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Sunday, 20 December 2015 22:49

Q&A: Rick Murdock, Executive Director, Michigan Association of Health Plans

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Rick Murdock Rick Murdock

The growth of private health exchanges and the migration of more employers to self-insured health benefits are the key trends Michigan Association of Health Plans Executive Director Rick Murdock is watching for 2016. Murdock also expects continued moderation in premium increases. The Association of Health Plan represents 17 health plans in Michigan that collectively cover more than 2.5 million people through commercial, individual, Medicare and Medicaid products.

What are the opportunities and challenges in 2016 in terms of health benefits?

There’s continued evolution within the Affordable Care Act, and that’s kind of on the margins. When you take a step back, we have a lot of conversations about the public exchange for the individual market and the small market, but that’s not really what’s taking place. What’s taking place is off the market. It’s dealing with the private exchanges, it’s dealing with some of the other exchanges that are going to go on in the large employer base and what’s happening with self-insured products. From our point of view, we’re trying to position our members to get more engaged in those markets and create opportunities to do so.

Where do you see the industry going next year?

I see a lot more movement toward addressing — on the commercial side — the self-insured and private exchange opportunities.

How will the economy play into all of this?

The economy kind of drives the benefit plans and how much we continue to drive high-deductible plans that have just grown tremendously over the last five years. To keep health care more affordable or to sustain that affordability, there’s going to be just the continued offering of — you can call it high-deductible (plans) or you can call it more consumer engagement. The employee or the individual is going to have more financial stake in health care because of the nature of the economy and the cost-sharing that goes on. That’s just totally necessary to keep the overall health care coverage on track.

We have the individual mandate and we have the employer mandate out there. You’re supposed to have health care coverage equal to the essential health benefits package. We still have the remnants, if you will, of the Affordable Care Act, but the common policy (of employers) now is just driving more toward increased cost-sharing.

What’s an issue that you see arising in 2016 for health plans and their members?

One of the real issues out there is the discounts that are negotiated by health plans (with care providers). You make a lot of difference between in-network and out-of-network (prices) and you can call it a drive-by-type of thing where you have a lot of providers and consumers who have no choice about whether they are in-network or out-of-network.

When might that kind of issue arise?

These are the specialists — the radiologists, anesthesiologists and others — who send a bill that says ‘out of network rates’ because they might have provided a service within a hospital that was an in-network provider and that’s as far as the consumer knew and they had no choice of the provider. Those issues we’re going to get more into over the next year. One way or another, that’s going to come to a head. We’re looking at some legislation that at least can create a little more transparency on those relationships.

What about rates for 2016? Will the moderation in annual premium increases of the last few years continue for some product areas and markets?

I would use the term ‘moderation’ in premium increases to continue with more pressure for reducing the administrative costs for those serving self-insured plans. Issues of HICA (health insurance claims assessment) and the ACA premium tax will have an inflationary factor in rates.

What’s lurking just beyond the horizon that’s going to get more attention next year?

We’re starting to look at where technology is going, and I think where the growth will just take off like a rocket in the next 12 to 18 months is in specialty drugs. So we need to be ready for that. It’s going to be a big budget-buster on the public sector side. And the issue there isn’t around the efficacy of the product. It’s really about the price. These are all price issues and how much profit is enough on the pharmacy side. I wouldn’t say it’s new. I just think we’re going to see it accelerated.

Interview conducted and condensed by Mark Sanchez.

Read 1557 times Last modified on Monday, 28 December 2015 10:31

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