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CBIA Health Connections an example of a successful exchange for 15+ years

CBIA Health Connections an example of a successful exchange for 15+ years. January 8, 2010. Presentation Overview. CBIA Health Connections Who we are Why we are successful Rating rules in Connecticut What we do Lessons learned and opportunities. CBIA Health Connections.

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CBIA Health Connections an example of a successful exchange for 15+ years

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  1. CBIA Health Connectionsan example of a successful exchange for 15+ years January 8, 2010

  2. Presentation Overview • CBIA Health Connections • Who we are • Why we are successful • Rating rules in Connecticut • What we do • Lessons learned and opportunities

  3. CBIA Health Connections • Introduced Jan. 1, 1995 • Employee choice model • 4 Health Plan choices • 5000+ companies • 75,000+ members

  4. CBIA Health Connections • Standardized Benefits across Health Plans • Employer Chooses CBIA Health Connections • Employee Chooses the Insurer • Price • Network • Formularies • Satisfaction

  5. Why CBIA has been Successful • Deliver value to: • Market, Employer, Employees, Insurers • Engaged with and understand our customers • Stay true to core mission – small employers • Private sector status allows for: • Innovation and adaptation to market changes • Efficient operations • Avoid selection issues

  6. Rating Rules in CT • Small Case Reform Laws – under 50 full time employees • Adjusted Community Rating – no rate bands for claim experience • Guarantee issue • Guaranteed renewability • Rating factors allowed: • Age, family tier, gender, area, case size, SIC, plan design • Reinsurance pool (CSEHRP)

  7. Exchange & Administration CBIA Health Connections administered like one large plan to the insurers but there are a lot of details……

  8. Lessons Learned in the Market • Potential Pitfalls • Rates based on claims & health status • Adverse selection • Looking to save administrative costs only • Operating outside of regular market practices • Broker compensation variances

  9. Things to Think About • Unintended consequences of rating changes • Coordination of multiple funding sources • Subsidies • Part-time employees • Risk adjustment (premium redistribution) • Minimal focus on wellness and behavior change

  10. Opportunities • Bring culture of wellness to the small business market • Has worked in large company market • Currently no financial incentive • Plan design with incentives / disincentives for wellness, prevention and care of chronic illness • Decision support tools to help employees / patients make informed decisions about their health • More transparency of quality and costs from providers • Promote competition, innovation and quality – subsidy should follow the customer

  11. CBIA Health Connectionsan example of a successful exchange for 15+ years January 8, 2010

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