Steward’s fully integrated community care organization serves more than one million patients annually in 85 communities in Eastern Massachusetts.  The plan network includes all of the Steward Health Care system community doctors and hospitals.

Both deductible, and no deductible plan designs will be offered.  The plan, called Steward Community Care, will be available as of April 1, 2012 to all Eastern MA small businesses.

Under the plan, a hospital or physician in the Steward network will deliver clinically appropriate care, with out-of-network care coming from Brigham and Women’s and Massachusetts General hospitals in Boston. Tertiary-level pediatric care will be provided through Mass. General.

Participating hospitals and medical centers:

• Carney Hospital
• Good Samaritan Medical Center
• Holy Family Hospital
• Merrimack Valley Hospital
• Morton Hospital and Medical Center
• Nashoba Valley Medical Center
• Norwood Hospital
• Quincy Medical Center
• Saint Anne’s Hospital
• St. Elizabeth’s Medical Center

Contact Waugh Agency, LLC for complete details, and a no obligation rate comparison.

Under the ACO model, physicians and hospitals are paid on a population based budget rather than a fee per service (as in most HMOs, and PPOs).  The creation of ACOs is a key facet of the 2010 Affordable Care Act, the comprehensive national health reform law that includes the individual mandate, healthcare exchanges, and patient safety programs.

According to this article from the Boston Globe, ACOs  ”will provide financial incentives for health care providers to give better care at lower cost”, which would benefit both patients and providers.  The HHS estimates this pilot program of 32 ACOs will save up to $1.1B in the 19 participating States, over five years.

The Medicare ACO pilot program starts Jan. 1, 2012.  Insurance carriers, and the Federal Government want to bring ACOs into the non-retiree market.  Blue Cross Blue Shield of MA, for example, has been experimenting with an ACO model for one of it’s payment networks since 2008.

Read the full HHS press release.

With 1st Quarter 2012 MA renewals underway, I am seeing moderate increases in most client’s group health premiums, versus last year.  This is inline with the MA Division of Insurance approved “base rates” for Q1 2012.  When these rates were approved by the DOI last month, the average reported increase was 4.8%, with a few carriers coming in much lower. Bear in mind, these are the “base rates”, which are not adjusted for group size, average age, and other demographics.

This article compares the Q1 2012 increase to last year’s, when some businesses saw rate increases “as high as 34 percent”.  That figure is a little misleading, because the maximum DOI allowed base rate increase last year was lower- around 8%- but after demographic and age adjustments, there were certainly companies that saw 30%+ renewal offers in 2011.

It can be frustrating for business owners to read that the State has capped rate increases at 6%, then see their own renewal offers come in much higher.  My agency specializes in obtaining the absolute lowest rates for our clients.  We can often use innovative premium-saving options such as health plans with a built in Health Reimbursement Arrangement, to reduce or eliminate the sting of an increase.

Below is a breakdown of Q1 2012 base rate increases for the major Massachusetts insurers:

Blue Cross HMO Blue (5.9 percent)

Harvard Pilgrim HMO (5.2 percent)

Neighborhood Health Plan (4.3 percent)

Tufts Health Plan (4 percent)

Harvard Pilgrim Health Care (3 percent)

Tufts HMO (2.6 percent)

CeltiCare (2.2 percent)

Fallon HMO (1.5 percent)

Fallon Community Health Plan (1.2 percent)

-figures are from State House News Service

Here is a link to a summary of the report from “The Ultimate MA Health Care Insider Info” blog.

MAIM wants to start by repealing the individual mandate (part of the 2006 law that requires MA residents to obtain health insurance or face tax penalties), then eventually unravel the entire Act Providing Access to Affordable, Quality, Accountable Health Care.  Presumably, they would prefer that the poorest Massachusetts Residents have no health insurance, and clog the ER’s.

I am not saying that I believe there are no problems with the Massachusetts health care system.  However, MA is one of the few states in the country where individuals can receive discounted or free health insurance, based on income.  As a licensed health insurance specialist who has participated in pilot programs with the MA Health Insurance Connector Authority, I work every day with individuals and groups who, if they were in most any state other than Massachusetts, could probably not afford health insurance.

There is also a movement to repeal the individual mandate on a national level, and the U.S. Supreme Court is set to issue a ruling by July, 2012.

link to Herald article

link to article from Masslive.com

link to the Kaiser report

This article from the NY Times discusses the Kaiser study in detail.

Thank you for visiting the Waugh Agency, LLC website.  We are a trusted, independent, non-biased source for group health and life insurance.  We also serve the needs of self employed, and Medicare eligible individuals.  Read the articles on our website to stay up to date with the rapidly changing health insurance market.

Thank you for the opportunity to be of service.

Sincerely,

Matt Waugh

Owner, Waugh Agency, LLC