UnitedHealthcare is hoping to roll out its own tiered network plan in New Jersey and will expand its provider coverage into New York, and AmeriHealth New Jersey is expanding into six new counties in the state for 2018, the insurers announced Thursday.
The declarations were made at the annual New Jersey Association of Health Underwriters State of the State event in Monroe Township.
UHC, the largest national insurer but only third-largest in the state, does not participate in the Affordable Care Act marketplace, but does sell commercial plans in New Jersey.
The plans that will go into effect in 2018 will include the expansion, said Paul Marden, CEO of UnitedHealthcare in New Jersey.
“The Oxford Garden State network is a growing, lower-cost, narrow-network product where members can currently obtain non-emergency medical care from New Jersey providers only. Since its introduction, brokers and employers have requested expanded provider access to New York providers, since many New Jersey businesses have employees that live or work in New York. Due to the demand, UnitedHealthcare is working to enhance Garden State access for our employers to allow them to obtain care from popular Oxford Metro network providers in New York. This is scheduled for introduction on Jan. 1, 2018,” according to an emailed statement from UHC.
The tiered plan that UHC is introducing to the commercial market already exists nationally and in New Jersey for self-funded plans, but will, if approved, be introduced on a limited scale for large group plans — where AmeriHealth and Horizon Blue Cross Blue Shield of New Jersey already have tiered plans.
Marden said the existence of the plan nationally is beneficial for multisite companies.
But the tiered plan is different from its competitors. While existing plans in the state focus on hospitals and health systems, the UHC product focuses on Accountable Care Organizations and physicians that are ranked Tier 1 by the insurer.
“Under the ACO arrangement, UHC collaborates with participating care providers to improve the coordination of a patient’s care, including sharing timely data and information about emergency room visits, hospital admissions and other care received outside the doctor’s office. NexusACO is the first national product built on the foundation of accountable care relationships with providers that deliver better quality of care and experience, at a better cost. NexusACO plan participants choose a primary care physician who coordinates their care — a trusted medical resource to help navigate the health care system, including specialists, hospitals and other care providers,” according to a statement from UHC.
The company is also increasing its reimbursements for wellness options, including fitness classes and triathlons.
(READ MORE from ROI-NJ on the NJAHU event. And READ MORE from ROI-NJ on health care costs.)
AmeriHealth, which saw a tough year in 2017 amid inquiries about its financial health, also had positive announcements Thursday.
Michael Munoz, market president for AmeriHealth New Jersey, which is a subsidiary of Independence Health Group in Philadelphia, said the company is expanding its Advantage tiered plan into six new counties, making it a viable option for insurance brokers to offer.
Munoz also said the company has turned around from the previous year and is operating in the black in the consumer markets. It is up by $80 million from the previous year, he added.
Part of AmeriHealth’s growth can be credited to the liquidation of Health Republic of New Jersey, the co-op insurer, which failed in 2016.
AmeriHealth was given all of Health Republic’s bronze and silver plans, while Horizon received the gold plans. In the marketplace, silver plans are the most popular nationally, with about 71 percent of enrollees through the Affordable Care Act in them, according to the Centers for Medicare and Medicaid Services.
According to filings with the Department of Banking and Insurance, AmeriHealth nearly doubled its silver membership with that move.
In the second quarter of 2016, the company had about 33,000 silver plan enrollees — which dropped to 29,000 by the fourth quarter — but in the latest filings, for the second quarter of 2017, AmeriHealth reported more than 51,000 silver plan enrollees.
Michael Considine told the audience at the event Thursday about Horizon’s experience with the shift, saying that, despite the additional gold plan members, typically higher-risk patients and therefore more costly for the company, along with the $85 million payout for ACA risk adjustments in the previous year, the company remained in the black.
Considine, Horizon’s vice president of Consumer and Small Group Market, said the company has a 73 percent market share in the individual market in the state.
Touting the company’s tiered plan, Considine said there are currently 450,000 enrollees in the low-cost OMNIA plan.
But with ongoing scrutiny from the federal government on the ACA, and decreased funding for marketing for open enrollment next month, the companies are unsure about what 2018 holds.