TriState | Spring | 2010 | Health Plan Analysis
Healthcare reform will be less of a game-changer in the TriState, at least for New York and New Jersey, which already ban medical underwriting, exert some controls over insurer rates and benefit plans. However, these states, along with Connecticut, will have to reconcile their state laws with the immediate impacts of the federal act to cover older dependents and set up high-risk pools, among other things. New York regulators continue to push for prior approval of HMO rate hikes in that state and impose stricter limits on profits than the federal government. Meanwhile, momentum is building to get more physicians wired up for the future of healthcare in the TriState. Connecticut is embarking on its largest medical home project to date—one that pairs up the state employee health plan and the state’s largest primary-care practice group, ProHealth Physicians Inc. New York Medicaid is paying its providers and pharmacies incentive payments for each prescription they send in electronically, which has the potential to boost overall e-prescribing there. On the pharmacy front, Horizon Blue Cross Blue Shield of New Jersey learns some shocking lessons about how often members skip needed prescriptions, while health plans throughout the TriState seek to promote mail-ordered prescriptions to varying degrees. One New York health plan is approaching wellness with a novel benefit design that is sure to catch on in the rest of the state.
