that account on. The goal is to give consumers more incentives to not spend on the care they don’t need, but these plans often raise concerns that subscribers will cut back on the care that they do need, too. A new study from a team of Harvard researchers explores how health insurance plans with high deductible effect the care that families do, and don’t, seek.

Researchers focused on families where at least one member has a chronic condition, that would likely require a greater amount of medical care. They compared families in Massachusetts who were enrolled in high deductible plans against those with more traditional insurance coverage.

Overall, the study found that individuals in high deductible plans did tend to delay care at a greater rate than those in more traditional plans. But even more interesting was who was delaying the care: In families where the child had a chronic condition, the healthier adult tended to be the one reporting holding off. For those with an unhealthy adult, however, it was the opposite: Care for children got delayed. These effects were even more significant for lower income families, as you can see in the chart above, tended to delay care at higher rates.

“One of the things that was fascinating was we tried to look at interfamilial effects,” says the study’s lead author, Alison Galbraith. “If you have someone who has a chronic condition, who is foregoing care, it looks like the healthy people are cutting back. Those are the people to worry about.”

What this study couldn’t probe was whether the delayed care was essential. If the care was indeed needed, that could be problematic and costly, leading to higher health care costs for any complications that arise down the line. If it wasn’t, it would signal a high deductible health plan working as it should, encouraging individuals not to seek the care they don’t need.

Either way, the impact of high deductible plans is becoming increasingly felt in the health care sector. Enrollment in high-deductible plans, among those with employer sponsored insurance, has more than doubled in the past two years, from 8 percent in 2009 to 17 percent last year.

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Health officials discuss Flagler needs, plans

Meeting the need

Federally Qualified Health Centers are defined by Medicare and Medicaid statutes and funded under the Public Health Service Act. They offer:

- Eligibility for a $650,000 start-up grant.

- Enhanced Medicare and Medicaid reimbursement.

- Medical malpractice coverage through the Federal Tort Claims Act.

- Medications for outpatients available at a reduced cost through the Drug Pricing Program.

- Safe Harbor to establish arrangements for goods and services.

- Access to National Health Service Corps.

- Access to the Vaccine for Children Program.

- Eligibility for various other federal grants and programs.

SOURCE: St. Johns River Rural Health Network

PALM COAST -- Flagler County needs a Federally Qualified Health Center that brings together all health care components in downtown Bunnell, especially primary and behavioral health care, within walking or bike-riding distance of some of the county's most economically disadvantaged residents.

That was one conclusion of the Flagler Community Health Assessment, a year's worth of personal interviews, summits with local healthcare providers, and hundreds of individual surveys compiled for a study conducted earlier this year by the Health Planning Council of Northeast Florida and the Flagler County Health Department. Officials summarized their findings, as well as plans for the future, at an invitation-only breakfast Wednesday.

"Many people who are able to access primary care are not getting behavioral health or substance abuse help. They just don't go," said Toni Barrett, spokeswoman for Stewart-Marchman-Act and a member of the Flagler Partnership for Community Health. "Likewise, people who are getting behavioral health or help with substance abuse are accessing primary care. There is a real need to get some integration of health care."

The study, funded through a $17,500 Florida Health Department grant via the Centers for Disease Control, was done to provide a comprehensive overview of Flagler County's health care needs for planning purposes.

The hard part starts now, said Dawn Emerick, president of the Health Planning Council of Northeast Florida, a nonprofit council that covers a seven-county area including Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties.

"This is not unique to Flagler County," she said. "The needs are very similar (all over). This is all very community driven."

Ultimately, health care officials envision a health care corridor along the spine of downtown Bunnell. Creating this corridor will be key to getting $650,000 in annual grant money to maintain a Federally Qualified Health Center.

Patrick Johnson, Flagler County Health Department administrator, praised the successes of the Flagler Free Clinic, the Sheltering Tree, Feed Flagler, Access Flagler and the mobile benefits program, among others. But he said the pieces will have to be connected for officials to be able to create a competitive application for the highly sought-after federal grant money.

"Only 87 of these have been funded across the nation -- two in Florida," Johnson said. "It's very competitive. We have to have something unique. We have to piece this together as a health campus in application form. And we have to be patient."

Overall, the health of Flagler County is good, he said.

"Two years ago, Flagler was the healthiest small county in Florida," Johnson said, noting that health information reported is always a year behind. "That's when we started to head into really hard economic times, and last year we slipped a little bit. When we look at community health, we are looking at the entire community."

Top local concerns include a lack of easy access to health care, chronic diseases like diabetes, and "behavioral health" problems like drug and alcohol abuse, according to the study.

