S&S Benefits.....Opinion, Hearsay & News Review

United Health Group’s buying spree is continuing with the proposed purchase of Sierra Health for more than $2.4 billion. The purchase will need to be approved in Sierra’s primary service areas of NV, CA and TX. In the meantime, the AMA asked the Department of Justice to block the proposal since the AMA has deep reservations about United’s goal of dominating the Nevada health insurance market. If the merger is allowed, the AMA estimates UHC would control 95% of the Vegas HMO market and 78% of the state HMO market. The Consumers for Health Care Choices group also asked the DOJ to block the merger.

In more reduced competition news, Highmark and Independence Blue Cross of PA have agreed to merge. The merger is expected to be reviewed very closely due to the dominant nature of each of the Blues plans in the market and the fact that there will be limited competition in Pennsylvania .

J.D. Power and Associates released its first-ever National Health Insurance Plan Satisfaction Study, which surveyed over 10,000 consumers on their health plan satisfaction. When it comes to where employees accept advice about how to stay healthy, 70% cited their doctor and just 2% trust employers. Online health articles were the most trusted source for 22%, while health plans were trusted by 12% and the government was most trusted by 6%.

More CDHP statistics: 5% of employers offer only a CDHP plan and the percentage of large firms offering a CDHP program is 38%. Only 8% of workers use a CDHP. High deductible health plan users go to the ER 10% less than patients with traditional health insurance according to Harv ard Medical School .

Small firms pay up to 18% more for health insurance than the largest firms according to the Commonwealth Fund. However, small business does not generally seek government intervention, but rather more open competition in the market according to the National Federation of Independent Business. In the meantime, competition is dwindling as the GAO reports that the typical largest health insurer in a state controls 43% of the market, up from 33% in 2002.

A study by Guardian Life shows that 50% of employees read their benefit brochure while 42% speak with HR to help make benefit choices. On average employees spent 1.4 hours examining their benefit options during open enrollment.

The CVS offer to buy Caremark is completed for $27 billion after Caremark turned down the offer from Express Scripts. The enterprise will fill more than one billion prescriptions per year.

The Department of Managed Health Care in California reviewed 90 cases where Blue Cross of California declined coverage for medical conditions by saying they had not been disclosed on consumer applications for coverage. They found that Blue Cross was wrong in denying coverage every time. Blue Cross was accepting applications without reviewing medical records and then denying coverage when the patient submitted a claim, according to the DMHC.

According to The Hartford, EAP plans have a positive effect on disability claims. They say companies without EAPs have 6% of their workers out on disability leave compared to 2% for employers with EAPs. Workers at companies without an EAP stayed out 22 days longer with musculoskeletal disorders than those who also had an EAP. Another finding was that 74% of employees with a disability claim who used an EAP were female and 71% who used an EAP were disabled due to a nonpsychiatric condition.

Researchers from the University of Michigan say treatment of coronary artery disease appears to be shifting away from the hospital. U.S. hospitalizations for heart attacks declined 10.6% from 2002 to 2005, most likely due to preventive treatments with statin drugs, aspirin and declines in smoking.

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