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

Coventry Health Care has signed an agreement to purchase Florida Health Plan Administrators which owns Vista Healthplans. Vista has about 295,000 HMO health plan members, mostly in south Florida .

In Texas in 2003, lawmakers and voters implemented a $250,000 cap on non-economic damages in medical malpractice cases. Malpractice insurance premiums in Texas have fallen by an average of 21.3% since that time. Now doctor applications to practice in Texas are skyrocketing, with over 4,000 applications for licenses in 2006, up from 2,992 the previous year. The Texas Medical Board is having trouble keeping up with the applications.

According to a recent Watson Wyatt survey, 49% of workers have trouble understanding their health coverage and admit confusion when it comes to basic terms. Seventy percent of workers prefer to receive health information in print, followed closely by 64% who prefer the information be accessible online. Only 52% or workers read their information cover to cover and many admit only scanning what is needed to enroll or make changes to their existing plan. Just less than half of workers feel comfortable explaining such terms as “copay” and “deductible.”

The New York Attorney General’s office has asked UnitedHealth Group to cease implementation of a program which ranks doctors according to quality and cost effectiveness. The attorney general’s office is concerned that consumers may be steered to doctors based on “faulty data and criteria” and may be encouraged to choose doctors based on price rather than quality.

An Express Scripts study found that plans with a generic vs. brand copayment differential of $21 or more used generic drugs at a rate 5.2% higher than plans with a $0 to $5 differential. A 1% generic use increase results in an estimated 1.6% decrease in total drug plan costs. Compared to plans with the lowest differential between generic and brand copayments, plans with $11-$15 and $16 to $20 differentials used generic drugs at rates that were 1.9% and 2.9% higher, respectively.

Another study by Carnegie Mellon University outlined in the Pittsburg Post- Gazette says that savings from prescription drug copays being raised are offset by other health plan increases such as ER visits and outpatient care. The study says 35% of any savings realized are offset by other medical cost increases that occur when people stop taking their prescriptions. The study covered 9 employers and 500,000 employees.