Reformed Reform!

Of course there’s no telling what will ultimately happen to Obamacare in the next congress under the new administration, but change is certain.  Addressing new mandates quickly requires nimble systems that can accommodate such change. Beyond that, one way of reading the tea leaves is to look at the work of the players that the new administration has tapped to lead CMS: Seema Verma. Verma was an adviser to Vice President Elect Mike Pence for Indiana’s CMS approved Healthy Indiana Plan 2.0 (HIP 2.0). The plan didn’t meet all the ACA requirements, but was granted special status as a "waiver" or single state experiment.  

A modern system like SpyGlass supports the account balances and interconnected features that plans like this require.

It’s understandable that Verma would want to capitalize on her past experience. Now that Verma is headed for the driver’s seat, it’s worth a look at how the plan that she crafted in Indiana was different from the ACA.  

Indiana's HIP 2.0 asks for a “premium contribution” from able-bodied individuals, and “says it with feeling” by allowing premium contributions to enable the “POWER Account”, which is similar to a health savings account. This one of the most salient features of the HIP 2.0 program, because if the individual actually makes contributions to their “premium” then they enable use of the POWER Account, can build up funds, and create “rollover” potential for their account.  

Here’s how Verma and a co-author, Brian Neale, describe it in a blog post in HealthAffairs.org

“HIP members begin coverage in HIP Plus, which offers benefits similar to those found in the commercial market and also includes modest dental and vision coverage. To maintain enrollment in HIP Plus, members are required to make monthly contributions in the amount equal to 2 percent of their income, comparable to the Marketplace’s premium formula. Unlike premiums, members own these contributions and are refunded their pro-rata share when they leave the program. The member’s pro-rata share is also rolled over from one plan year to the next, thereby reducing the contribution amount required for the upcoming plan year. Rollover amounts are increased for members who complete requisite preventive care services”

Under this test program in Indiana, able-bodied individuals are certainly encouraged to make a contribution towards the cost of their coverage. One of the features of enabling anything is that failure to enable it takes it off the table. This has been one of the criticisms of Indiana’s plan, so this may be an area that Verma adapts as she works to broaden the reach and scope of her ideas.  

In any case, it’s worth noting that technical capabilities to support features like this for plan administrators are also the “price to play” in the market as you try to draw groups, consumers and plans towards yourself. A modern system like SpyGlass supports the integration-oriented features that plans like this require. It’s also fully and solely cloud based, so you’ll be able to run all the real time interfaces you need. With a modern object oriented architecture, Beacon is nimble with the software and can make the changes you need to lead with innovative features.  

Get your administrative capabilities ready for America’s dynamic, ever changing health plan administration landscape. 

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