HMOs wait for details of health care reform's changes

Leaders of three Minnesota health maintenance organizations -- Medica, Blue Cross Blue Shield of Minnesota, and HealthPartners -- agree on one thing: the No. 1 challenge they face is planning for the law's reforms when the government is still ironing out the details.

While the public sees it as a done deal that's a sweeping 2,000-plus pages long, Minnesota's HMOs see it as merely a framework with a lot of important pieces missing.

President Obama signed the legislation six months ago this week.

Geoff Bartsh of HealthPartners points to one example. Bartsh said the law requires health insurance policies to provide a core list of things that plans must cover, but the Department of Health and Human Services is still working up the list.

"We have a broad list of categories but we don't know the specifics," he said. "And how that 'essential benefits' is defined will have real serious implications about what products look like in the future."

Bartsh said fortunately Minnesota law already mandates that HMOs provide a rich set of benefits for consumers. He hopes the new federal regulations won't be all that different.

"We're going to proceed as if that's the case but we're waiting to see when the guidance comes out and if the rules change what we're doing, we'll have to adapt and adjust to that very quickly," he said.

It's not clear when the regulations will come out, so all health insurance providers can do is wait. Still another big unknown looms. In 2014, the health care reform law mandates that states create their own health insurance exchanges or the federal government will. These are expected to be online insurance policy marketplaces where consumers can compare and purchase individual policies.

There's a lot of uncertainty in just what those exchanges will look like and how they'll operate.

Phil Stalboerger, with Blue Cross Blue Shield Minnesota, said regardless of what type of insurance consumers have today, they'll likely see changes in the next couple of years. He says deductibles are likely to change, and Blue Cross wants to know what employers and policy holders want.

"Essentially the market will play out a lot of what the market is going to want to pay for a deductible or not," he said. "You may see them change. They may change for certain customers based on the kind of coverage they have today."

Officials with all three HMOs say deductibles, premiums, co-pays are likely go up in the next few years but they couldn't predict just how much.

They all mentioned that a key way to stem rising costs is to help policyholders lead healthier lives.

Medica's Scott Reid said employers are dealing with higher health care costs by requiring employees to pay higher deductibles and out-of-pocket costs. Reid said under health care reform, there will be more emphasis on helping people live healthy lifestyles to contain costs.

"What we're doing as a health plan is working to get them more personalized, more unique, more specific information for them to help manage their health to keep them healthy," he said.

For policyholders with high risks of certain diseases, he said, helping them understand those risks and providing detailed, personalized information to them will help them manage their costs.

Amid all the uncertainty about Health reform and its effects, Reid says there's no doubt there will be more incentives for people to take care of their health -- and for their HMOs to help them.

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