Comments on: All High-Risk Pools Are Not Equal: Examining The Minnesota Model

By: Malaika Stoll

Malaika Stoll — Mon, 12 Apr 2010 14:19:09 +0000

In addition to insurance coverage, high risk patients need medical homes—first contact, personal care that effectively coordinates care across settings. This is good for patients, and if done right, can reduce duplication, unnecessary utilization and costs. Part of any high risk insurance pool should be direct support for practices implementing medical home models, and focused efforts at linking patients with medical homes.

I am the Project Director of a Primary Care Initiative at a large health network in Pennsylvania. Our goal is to improve and expand primary care for our community. With an aim to reduce re-admissions, unncessary ED visits and ambulatory sensitive admissions, we are focused on improving primary care, and transition care (around admissions), for this high risk population. Supporting and training care managers in primary care practices is one strategy we are testing

By: Does Minnesota Have the Answer for High-Risk Pools? « Actively Fused LLC

Does Minnesota Have the Answer for High-Risk Pools? « Actively Fused LLC — Wed, 07 Apr 2010 16:56:07 +0000

[...] death spiraling into oblivion, Minnesota’s program soldiers on with minimal pain. According to Health Affairs, there seem to be four keys to its huge [...]

By: uberVU - social comments

uberVU - social comments — Mon, 22 Mar 2010 00:41:53 +0000

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By: bett martinez

bett martinez — Sun, 21 Mar 2010 19:49:49 +0000

As a health insurance broker in CA I have to comment. Of the blast of calls each day I received when Anthem announced it’s huge rate increases on the individual under 65 market, I could switch about one out of 20 to other companies. The rest couldn’t qualify. And people call me for my reputation of
knowledge to help them get through underwriting, with integrity. The other thing is with respect to choice of plans. Not too bad, if you take Maternity off the table. Which is happening here with all plans.

For years I’ve recommended clients with healthy teens to buy them separate coverage, including maternity. Boys as well as girls. Because you never know when a young person could lose capacity to qualify for coverage. Here’s one story: a couple of years ago a client was having a child by a SURROGATE, and no company would give her health coverage, let alone something that would cover the child. fortunately we were able to switch her husband to coverage with maternity which allows guarantees that the baby would be insured no matter what her health turned out to be.

Today, that would be very difficult. Aetna took all maternity plans off the individual market. And the rest of the companies followed suit by severely restricting what they offer, few plans, high deductibles etc. Choice you say? Much less.

In CA we have MRMIP Major Risk coverage. when it began, a couple of decades ago, I howled. Coverage was limited to $50,000 per year, $75k lifetime maximum. Today it’s $75k per year, with $750k lifetime. Is that enough? I’m seeing accident cases with college students coming in at $3 million in the first year.

Also, we have had long waiting periods when the pool is full. Of course, you have to ration the pool if you are limiting to sick people, generally high users.

Standing in my shoes now, I see the problem as very complex. It does seem that extending the pool, and allowing healthy people and people for whom maternity isn’t an issue to subsidize the others is in keeping with our highest ideals as a society – or what they should be – that each of us wants what’s best for all of us, and that includes ourselves in the mix.

bett martinez