Jan. 11, 2011

Today’s issue is brought to you by AIS’s Health Reform Week, the nation’s leading publication on the business implications of the massive changes for the health industry mandated by reform.

Today's Featured Story

Insurers Alter Their Sales Commission Structure, Partly to Help Meet Medical Loss Ratio Rules
Reprinted from AIS’s Health Reform Week

In an action clearly designed to help it comply with minimum medical loss ratio regulations under the health reform law, Aetna Inc. confirmed Dec. 9 that it is changing its health insurance sales-commission structure for groups of 51 or more employees to a “service fee model.” This change, effective Feb. 1, means the “customer will compensate the broker directly,” Aetna noted, which in turn means that the commissions will not be considered part of the insurer’s revenue as they would have otherwise. Therefore, the MLRs calculated for such business will be higher and any rebates owed for falling below minimum MLRs in 2011 and subsequent years will be lower .... Read Full Story


Quote of the Day

“Despite taking 300-plus pages to define a simple ratio of medical expense divided by premium, or ‘Medical Loss Ratio,’ the regulations [that became effective on Jan. 1] still are not clear.”

— From a recent investment analysis by Credit Suisse.

Click here to read the DRUG BENEFIT NEWS article in which this quote appeared. (Free for DBN subscribers; $17 for non-subscribers).


Today's Datapoint

253,000…was Humana Inc.’s increase in Medicare Advantage members during the 12-month period that ended on Nov. 12, the largest increase for any insurer, according to data released recently by CMS. Humana lost 114,000 PFFS members, which were more than offset by gains of 322,000 PPO and 45,000 HMO members.

Click here to read the MEDICARE ADVANTAGE NEWS article in which this datapoint appeared. (Free for MAN subscribers; $17 for non-subscribers).


People on the Move

The American Hospital Assn. named Erik Rasmussen senior director for legislative affairs. Rasmussen was a staffer for the House Ways and Means Subcommittee on Health, and was chief of staff to Rep. Kenny Hulshof (R-Mo.) and a health policy advisor to Rep. J.D. Hayworth (R-Ariz.)....The Blue Cross and Blue Shield Assn. appointed Kim Holland executive director for state affairs. Holland was the Oklahoma insurance commissioner.


Today's Featured Health Business Job Opening

Express Scripts
RN Clinical Specialist (3 positions)
Phoenix, Ariz.;
Dallas, El Paso or Houston, Texas;

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