Panel ponders solutions to shrinking small group health insurance market

By Anjalee Khemlani
Freehold | Oct 19, 2017 at 11:50 am

The fully-insured small group insurance market is frustratingly without options.

A number of insurers have decreased their offerings or exited altogether in recent years.

CentraState Health CEO John Gribbin knows this all too well.

“(We’re) trying to offer the small group market options to deal with what is such a vexing problem,” he said.

Gribbin introduced a panel of brokers and medical professionals Wednesday in Freehold who discussed the current small group market and the impact of decisions insurers have made in the state.

Fred Morelli, CEO and president of PIER Practice Solutions, said self-funded plans are not viable options for small employers because they cannot leverage their size for better rates the way larger companies can.

“Insurance companies do not have a soul,” he said. “I’m in insurance 45 years and I will tell you it’s a bottom-line game and, at the end of the day, they would like to keep you healthy because they would like to keep their bottom line healthy.

“If you look at how insurance companies work, they just pass extra costs through rate increases. So, every year when you say your rates went up, that’s because actuaries are looking for another way to increase that pool. This is all mathematics.”

This year, according to the executive director of Affiliated Physicians and Employers Health Plan, Dawn Clessuras, there have been insurers who have backed out of the market, narrowing the options for small employers.

Aetna has backed out, meanwhile Oscar Health is a new, optimistic player in the market. In the past year, UnitedHealthcare has said it is targeting the small group market.

Vaughn Reale, vice president of sales at EmpiRx Health, said all plans have had double-digit increases, including the OMNIA plan from Horizon Blue Cross Blue Shield of New Jersey, which was advertised as a low-cost option.

In the individual market, according to the latest release of 2018 premiums from the state Department of Banking and Insurance, the OMNIA plan ranked mostly in the middle of the pack.

Morelli said the Affordable Care Act was less of a repair of the insurance market, and more of a cost-shift for the market.

“One of the most damaging parts of (the) high-deductible plan is you’re not going to the doctor because you don’t want to spend that extra money,” he said. “When that first came out, the doctors were telling me almost every day that they were getting cancelations.”

Dr. Robert Pedowitz, medical director of family practice at CentraState, said 2018 is very scary, because of how the insurance companies are acting.

While he is gaining patients from the OMNIA plan, he has lost patients because of the insurance their employers choose, which may exclude his practice.

The increase in tiered and narrow-network plans has created this effect.

For example, AmeriHealth New Jersey’s Tier 1 Advantage plan is in 20 out of 21 counties, and its Advantage plan expanded this year to 13 of 21 counties.

Oscar Health’s entrance into the small group market is limited — to EPO plans based on the QualCare network concentrated in North Jersey, with access to New York City providers as well.

Reale said employers should, with the help of brokers, look for creative solutions, such as alternate funding mechanisms like health savings accounts and health reimbursement accounts, among other options.

“While you can’t mandate it, try to make your employees take voluntary health assessments,” he said.

Especially when choosing high deductible health plans, which are often lower-cost, but are meant for lower utilization of the health system.

Gribbin said his employees all take annual health assessments so the employer can determine what the most important health risks are.

CentraState has partnered with 15 other hospitals around the state who offer similar programs for small business employers.

“A healthy employee helps everyone,” Reale said.

Anjalee Khemlani | akhemlani@roi-nj.com | AnjKhem