Statistically, Flagler County's percentage of adults who are smokers, obese, have high blood pressure and cardiovascular problems and high cholesterol is higher than the state average.

Johnson related that a nurse told him that if health care workers could "decrease smoking, weight, high blood pressure and cholesterol, we could solve 75 percent of the health problems."

Health care in general, he said, has moved away from the infectious diseases that were aggressively treated in the early 1900s and now is focusing more on chronic diseases that come with living a longer life.

"We all know the longer you live, you're going to probably develop some kind of chronic disease," Johnson said. "We want to live as long and as healthy as we can, but we're all going to die.

"We're trying to be younger and younger."

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Health plans launch own exchanges ahead of public versions

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St. Paul, Minn. — Commercial health insurers are scrambling for position as a key part of the federal health law threatens to upend their marketplace in two years.

Health plans are trying to lock in business before government-sponsored health insurance exchanges go online in 2014. Several large insurers are launching private insurance exchanges to protect themselves against competition from the public exchanges.

Not since the advent of Medicare and Medicaid in the 1960s has there been such big changes looming on the horizon for health insurers. In less than two years, the federal health care law will usher in more restrictions on premium increases, tens of millions of new customers, and a way for consumers to comparison shop online for their health insurance.

An estimated 1 million Minnesotans will eventually get their health insurance through an exchange.

Sabrina Corlette, research professor at Georgetown's Health Policy Institute, said those are just a few of the changes coming in 2014. Just how insurance markets will shake out is anyone's guess, she said.

"Insurance companies are grappling with the uncertainty like everybody else and trying to look two years down the road and how to position themselves," Corlette said. "[What] also needs to be watched closely [is] that it's working for the consumer."

Corlette says there's a lot of jockeying going on as insurers try to position themselves to either maintain or expand the market share they currently have. That's no simple task given the shifting sands.

The prospect of public insurance exchanges are driving some of the maneuvering. As laid out in the health care law, they will allow consumers and small businesses to comparison shop for health plans. Now, a spate of new privately-run online insurance shopping sites are cropping up to cater to small businesses struggling with rising premiums, including "My Plan by Medica" in Minnesota.

Last August, United Health Group's subsidiary OptumHealth bought Connextions, an exchange company based in Florida. Then in September, three large, independent health insurers invested in Minneapolis-based Bloom Health's private exchange.

Medica's John Naylor said public or private, the basic concept of an exchange — allowing employees to choose among many different policies online — is a good one.

"We have seen a trend of giving consumers more choice. And in health care, it's an industry that with the exchanges out there coming in 2014, there's a lot of focus and energy around how do we give employees choice," Naylor said.

But with many private exchanges, there's only so much choice. On the public exchanges, users will be able to choose among a variety of plans offered by different insurers who are competing for business.

Not so on some of the new private exchanges. They may offer plans from only one insurer — the one that's providing the exchange. That's the case with both My Plan by Medica and the Blue KC Exchange from Blue Cross Blue Shield of Kansas City.

Blue Cross' Ron Rowe said the goal is to get people used to dealing with an exchange and the company's products before there's additional competition from the public exchanges.

"Our thought is that at least today we're better off to develop a relationship with them, have them used to getting their service from us, feeling good about the service they get from us, developing some rapport, some trust," Rowe said.

Rowe said the hope is to develop some customer loyalty, so Blue Cross won't lose business to the public exchanges once they go online.

Washington and Lee health law professor Timothy Jost said the private exchanges may help insurers fend off competition once the public exchanges go online.

"It's not all that easy to switch a plan once you have a plan in place; people are used to using the doctors and hospitals associated with a particular plan," Jost said.

Exchanges are also allowing employers to cap the amount they pay for workers' health coverage. Employees get to pick from a range of plans, some of which may require that they pay extra.

Abir Sen of the Minnesota-based private exchange Bloom Health said that approach is attractive to small businesses. He said it's a way for them to gain control over unpredictable, but growing health care costs.

"This is very much a market-driven solution where the market is telling us here's what we need and the industry is responding accordingly," Sen said.

But over time, capping employer contributions could leave workers shouldering an ever-growing portion of premium costs.

The big question for insurers is if they build exchanges, will small employers come?

Economist Paul Fronstin, director of the non-partisan Employer Benefits Research Institute said small business owners will approach both private and public exchanges with caution.

"Enrollment in both is going to start off slow and grow over time as employers see how they're working and get more information about them," Fronstin said.

Corlette said cost will be the deciding factor in whether businesses buy insurance from either a public or private exchange.

"It's got to be affordable. And if you're offering them an alternative, it's got to be cheaper than what they can currently get," she said.

Corlette says the exchanges also need to provide decent coverage that's easy to administer.

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